Skip to main content
Top
Published in: International Journal of Public Health 1/2018

01-01-2018 | Original Article

The education gradient in cancer screening participation: a consistent phenomenon across Europe?

Published in: International Journal of Public Health | Issue 1/2018

Login to get access

Abstract

Objectives

To extend the literature on educational inequalities in cancer screening participation (1) by simultaneously focusing on participation in screening for cervical, breast and colorectal cancer across 27 European countries and (2) by statistically testing whether these educational inequalities vary according to country-specific screening strategies: organised or opportunistic.

Methods

Self-reported data from Eurobarometer 66.2 (2006) on cancer screening participation in the preceding 12 months were used to outline cross-national variations in screening strategies, target populations and participation rates. Multilevel logistic regressions were applied.

Results

Individuals with higher levels of education were more likely to participate in screening for cervical, breast and colorectal cancer than were those with less education. Educational inequalities were significantly smaller in countries with organised cervical cancer screening than they were in countries with opportunistic screening (OR = 0.716, 95% CI 0.549–0.935). The same interaction was observed for participation in screening for breast and colorectal cancer, albeit with marginal significance.

Conclusions

This study clearly highlights the crucial role of educational level in the likelihood of participating in cancer screening. Countries can reduce educational inequalities by applying organised screening programmes.
Literature
go back to reference Almeida CM, Rodriguez MA, Skootsky S, Pregler J, Steers N, Wenger NS (2013) Cervical cancer screening overuse and underuse: patient and physician factors. Am J Managed Care 19:482–489 Almeida CM, Rodriguez MA, Skootsky S, Pregler J, Steers N, Wenger NS (2013) Cervical cancer screening overuse and underuse: patient and physician factors. Am J Managed Care 19:482–489
go back to reference Bastos J, Peleteiro B, Gouveia J, Coleman MP, Lunet N (2010) The state of the art of cancer control in 30 European countries in 2008. Int J Cancer 126:2700–2715PubMed Bastos J, Peleteiro B, Gouveia J, Coleman MP, Lunet N (2010) The state of the art of cancer control in 30 European countries in 2008. Int J Cancer 126:2700–2715PubMed
go back to reference Carrieri V, Wübker A (2013) Assessing inequalities in preventive care use in Europe. Health Policy 113:247–257CrossRefPubMed Carrieri V, Wübker A (2013) Assessing inequalities in preventive care use in Europe. Health Policy 113:247–257CrossRefPubMed
go back to reference European Commission (2003) Council recommendation on cancer screening. Commission of the European Communities Brussels, Brussels European Commission (2003) Council recommendation on cancer screening. Commission of the European Communities Brussels, Brussels
go back to reference European Commission (2014) Report from the commission to the European parliament, the council, the European economic and social committee and the committee of the regions. European Commission, Brussels European Commission (2014) Report from the commission to the European parliament, the council, the European economic and social committee and the committee of the regions. European Commission, Brussels
go back to reference Frederiksen B, Jørgensen T, Brasso K, Holten I, Osler M (2010) Socioeconomic position and participation in colorectal cancer screening. Br J Cancer 103:1496–1501CrossRefPubMedPubMedCentral Frederiksen B, Jørgensen T, Brasso K, Holten I, Osler M (2010) Socioeconomic position and participation in colorectal cancer screening. Br J Cancer 103:1496–1501CrossRefPubMedPubMedCentral
go back to reference Hox JJ, Moerbeek M, van de Schoot R (2010) Multilevel analysis: techniques and applications. Routledge, New YorkCrossRef Hox JJ, Moerbeek M, van de Schoot R (2010) Multilevel analysis: techniques and applications. Routledge, New YorkCrossRef
go back to reference Jusot F, Or Z, Sirven N (2012) Variations in preventive care utilisation in Europe. Eur J Ageing 9:15–25CrossRefPubMed Jusot F, Or Z, Sirven N (2012) Variations in preventive care utilisation in Europe. Eur J Ageing 9:15–25CrossRefPubMed
go back to reference Karsa L, Anttila A, Ronco G, Ponti A, Malila N, Arbyn M, Segnan N, Castillo-Beltran M, Boniol M, Ferlay J (2008) Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening-first report. European Commission, Brussels Karsa L, Anttila A, Ronco G, Ponti A, Malila N, Arbyn M, Segnan N, Castillo-Beltran M, Boniol M, Ferlay J (2008) Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening-first report. European Commission, Brussels
go back to reference Kesic V, Poljak M, Rogovskaya S (2012) Cervical cancer burden and prevention activities in Europe. Cancer Epidemiol Biomark Prev 21:1423–1433CrossRef Kesic V, Poljak M, Rogovskaya S (2012) Cervical cancer burden and prevention activities in Europe. Cancer Epidemiol Biomark Prev 21:1423–1433CrossRef
go back to reference Link BG, Phelan J (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 1:80–94CrossRef Link BG, Phelan J (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 1:80–94CrossRef
go back to reference Link BG, Northridge ME, Phelan JC, Ganz ML (1998) Social epidemiology and the fundamental cause concept: on the structuring of effective cancer screens by socioeconomic status. Milbank Q 76:375–402CrossRefPubMedPubMedCentral Link BG, Northridge ME, Phelan JC, Ganz ML (1998) Social epidemiology and the fundamental cause concept: on the structuring of effective cancer screens by socioeconomic status. Milbank Q 76:375–402CrossRefPubMedPubMedCentral
go back to reference Mackenbach JP, Kunst AE (1997) Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 44:757–771CrossRefPubMed Mackenbach JP, Kunst AE (1997) Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 44:757–771CrossRefPubMed
go back to reference Mirowsky J, Ross CE (2003) Education, social status, and health. de Gruyter, New York Mirowsky J, Ross CE (2003) Education, social status, and health. de Gruyter, New York
go back to reference Missinne S, Bracke P (2014) Age differences in mammography screening reconsidered: life course trajectories in 13 European countries. Eur J Public Health 25(2):314–320CrossRefPubMedPubMedCentral Missinne S, Bracke P (2014) Age differences in mammography screening reconsidered: life course trajectories in 13 European countries. Eur J Public Health 25(2):314–320CrossRefPubMedPubMedCentral
go back to reference Missinne S, Neels K, Bracke P (2014) Reconsidering inequalities in preventive health care: an application of cultural health capital theory and the life-course perspective to the take-up of mammography screening. Sociol Health Illn 36:1259–1275CrossRefPubMed Missinne S, Neels K, Bracke P (2014) Reconsidering inequalities in preventive health care: an application of cultural health capital theory and the life-course perspective to the take-up of mammography screening. Sociol Health Illn 36:1259–1275CrossRefPubMed
go back to reference Palència L, Espelt A, Rodríguez-Sanz M, Puigpinós R, Pons-Vigués M, Pasarín MI, Spadea T, Kunst AE, Borrell C (2010) Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol 39:757–765. doi:10.1093/ije/dyq003 CrossRefPubMed Palència L, Espelt A, Rodríguez-Sanz M, Puigpinós R, Pons-Vigués M, Pasarín MI, Spadea T, Kunst AE, Borrell C (2010) Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol 39:757–765. doi:10.​1093/​ije/​dyq003 CrossRefPubMed
go back to reference Papacostas A (2006) Eurobarometer 66.2: nuclear energy and safety, and public health issues. In: ICPSR21460-v2 (ed). GESIS/Ann Arbor, MI: Inter-university Consortium for Political and Social Research Cologne, Germany Papacostas A (2006) Eurobarometer 66.2: nuclear energy and safety, and public health issues. In: ICPSR21460-v2 (ed). GESIS/Ann Arbor, MI: Inter-university Consortium for Political and Social Research Cologne, Germany
go back to reference Rodin D, Stirbu I, Ekholm O, Dzurova D, Costa G, Mackenbach JP, Kunst AE (2012) Educational inequalities in blood pressure and cholesterol screening in nine European countries. J Epidemiol Community Health 66:1050–1055CrossRefPubMed Rodin D, Stirbu I, Ekholm O, Dzurova D, Costa G, Mackenbach JP, Kunst AE (2012) Educational inequalities in blood pressure and cholesterol screening in nine European countries. J Epidemiol Community Health 66:1050–1055CrossRefPubMed
go back to reference Sabates R, Feinstein L (2006) The role of education in the uptake of preventative health care: the case of cervical screening in Britain. Soc Sci Med 62:2998–3010CrossRefPubMed Sabates R, Feinstein L (2006) The role of education in the uptake of preventative health care: the case of cervical screening in Britain. Soc Sci Med 62:2998–3010CrossRefPubMed
go back to reference Schneider SL (2008) The International Standard Classification of Education (ISCED-97). An evaluation of Content and Criterion Validity for 15 European Countries. Mannheimer Zentrum für Europäische Sozialforschung, Manheim Schneider SL (2008) The International Standard Classification of Education (ISCED-97). An evaluation of Content and Criterion Validity for 15 European Countries. Mannheimer Zentrum für Europäische Sozialforschung, Manheim
go back to reference Silles MA (2009) The causal effect of education on health: evidence from the United Kingdom. Econ Educ Rev 28:122–128CrossRef Silles MA (2009) The causal effect of education on health: evidence from the United Kingdom. Econ Educ Rev 28:122–128CrossRef
go back to reference Stirbu I, Kunst A, Mielck A, Mackenbach JP (2007) Educational inequalities in utilization of preventive services among elderly in Europe. Tackling Health Inequalities. Europe: an integrated approach-EUROTHINE. Final Report. Erasmus MC, Rotterdam Stirbu I, Kunst A, Mielck A, Mackenbach JP (2007) Educational inequalities in utilization of preventive services among elderly in Europe. Tackling Health Inequalities. Europe: an integrated approach-EUROTHINE. Final Report. Erasmus MC, Rotterdam
go back to reference UNICEF, WHO (1978) Les soins de santé primaires: rapport de la Conférence internationale sur le soins de santé primaires, Alma-Ata (URSS, 6-12 septembre). vol 88. Organisation Mondiale de la Santé Geneva UNICEF, WHO (1978) Les soins de santé primaires: rapport de la Conférence internationale sur le soins de santé primaires, Alma-Ata (URSS, 6-12 septembre). vol 88. Organisation Mondiale de la Santé Geneva
go back to reference Von Dem Knesebeck O, Verde P, Dragano N (2006) Education and health in 22 European countries. Soc Sci Med 63:1344–1351CrossRef Von Dem Knesebeck O, Verde P, Dragano N (2006) Education and health in 22 European countries. Soc Sci Med 63:1344–1351CrossRef
go back to reference Wang A, Clouston SA, Rubin MS, Colen CG, Link BG (2012) Fundamental causes of colorectal cancer mortality: the implications of informational diffusion. Milbank Q 90:592–618CrossRefPubMedPubMedCentral Wang A, Clouston SA, Rubin MS, Colen CG, Link BG (2012) Fundamental causes of colorectal cancer mortality: the implications of informational diffusion. Milbank Q 90:592–618CrossRefPubMedPubMedCentral
go back to reference Zapata-Moya AR, Navarro-Yáñez CJ, Bracke P (working paper) The reproduction of health inequalities through the process of disseminating preventive health measures and behaviours. Ghent University Zapata-Moya AR, Navarro-Yáñez CJ, Bracke P (working paper) The reproduction of health inequalities through the process of disseminating preventive health measures and behaviours. Ghent University
Metadata
Title
The education gradient in cancer screening participation: a consistent phenomenon across Europe?
Publication date
01-01-2018
Published in
International Journal of Public Health / Issue 1/2018
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI
https://doi.org/10.1007/s00038-017-1045-7

Other articles of this Issue 1/2018

International Journal of Public Health 1/2018 Go to the issue

ACKNOWLEDGEMENT TO REVIEWERS

Acknowledgement to Reviewers 2017