Socioeconomic Inequalities in Cervical and Breast Cancer Screening among Women in Korea, 2005-2015

Abstract

Purpose: Consistent evidence indicates that cervical and breast cancer screening rates are low among socioeconomically deprived women. This study aimed to assess trends in cervical and breast cancer screening rates and to analyze socioeconomic inequalities among Korean women from 2005 to 2015.

Materials and methods: Data from the Korean National Cancer Screening Survey, an annual nationwide cross-sectional survey, were utilized. A total of 19910 women were finally included for analysis. Inequalities in education and household income status were estimated by slope index of inequality (SII) and relative index of inequality (RII), along with calculation of annual percent changes (APCs), to show trends in cancer screening rates.

Results: Cervical and breast cancer screening rates increased from 54.8% in 2005 to 65.6% in 2015 and from 37.6% in 2005 to 61.2% in 2015, respectively. APCs in breast cancer screening rates were significant among women with higher levels of household income and education status. Inequalities by household income in cervical cancer screening uptake were observed with a pooled SII estimate of 10.6% (95% CI: 8.1 to 13.2) and RII of 1.4 (95% CI: 1.3 to 1.6). Income inequalities in breast cancer screening were shown to gradually increase over time with a pooled SII of 5.9% (95% CI: 2.9 to 9.0) and RII of 1.2 (95% CI: 0.9 to 1.3). Educational inequalities appeared to diminish over the study period for both cervical and breast cancer screening.

Conclusion: Our study identified significant inequalities among socioeconomically deprived women in cervical and breast cancer screening in Korea. Especially, income-related inequalities were greater than education-related inequalities, and these were constant from 2005 to 2015 for both cervical and breast cancer screening.

Keywords: Uterine cervical neoplasms; breast neoplasms; early detection of cancer; healthcare disparities; socioeconomic factors.

Fig. 1. Absolute and relative inequalities in cervical cancer screening from 2005 to 2015. (A) Absolute educational inequalities in cervical cancer screening rates. (B) Absolute inequalities in household income in cervical cancer screening rates. (C) Relative educational inequalities in cervical cancer screening rates. (D) Relative inequalities in household income in cervical cancer screening rates. Solid line is line of equality; dotted line is pooled coefficient. SII, slope index of inequality; RII, relative index of inequality; CI, confidence interval.

Fig. 2. Absolute and relative inequalities in breast cancer screening from 2005 to 2015. (A) Absolute educational inequalities in breast screening rates. (B) Absolute inequalities in household income in breast screening rates. (C) Relative educational inequalities in breast screening rates. (D) Relative inequalities in household income in breast screening rates. Solid line is line of equality; dotted line is pooled coefficient. SII, slope index of inequality; RII, relative index of inequality; CI, confidence interval.