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Title: Mirror, mirror on the wall, when are inequalities higher, after all? Analysis of breast and cervical cancer screening in 30 European countries
Authors: Quintal, Carlota 
Antunes, Micaela 
Keywords: Breast cancer screening; Cervical cancer screening; European health interview survey; Inequalities
Issue Date: Nov-2022
Publisher: Elsevier
Project: info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDB/05037/2020/PT/Centre for Business and Economics Research - University of Coimbra 
Serial title, monograph or event: Social Science & Medicine
Volume: 312
Abstract: Screening for breast and cervical cancer is strongly related with a reduction in cancer mortality but previous evidence has found socioeconomic inequalities in screening. Using up-to-date data from the second wave of the European Health Interview Survey (2013-2015), this study aims to analyse income-related inequalities in mammography screening and Pap smear test in 30 European countries. We propose a framework that combines age group and screening interval, identifying situations of due-, under-, and over-screening. Coverage rates, standard and generalised concentration indices are calculated. Overall, pro-rich inequalities in screening persist though there are varied combinations of prevalence of screening attendance and relative inequality across countries. Bulgaria and particularly Romania stand out with low coverage and high inequality. Some Baltic and Mediterranean countries also present less favourable figures on both accounts. In general, there are not marked differences between mammography and Pap smear test, for the recommended situation ('Due-screening'). 'Extreme under-screening' is concentrated among lower income quintiles in basically all countries analysed, for both screenings. These women, who never screened, are at risk of entering the group of 'Lost opportunity', once they reach the upper-limit age of the target group. At the same time, there are signals of 'Over-screening', within target group, due to screening more frequently than recommended. In several countries, 'Over-screening' seems to be concentrated among richer women. This is not only a waste of resources, but it can also cause harms. The inequalities found in 'Extreme under-screening' and 'Over-screening' raise concerns on whether women are making informed choices.
ISSN: 02779536
DOI: 10.1016/j.socscimed.2022.115371
Rights: embargoedAccess
Appears in Collections:I&D CeBER - Artigos em Revistas Internacionais
I&D CEISUC - Artigos em Revistas Internacionais

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