Does lack of resources impair access to breast and cervical cancer screening in Japan?

<div><p>Objectives</p><p>To assess the impact of the quantity of resources for breast and cervical cancer screening on the participation rates in screening in clinical settings in municipalities, as well as to clarify whether lack of resources impairs access to cancer screening in Japan.</p><p>Methods</p><p>Of the 1,746 municipalities in 2010, 1,443 (82.6%) and 1,469 (84.1%) were included in the analyses for breast and cervical cancer screening, respectively. In order to estimate the effects of the number of mammography units and of gynecologists on the participation rates in breast and cervical cancer screening in clinical settings, multiple regression analyses were performed using the interaction term for urban municipalities.</p><p>Results</p><p>The average participation rate in screening in clinical settings was 6.01% for breast cancer, and was 8.93% for cervical cancer. The marginal effect of the number of mammography units per 1,000 women was significantly positive in urban municipalities (8.20 percent point). The marginal effect of the number of gynecologists per 1,000 women was significantly positive in all municipalities (2.54 percent point) and rural municipalities (3.68 percent point).</p><p>Conclusions</p><p>Lack of mammography units in urban areas and of gynecologists particularly in rural areas impaired access to breast and cervical cancer screening. Strategies are required that quickly improve access for the residents and increase their participation rates in cancer screening.</p></div

Characteristics of breast cancer screening in clinical settings in Japan in 2010.

<p>Characteristics of breast cancer screening in clinical settings in Japan in 2010.</p

Determinants of the participation rates in breast cancer screening in clinical settings in Japan.

<p>Determinants of the participation rates in breast cancer screening in clinical settings in Japan.</p

Determinants of the participation rates in cervical cancer screening in clinical settings in Japan.

<p>Determinants of the participation rates in cervical cancer screening in clinical settings in Japan.</p

Characteristics of cervical cancer screening in clinical settings in Japan in 2010.

<p>Characteristics of cervical cancer screening in clinical settings in Japan in 2010.</p

Basic characteristics of the endoscopic screening group, radiographic screening group, and outpatient group.

<p>Basic characteristics of the endoscopic screening group, radiographic screening group, and outpatient group.</p

Descriptive statistics.

<p>Descriptive statistics.</p

Multilevel regression of time intervals.

<p>Note:</p>*<p>p<.1,</p>†<p>p<.05,</p>‡<p>p<.01,</p>§<p>p<.001.</p

Flow-chart of the selection process for the target group.

<p>There were 2,066 potential subjects with gastric cancer in the 4 cities examined in Tottori Prefecture (i.e., Tottori, Yonago, Kurayoshi, and Sakaiminato). The following patients were excluded: those who 1) were over 80 years old and less than 39 years old at the time of gastric cancer diagnosis, 2) had registry duplication, 3) lacked the date for gastric cancer diagnosis, or 4) had a diagnosis other than gastric cancer. Two patients who had registry duplication, 44 patients who were not cases of gastric cancers, and 270 patients in whom the date of diagnosis was unclear were also excluded. From the local registry, 1,513 subjects were selected. Based on the participants list for gastric cancer from 2000 to 2006, 20 subjects whose screening methods were unclear were excluded. The remaining 1,493 subjects were divided into 3 groups according to the method of cancer detection: endoscopic screening group (n = 347), radiographic screening group (n = 166), and outpatient group (n = 980).</p

Cox proportional hazard analysis of gastric cancer death and all-causes death in the endoscopic screening group, radiographic screening group, and outpatient group.

<p>Cox proportional hazard analysis of gastric cancer death and all-causes death in the endoscopic screening group, radiographic screening group, and outpatient group.</p