Le disuguaglianze di accesso ai programmi di screening dei tumori della mammella, del colon retto e della cervice uterina sono aumentate durante il periodo pandemico. Risultati di un health equity audit condotto dall'Agenzia di Tutela della Salute d

Epidemiol Prev. 2024 Mar-Apr;48(2):130-139. doi: 10.19191/EP24.2.A672.040.

Abstract

Objectives: to evaluate the disparities in access to cancer screening programmes in the Province of Pavia (Lombardy Region, Northern Italy), along with identifying the factors influencing these disparities; to assess the impact of the pandemic emergency on invitation and screening coverage in the three organized screening programmes, which are provided free of charge to the target population.

Design: observational retrospective study covering both the pre-pandemic and the pandemic periods.

Setting and participants: for breast cancer screening, the eligible population comprises women aged 45 to 74; colorectal cancer screening is offered to men and women aged 50 to 74; cervical cancer screening is tailored based on women age. The management of all three screening programmes is overseen by the Health Protection Agency of Pavia, which proactively invites the eligible population through invitation letters.

Main outcomes measures: for each screening programme, the examination coverage (the number of screened individuals out of the total eligible population) was analysed considering its influencing factors, with a specific emphasis on equity-related factors such as demographics (sex, age), geographic factors (country and continent of birth, residential district), comorbidities.

Results: the SARS-CoV-2 pandemic has led to a reorganization of healthcare services and to a reduction of the offer, resulting in an overall reduction in test coverage for all three programmes (-16.3% for breast and colorectal cancer screening, -8.5% for cervical cancer screening). The disparities in coverage among various population groups, reflecting inequalities in access, further escalated from the pre-pandemic to the pandemic period. Noteworthy, equity-related predictors of reduced screening access were non-Italian nationality and residency in rural or mountainous districts.

Conclusions: during periods of healthcare system strain, such as the pandemic, disparities in access can become more pronounced. It is crucial to implement measures for enhancing access to screening in a more equitable manner.

Keywords: Equity; Health equity audit (HEA); Mass screening; Prevention; SARS-CoV-2.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Breast Neoplasms* / diagnosis
  • Breast Neoplasms* / epidemiology
  • Breast Neoplasms* / prevention & control
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Colorectal Neoplasms* / diagnosis
  • Colorectal Neoplasms* / epidemiology
  • Colorectal Neoplasms* / prevention & control
  • Early Detection of Cancer* / statistics & numerical data
  • Female
  • Health Equity*
  • Health Services Accessibility* / statistics & numerical data
  • Healthcare Disparities*
  • Humans
  • Italy / epidemiology
  • Male
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Pandemics*
  • Retrospective Studies
  • SARS-CoV-2
  • Uterine Cervical Neoplasms* / diagnosis
  • Uterine Cervical Neoplasms* / epidemiology
  • Uterine Cervical Neoplasms* / prevention & control