The early detection cancer is essential to reduce mortality and increase the chances of long-term survival. Current evidence has shown that early detection of certain tumors can be an effective way to reduce the negative impact that this disease produces. This is where cancer prevention programs come into play. cancer screeningpreventive-assistance programs of Public health. In SpainThe programs of screening current, which are part of the common portfolio of healthcare services of the National system of health and are carried out in all autonomous communities and cities, are of breast cancer, Colorectal cancer y cervical cancerHowever, is the entire target population subjected to them?
He report ‘National cancer profiles: Spain 2023’ of the OECD reveals varying participation figures depending on the type of cancer in question. Screening programmes, in addition to reducing premature morbidity and mortality in cancer, are essential in addressing social inequalities. In addition, they are very effective when the target population is properly determined and participation levels are high. Although the Strategy in Cancer Spanish reflects the recommendations of the UE about him screening of cancer by including the screenings in it National system of healththe application of these guidelines is the responsibility of the autonomous communities. This leads to differences in coverage and participation between them.
In 2020, there were programs population screening in all the autonomous communities for which data on breast cancer (14 communities) and colorectal cancer (13 communities) were available. However, only six autonomous communities had adopted screening programmes screening population-based cervical cancer screening, many of which were still in the pilot or partial implementation phase, except in the Basque Country. Regarding the breast cancerhe screening Population-based research is carried out in all communities and in Ceuta y MelillaIn 2019, around 74% of Spanish women between 50 and 69 years of age reported having had a mammogram in the last two years, compared to 66% of the population as a whole. UE. Low participation rates in education programs screening They were concentrated in groups of women with lower levels of education and income.
In 2019, around 74% of Spanish women aged between 50 and 69 reported having had a mammogram in the last two years, compared to 66% in the EU as a whole.
In addition, significant gaps were observed in screening percentages in 2019. breast cancer reported among Spanish women with the lowest (71%) and highest (77%) levels of education and among those with lower (67%) and higher incomes (79%). These differences are lower than the average of all countries in the UE. In this context, in EstremaduraA retrospective study of women who missed their screening appointments concluded that the main causes of non-attendance were poor coordination between levels of health care, low health literacy, failures in information systems and accessibility problems.
On the other hand, the screening population of cervical cancer was incorporated into the portfolio of services of the National system of health in the year 2019. Since always, this screening It has been offered opportunistically to women between the ages of 25 and 65, every three to five years. This screening It consists of a cytology for women between 25 and 34 years of age, and an HPV test for those between 35 and 65 years of age. In the same year in which it was introduced, 56% of Spanish women aged 15 or older reported having had a cytology test. cervical cytology over the past three years, a proportion lower than that of most countries in the UE (60%). The rates are considerably higher among women with a high level of education (74%) and those with high incomes (68%). In contrast, the percentages were 42% for women with less education and 53% for those with lower incomes.
A few years before the incorporation of the screening of this type of cancer, in 2014, was incorporated into the portfolio of common services of the SNS the one of Colorectal cancerwith a five-year period for its implementation in the autonomous communities and a ten-year period to achieve 100% coverage of the target population. Although all the autonomous communities began to implement the programme, significant disparities have been observed in terms of participation rates.
In 2019, the proportion of the Spanish population aged between 50 and 74 who reported having participated in the colorectal cancer screening programme in the last two years was around 30%.
In this sense, in 2019, the proportion of the Spanish population between 50 and 74 years of age who reported having participated in the screening program for Colorectal cancer In the last two years it was around 30%, slightly below the average of the UE (33%). More than 36% of people in the highest income quintile reported having recently undergone a colorectal cancer screeningwhile in the lowest quintile the proportion was 22%.
HOW TO ADDRESS INEQUALITIES IN ACCESS AND PARTICIPATION?
There have been many autonomous communities that, between 2013 and 2020, detected social groups that were not integrated into the target population of the programs cancer screening. Subsequently, a 2021 study revealed that, of the 12 autonomous communities that participated, all detected a lack of coverage in colorectal cancer screening programs, 10 observed a lack of coverage in colorectal cancer screening breast cancer and seven in the screening of cervical cancerAs for which groups were usually left without coverage, it was identified that, generally, these were migrants in an irregular situation and the population institutionalized in penitentiary centers.
In response to this, some autonomous communities have carried out interventions to address inequalities in access to social programs. screeningeither through a general approach based on information and awareness campaigns or through a specific approach targeting vulnerable groups. For example, this could be done by translating material into other languages. In 2020, ten autonomous communities reported interventions to reduce inequalities in participation rates in HIV screening. breast cancerfive in the of Colorectal cancer and only two in cancer cervix.
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