The impact of level of education on adherence to breast and cervical cancer screening: Evidence from a systematic review and meta-analysis |
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| Affiliation: | 1. Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy;2. Health Care Walkers'' Cooperative (OSA), Via Lucio Volumnio 1, 00178 Rome, Italy;3. Health Division, Directorate for Employment, Labour and Social Affairs, OECD-Organization for economic Cooperation and Development, 2 rue André Pascal, 75775 Paris, Cedex 16, France;1. Wolfson Institute of Preventive Medicine, Queen Mary University of London, London;2. Health Behaviour Research Centre, University College London, London, UK;3. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA;4. Institute for Women''s Health, University College London, London, UK;5. Division of General Internal Medicine, Northwestern University, Chicago, USA;6. Centre for Behavioural Medicine, University College London, London, UK;1. Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark;2. Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark;3. Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark;4. Department for Public Health Programs, Randers Regional Hospital, Central Denmark Region, Skovlyvej 1, Randers, NE 8930, Denmark |
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| Abstract: | Objective. To assess the inequalities in adherence to breast and cervical cancer screening according to educational level. Methods. A systematic review was carried out between 2000 and 2013 by querying an electronic database using specific keywords. Studies published in English reporting an estimation of the association between level of education and adherence to breast and/or cervical cancer screening were included in the study. Two different meta-analyses were carried out for adherence to breast and cervical cancer screening, respectively: women with the highest level of education and women with the lowest level of education were compared. The level of heterogeneity was investigated and subgroup analyses were carried out. Results. Of 1231 identified articles, 10 cross-sectional studies were included in the analysis. The meta-analyses showed that women with the highest level of education were more likely to have both screenings with an overall OR = 1.61 (95% CI 1.36–1.91; I2 = 71%) for mammography and OR = 1.96 (95% CI 1.79–2.16; I2 = 0%) for Pap test, respectively. Stratified meta-analysis for breast cancer screening included only studies that reported guidelines with target age of population ≥ 50 years and showed a reduction in the level of heterogeneity and an increase of 36% in the adherence (95% CI 1.19–1.55; I2 = 0%). Conclusions. This study confirms and reinforces evidence of inequalities in breast and cervical cancer screening adherence according to educational level. |
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