Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 18;24(1):3437.
doi: 10.1186/s12889-024-20901-2.

Understanding the mechanisms underlying the socioeconomic disparities in cancer screening among Australian women

Larry Myers  1   2 , Nicole Perry  3 , Laura Anderson  1   4 , Michael Ireland  2   5 , Claire Nightingale  6 , Belinda Goodwin  1   5
Affiliations

Understanding the mechanisms underlying the socioeconomic disparities in cancer screening among Australian women

Larry Myers et al. BMC Public Health. .

Abstract

Background: Little is known about individual, as opposed to area-level, variance in socioeconomic status (SES) and how this impacts screening participation. This study explores potential mechanisms underlying the relationship between SES and cancer screening amongst women eligible for breast, cervical, and bowel cancer screening.

Methods: Australian women aged 50-74 years (N = 874) took part in an online survey examining participants' health and cancer screening behaviours. Relationships between individual and area-level SES, cancer screening participation, stress, general self-efficacy, and screening literacy were examined using structural equation modelling. Frequency of cancer screening barriers were calculated for each cancer type and compared for SES categories.

Results: The structural equation model including stress and screening literacy as mediators yielded excellent fit, χ2 (26) = 33.322, p = .153, TLI = 0.992. Lower individual level SES was associated with higher stress and lower screening literacy. Higher stress was related to lower screening participation in all three programs, and lower screening literacy was associated with low cervical and breast cancer screening. The only significant relationship between area-level SES and screening participation was with participation in cervical screening. All indirect effects between area level SES and screening were non-significant. The types of barriers reported for each cancer screening type were similar between high and low socioeconomic individuals. In all three screening programs, intending to participate in cancer screening but not getting around to it, and not liking the screening method were commonly reported reasons for non-participation.

Conclusions: This study is the first to investigate the effects of individual level SES on cancer screening in Australia and one of the few studies to examine underlying mechanisms simultaneously across various screening programs. Reducing stress and improving screening literacy may help to improve cancer screening participation among low SES individuals. Our results also suggest that tailoring interventions to the SES background of women may not enhance their effectiveness. Interventions aiming to reduce the SES screening disparities may achieve more success through addressing underlying mechanisms as opposed to the behavioural barriers themselves.

Keywords: Bowel Cancer; Breast Cancer; Cancer Screening; Cervical Cancer; Social determinants of Health; Women’s Health.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: In accordance with the Declaration of Helsinki, ethical approval for this study was granted by the Human Research Ethics Committee at the University of Southern Queensland (ref. H22REA090). All subjects received an information sheet, and all participants provided informed consent prior to participating in this research. Consent for Publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Full structural model Note: PSS = perceived stress. Dotted lines represent non-significant paths. * p < .05, ** p < .01, *** p < .001. Only standardised effects are reported
Fig. 2
Fig. 2
Reasons for non-participation in bowel, breast, and cervical cancer screening Note: 1 or more levels of deprivation = low SES. No indicators of deprivation = high SES. Numbers of participants who reported a barrier in each group: 155 (bowel cancer screening – low SES); 95 (bowel– high SES); 83 (breast– low SES); 48 (breast– high SES); 151 (cervical-low SES); and 73 (cervical-high SES)
See this image and copyright information in PMC

References

    1. Australian Institute of Health and Welfare. Cancer in Australia 2021. 2021 [cited 2021 Dec 6]; https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/summary
    1. Stanbury JF, Baade PD, Yu Y, Yu XQ. Cancer survival in New South Wales, Australia: socioeconomic disparities remain despite overall improvements. BMC Cancer. 2016;16(1):48. - PMC - PubMed
    1. Roder D. Impact of population screening programs on cancer outcomes. Cancer Forum. 2012;36(1):5–20.
    1. Australian Institute of Health and Welfare. National Bowel Cancer Screening Program monitoring report 2022. Australian Government; 2022. p. 122.
    1. Australian Institute of Health and Welfare. BreastScreen Australia monitoring report 2022 [Internet]. Australian Institute of Health and Welfare; 2022 [cited 2022 Dec 23]. https://www.aihw.gov.au/reports/population-screening/breastscreen-austra...

LinkOut - more resources