Investigator
Inserm
Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island
Abstract Background Réunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake. Methods We conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student’s t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening. Results A total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2–4.3]), no children (AOR 2.5 [1.4–4.3]), having free universal health coverage (AOR 1.7 [1.1–2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1–3.7]), low health literacy (AOR 2.7 [1.7–4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI > 30 (AOR 2.6 [1.5–4.4]). Conclusions This is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island’s diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.
Burden of cervical cancer in Martinique, 2012–2021
To provide an updated overview of the burden and temporal trends in incidence, mortality and survival of cervical cancer in a French Caribbean region between 2012 and 2021. This retrospective study included all cases of cervical cancer diagnosed and registered by the Martinique Population-Based Cancer Registry between 2012 and 2021. Data were recorded strictly according to international standards set by the International Agency for Research on Cancer, French and European Network of Cancer Registries. A descriptive epidemiological analysis and a survival analysis for invasive cases were performed. We calculated world age-standardized incidence and mortality rates, using the WHO standard world population. Overall survival, with a 95 % confidence interval, was calculated as the time from diagnosis to death from any cause. Patients were censored at the date of last follow-up or at the cut-off date of December 31, 2023. We used the Kaplan-Meier product limit method to estimate overall survival at 1, 3, 5 and 10 years. Over the study period, 1196 in situ tumors and 202 invasive cases were diagnosed. 45.0 % of women were aged 65 and over, and 67.3 % received chemotherapy and/or radiotherapy. Most invasive cases were diagnosed with locally advanced stage (43.1 %) and were squamous cell carcinomas (75.2 %). Trends in world age-standardized incidence and mortality rates were globally constant at 6 per 100,000 and 3 per 100,000 person-years, respectively. Overall survival at 5 years was 51.4 % (44.2 %; 58.1 %), and at 10 years, 41.8 % (33.8 %; 49.6 %). In this retrospective cohort study, data from a qualified cancer registry comprehensively described the burden of cervical cancer in a Caribbean region. These findings are essential for planning, monitoring, and evaluating the ongoing impact of the national vaccination, screening, and treatment measures required to drastically contribute to the elimination of cervical cancer in these particularly high-burden regions.
