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Low Coverage and Disparities of Breast and Cervical Cancer Screening in Thai Women: Analysis of National Representative Household Surveys

  • Mukem, Suwanna (Epidemiology Unit, Faculty of Medicine, Prince of Songkla University) ;
  • Meng, Qingyue (School of Public Health, Peking University) ;
  • Sriplung, Hutcha (Epidemiology Unit, Faculty of Medicine, Prince of Songkla University) ;
  • Tangcharoensathien, Viroj (International Health Policy Program)
  • Published : 2016.01.11

Abstract

Background: The coverage of breast and cervical cancer screening has only slightly increased in the past decade in Thailand, and these cancers remain leading causes of death among women. This study identified socioeconomic and contextual factors contributing to the variation in screening uptake and coverage. Materials and Methods: Secondary data from two nationally representative household surveys, the Health and Welfare Survey (HWS) 2007 and the Reproductive Health Survey (RHS) 2009 conducted by the National Statistical Office were used. The study samples comprised 26,951 women aged 30-59 in the 2009 RHS, and 14,619 women aged 35 years and older in the 2007 HWS were analyzed. Households of women were grouped into wealth quintiles, by asset index derived from Principal components analysis. Descriptive and logistic regression analyses were performed. Results: Screening rates for cervical and breast cancers increased between 2007 and 2009. Education and health insurance coverage including wealth were factors contributing to screening uptake. Lower or non-educated and poor women had lower uptake of screenings, as were young, unmarried, and non-Buddhist women. Coverage of the Civil Servant Medical Benefit Scheme increased the propensity of having both screenings, while the universal coverage scheme increased the probability of cervical screening among the poor. Lack of awareness and knowledge contributed to non-use of both screenings. Women were put off from screening, especially Muslim women on cervical screening, because of embarrassment, fear of pain and other reasons. Conclusions: Although cervical screening is covered by the benefit package of three main public health insurance schemes, free of charge to all eligible women, the low coverage of cervical screening should be addressed by increasing awareness and strengthening the supply side. As mammography was not cost effective and not covered by any scheme, awareness and practice of breast self examination and effective clinical breast examination are recommended. Removal of cultural barriers is essential.

Keywords

Breast and cervical cancer screening;coverage, disparity;socio-economic factors;Thailand

Acknowledgement

Supported by : Thailand Research Fund

References

  1. Padela AI, Peek M, Johnson-Agbakwu CE, Hosseinian Z, Curlin F (2014). Associations between religion-related factors and cervical cancer screening among Muslims in greater Chicago. J Low Genit Tract Dis, 18, 326-32. https://doi.org/10.1097/LGT.0000000000000026
  2. Palencia L, Espelt A, Rodriguez-Sanz M, et al (2010). Socioeconomic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol, 39, 757-65. https://doi.org/10.1093/ije/dyq003
  3. Park MJ, Park EC, Choi KS, Jun JK, Lee HY (2011). Sociodemographic gradients in breast and cervical cancer screening in Korea: the Korean National Cancer Screening Survey (KNCSS) 2005-2009. BMC Cancer, 11, 257. https://doi.org/10.1186/1471-2407-11-257
  4. Peirson L, Fitzpatrick-Lewis D, Ciliska D, Warren R (2013). Screening for cervical cancer: a systematic review and metaanalysis. BMC Syst Rev, 2, 35. https://doi.org/10.1186/2046-4053-2-35
  5. Porapakham Y, Bunyaratapun P (2006). The third national health examination survey, 2003-4. Health System Research Institute, Nonthaburi.
  6. Praditsitthikorn N, Teerawattananon Y, Tantivess S, et al (2011). Economic evaluation of policy options for prevention and control of cervical cancer in Thailand. Pharmacoeconomics, 29, 781-806. https://doi.org/10.2165/11586560-000000000-00000
  7. Putthasri W, Tangcharoensathien V, Mugem S, Jindawatana W (2004). Geographical distribution and utilization of mammography in Thailand. Regional Health Forum, 8, 84-91.
  8. Sahn DE, Stifel D (2000). Assets as a measure of household welfare in developing countries. Working Paper 00-11. Washington University, St. Louis, Missouri.
  9. Sahn DE, Stifel D (2001). Exploring Alternative measures of welfare in the absence of expenditure data. Department of Economics, Cornell University, New York.
  10. Sriamporn S, Khuhaprema T, Parkin M (2006). Cervical cancer screening in Thailand: an overview. J Med Screen, 13, 39-43.
  11. Srisuwan S, Puapornpong P, Srisuwan S, Bhamarapravatana K, Suwannarurk K (2015). Knowledge, attitudes and practices regarding cervical cancer screening among village health volunteers. Asian Pac J Cancer Prev, 16, 2895-8. https://doi.org/10.7314/APJCP.2015.16.7.2895
  12. Srithamrongsawat S, Aekplakorn W, Jongudomsuk P, et al (2010). Funding health promotion and prevention - the Thai experience. World Health Organization, Geneva.
  13. Srithamrongsawat S, Jongudomsuk P, Suntorntham S (2014). NHSO Annual Report Fiscal Year 2013. National Health Security Office, Nonthaburi.
  14. Thanapprapasr D, Deesamer S, Sujintawong S, Udomsubpayakul U, Wilailak S (2012). Cervical cancer screening behaviours among Thai women: results from a cross-sectional survey of 2112 healthcare providers at Ramathibodi Hospital, Thailand. Eur J Cancer Care, 21, 542-7. https://doi.org/10.1111/j.1365-2354.2012.01333.x
  15. WHO (2015). Cancer: Early detection of cancer. [cited 2015 10/1].
  16. Yothasamut J, Putchong C, Sirisamutr T, Teerawattananon Y, Tantivess S (2010). Scaling up cervical cancer screening in the midst of human papillomavirus vaccination advocacy in Thailand. BMC Health Services Res, 10, 5. https://doi.org/10.1186/1472-6963-10-5
  17. Azami-Aghdash S, Ghojazadeh M, Sheyklo SG, et al (2015). breast cancer screening barriers from the womans perspective: a meta-synthesis. Asian Pac J Cancer Prev, 16, 3463-71. https://doi.org/10.7314/APJCP.2015.16.8.3463
  18. Bayrami R, Taghipour A, Ebrahimipour H (2015). Personal and socio-cultural barriers to cervical cancer screening in Iran, patient and provider perceptions: a qualitative study. Asian Pac J Cancer Prev, 16, 3729-34. https://doi.org/10.7314/APJCP.2015.16.9.3729
  19. Chalapati W, Chumworathayi B (2007). Can a home-visit invitation increase Pap smear screening in Samliem, Khon Kaen, Thailand? Asian Pac J Cancer Prev, 8, 119-23.
  20. Chumworathayi P, Chumworathayi B (2007). Why Thai women do not have cervical carcinoma test? Srinagarind Med J, 22, 369-75.
  21. Damiani G, Federico B, Basso D, et al (2012). Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health, 12, 99. https://doi.org/10.1186/1471-2458-12-99
  22. Drain PK, Halperin DT, Hughes JP, et al (2006). Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries. BMC Infect Dis, 6, 172. https://doi.org/10.1186/1471-2334-6-172
  23. Ferlay J, Shin HR, Bray F, et al (2010). GLOBOCAN 2008 v2.0, cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer.
  24. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer.
  25. Filmer D, Pritchett LH (2001). Estimating wealth effects without expenditure data - or tears: an application of educational enrolment in states of India. Demography, 38, 115-32.
  26. Gozsche PC, Jogensen K (2013). Screening for breast cancer with mammography, a Cochrane summary, 2013. [cited 2015 10/1].
  27. Kanaga KC, Nithiya J, Noor Shatirah MFV (2011). Awareness of breast cancer and screening procedures among Malaysian women. Asian Pac J Cancer Prev, 12, 1965-7.
  28. Khuhaprema T, Attasara P, Sriplung H, et al (2013). Cancer in Thailand volume VII, 2007-2009. Bangkok Medical Publisher, Bangkok.
  29. Lee K, Lim HT, Hwang SS, Chae DW, Park SM (2010). Socioeconomic disparities in behavioural risk factors for cancer and use of cancer screening services in Korean adults aged 30 years and older: the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). Public Health, 124, 698-704. https://doi.org/10.1016/j.puhe.2010.07.004
  30. National Statistical Office (2006). Report on Reproductive Health Survey, 2006. Statistical Forecasting Bureau, National statistical office, Bangkok.
  31. O'Donnell O, Van Doorsslaer E; Wagstaff A, Lindelo M. (2008). Analyzing health equity using household survey data analyzing: A guide to techniques and their implementation. The World Bank, Washington, DC.
  32. Abu-Helalah MA, Alshraideh HA, Al-Serhan AA, Kawaleet M, Nesheiwat AI (2015). Knowledge, barriers and attitudes towards breast cancer mammography screening in jordan. Asian Pac J Cancer Prev, 16, 3981-90. https://doi.org/10.7314/APJCP.2015.16.9.3981
  33. Ahmadian M, Samah AA (2012). A Literature Review of Factors Influencing Breast Cancer Screening in Asian Countries. Life Sci J, 9, 585-94.
  34. American Cancer Society (2015) Guidelines for the Early Detection of Cancer. [cited 2015 10/1];
  35. Anothaisintawee T, Tantai N, Teerawattananon Y (2013). Costutility of once-in-a-lifetime breast cancer screening with mammography in Thai women. J Health Systems Res, 7, 413-2.

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