THE INTRODUCTION OF THE CALL-RECALL METHOD IN THE ORGANIZATION OF THE NATIONAL CANCER SCREENING PROGRAM AND SOCIO-ECONOMIC DETERMINANTS OF PARTICIPATI
THE INTRODUCTION OF THE CALL-RECALL METHOD IN THE ORGANIZATION OF THE NATIONAL CANCER SCREENING PROGRAM AND SOCIO-ECONOMIC DETERMINANTS OF PARTICIPATI

Summary/Abstract: Although life expectancy in Hungary increased in recent decade, the mortality statistics remained high for malignancies of cervix and breast preventable by screening. The call-recall method based organization of screening has been recently introduced in the Hungarian practice through a governmental project, supporting screening centres with trained staff and providing mammographs in outpatient services. This study aims to describe the geographical heterogeneity of participation in the screening programs and to investigate the relative impact of socio-economic determinants on screening rates. It looks at the whole population of Hungary. The screening rates and their relationships with socio-economic factors were computed for periods before and after the call-recall operation system had been launched. The age adjusted relative screening participation rates were computed for the sub-regions of Hungary using discharge reports of outpatient services for cervical cytology and mammography. The socio-economic characteristics of sub-regions were available from national surveys. The correlation between sub-region specific data on screening participation rates and the socioeconomic characteristics were analysed. For the entire female population, the examination rates for cervix cytology were 11.4 % in 2001 and 15.8 % in 2005, while for mammography 6.7 % in 2001 and 10.4 % in 2005. The relative agestandardized sub-regional examination rates varied to a great extent for both types of examinations. For the cervix examination, the ranges of values were 0.065 – 1.741 in 2001 and 0.676 – 1.598 in 2005. The variance decreased significantly in this time period (F= 3.438; p<0.001). For mammographies, the corresponding ranges were 0.235 – 4.078 in 2001 and 0.308 – 1.756 in 2005. The degree of variability decreased in this case as well (F= 4.014; p<0.001). In 2001, cervix cytology proved to be independent of socio-economical factors. Mammography, on the other hand, demonstrated a significant correlation with many the indicators of social deprivation. In 2005, cervix cytology showed similar independency of socio-economic factors. In this year, mammography did not reveal any association with any parameter of the socio-economic situation. The introduction of the new organization of screening, recommended by the World Health Organisation, resulted in improved performance at the national level, and it was accompanied by the narrowing of the gap between the sub-regions with fair and unacceptably low examination rates. It is evident that in the case of mammography the limitations of opportunistic screening can be solved by the invitation based methods: improved general performance, reducing geographical inequality and weakening the influence of socio-economic factors at the level of the population. No correlations were found between cervix screening participation and socio-economic factors.

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