title: Social stratification, risk factor prevalence and cancer screening attendance.
abstract: This analysis aimed to assess the extent to which exposure to cancer risk factors and attendance of screening programmes are influenced by social characteristics. The validated Evaluation of deprivation and health inequalities in public health centres (EPICES) index was used to measure social deprivation. A sample of the general population (N=1603) was assessed to search for potential correlations between screening attendance, risk factors and any components of the EPICES score. In 2011, 33% of the population studied was classified as 'vulnerable'. Sex had no significant impact on this rating (32% men, 35% women), whereas occupational status did. Vulnerable individuals were more likely already to have cancer (10 vs. 7%; nonsignificant difference; odds ratio 1.43 [0.98-2.10]). The mean BMI was 26.0 kg/m (SD 4.9) for the vulnerable population versus 24.8 kg/m (SD 3.9) in the nonvulnerable population (P<0.01). The prevalence of current smoking was higher in the vulnerable group (38 vs. 23%, odds ratio 2.03 [1.61-2.56]). In contrast, no statistically significant difference was observed between attendance rates for nationwide organized cancer screening programmes (breast and colorectal; target age group 50-74 years) by the vulnerable and nonvulnerable groups. Social indicators of vulnerable populations are associated with increased rates of risk factors for cancer, but not with screening attendance. Our data support the previously reported marked impact of organized programmes that reduce or even remove inequalities in access to cancer screening. However, although the organized programmes have indeed enabled population-wide, nonselective access to screening, primary prevention as it stands today remains inadequate in the underserved population and further improvements are warranted.
authors.affiliation: aCancer Control Department, Paoli-Calmettes Institute bAix Marseille University, UMR_S912, IRD cINSERM, UMR912 (SESSTIM), Marseille dCoordination Center for Cancer Screening, Bretonneau University Hospital, Tours eKantar Health, Montrouge fPorte de Saint-Cloud Clinic, Boulogne-Billancourt gRoche, Boulogne-Billancourt hDepartment of Medical Oncology, Jean Minjoz University Hospital, Inserm U645, Besançon iLéon Bérard Cancer Centre, Lyon jDepartment of Oncology and Hematology, Paul-Brousse University Hospital, Inserm U1004, Villejuif, France.
authors.forename: François
authors.initials: F
authors.lastname: Eisinger
authors.forename: Jérôme
authors.initials: J
authors.lastname: Viguier
authors.forename: Chantal
authors.initials: C
authors.lastname: Touboul
authors.forename: Yvan
authors.initials: Y
authors.lastname: Coscas
authors.forename: Xavier
authors.initials: X
authors.lastname: Pivot
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Christine
authors.initials: C
authors.lastname: Lhomel
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Morère
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000191:economics / Q000639:trends*; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D066252:Sociological Factors