title: Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention.
abstract: BACKGROUND
  Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention.
  
  
  METHODS
  The study population involved all residents aged >40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention.
  
  
  RESULTS
  Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032).
  
  
  CONCLUSIONS
  Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Liang En
authors.initials: LE
authors.lastname: Wee
authors.forename: Gerald Choon-Huat
authors.initials: GC
authors.lastname: Koh
authors.forename: Run Ting
authors.initials: RT
authors.lastname: Chin
authors.forename: Wei Xin
authors.initials: WX
authors.lastname: Yeo
authors.forename: Branden
authors.initials: B
authors.lastname: Seow
authors.forename: Darren
authors.initials: D
authors.lastname: Chua
mesh_terms: D000328:Adult; D001208:Asia; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003153:Community Health Services / Q000592:standards; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data; D011203:Poverty / Q000523:psychology* / Q000706:statistics & numerical data; D011638:Public Housing; D012111:Residence Characteristics / Q000706:statistics & numerical data; D017678:Sex Distribution; D012846:Singapore; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control