Breast, colon, and prostate screening in the adult population of Croatia: does rural origin matter?
BACKGROUND
The aim of this study was to investigate the utilization of breast, colon and prostate cancer screening in the adult Croatian population in a period without national cancer screening programs, with a special interest in respondents' rural versus urban origin.


METHODS
Self-reported screening utilization was investigated in the Croatian Adult Health Survey, which collected health-related information from a representative sample of the adult Croatian population. Breast cancer screening was investigated in women aged over 40 years, while colon and prostate screening was investigated in respondents aged over 50 years. The data were analysed using binary logistic regression.


RESULTS
One in five women reported breast cancer screening uptake in the year preceding the survey (22.5%), while only 4.5% reported a colon screening. A total of 6.1% men reported colon screening, while 13.7% of men reported having a prostate cancer screening. Respondents with rural origin reported all sites screening utilization less frequently than those of urban origin (breast: 14.5% vs 27.4%; prostate: 9.6% vs 16.3%; colon-men: 5.7% vs 6.3%; colon-women: 3.6% vs 5.1%; respectively). Multivariable models indicated that people with higher socio-economic status more commonly reported breast and prostate cancer screening uptake. Access to health care was the only independent variable associated with colon cancer screening in men, and the strongest variable associated with colon cancer screening in women. Rural origin was associated only with lower odds of breast screening (adjusted odds ratio 0.60 [95% confidence interval 0.48-0.74]), while in the remaining models, rural origin was not a significant predictor for cancer screening uptake.


CONCLUSIONS
Opportunistic cancer screening uptake is low in the Croatian adult population, with existing socio-economic differences in breast and prostate screening, and their absence in colon cancer screening. Rural origin was significantly associated with breast screening, even after adjustment to socioeconomic status and problems in access to health care. Lack of rural origin significance in the other screening sites could be related to small sample sizes of people who reported opportunistic utilization. Overall, access to health care is the strongest cancer screening predictor, and this should have a prominent role in the development of a systematic cancer screening program on a national level.
Polasek
O
O
Andrija Stampar School of Public Health, Medical School, University of Zagreb, Rockefellerova, Croatia. opolasek@snz.hr
Kolcic
I
I
Voncina
L
L
Strnad
M
M
Vuletic
S
S
Kern
J
J
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D017523:Croatia / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs; D009790:Occupations; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012111:Residence Characteristics; D012423:Rural Health; D012424:Rural Population; D012959:Socioeconomic Factors