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Wide variations in cervical screening uptake, study shows

Women who are young, non-white, and disadvantaged still missing out

Caroline White

Thursday, 19 April 2012

There are wide variations in cervical screening uptake, not only across PCTs, but also at individual practice level, finds research published in the Journal of Public Health.

Rates are especially low in general practices with high proportions of women who are young, non-white, and disadvantage, the findings showed, prompting the authors to conclude that new strategies need to be deployed to encourage screening take-up among these groups.

In 2008, 54,800 new cases of cervical cancer were reported in Europe, and 25,000 women died of their disease. The UK accounted for 2500 of these new cases and 830 deaths.

The authors used 2008/9 QOF data on cervical screening uptake for 26 million women at almost 8000 practices across England in their analysis. They calculated deprivation scores as well as the racial mix and proportion of female patients aged 25-49 and 50-64 registered with a GP as of April 2008.

The analysis showed that the proportion of female patients aged 25-49 years, the percentage of black and ethnic minority patients, and the Index of Multiple Deprivation score were all associated with significantly lower rates of cervical screening in both PCTs and individual practices.

While the percentage of female patients aged 50–64 years, the overall QOF score and the records/information score were significantly associated with higher rates of coverage, this was only at individual practice level.

The average proportion of women screened was 78.5% at PCT level, and 83.5% at practice level, but uptake varied widely. It ranged from 66% to 86% for PCTs and from 0% to 100% in individual practices.

Their findings back up previous research, say the authors.

Lead author Dr Ji Young Bang, of The Department of Primary Care at Imperial College London, suggests that “a multifaceted approach is needed that includes patients, physicians, individual practices and policy makers,” if cervical screening uptake is to be improved.

And he cautions: “Performance indicators, such as cervical screening coverage, can be substantially influenced by population factors such as age, ethnicity, and socioeconomic status.

Using crude performance data to determine the quality of care provided by general practices and PCTs can be misleading. This is an important issue as the UK government has announced this year that the general practice performance data will be made available publicly in the near future.”

He concludes: “Our study illustrates that population and health system characteristics remain important influences on participation in preventative interventions such as cervical screening, even in a health system that offers free of charge access to universal healthcare. Also, in the 21st century, more than twenty years after the start of cervical screening in England, socioeconomic, ethnic and age-related disparities still exist.”

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