Socioeconomic factors and education levels significantly affect access to cancer screening and the most appropriate care for women in Europe, according to a recently published study. European Cancer Organization report (ECO). The report says inequalities in screening and care are prevalent among marginalized communities, such as ethnic minority groups and LGBTQ+ people.

“There are significant disparities in the uptake of cancer screening programs among women, and this is a critical issue,” said Isabel Rubio, MD, chief of breast surgical oncology at Clinica Universidad de Navarra in Madrid, Spain. She is also President of the European Society of Breast Cancer Specialists and Co-President of the ECO Prevention, Early Detection and Screening Network. Rubio said Medscape Medical News that addressing these disparities is essential to ensure that all women have equal access to the benefits of early detection and timely care.

“Socioeconomic position and social factors are the most important factors explaining the distribution of cancer,” said Dr. Salvatore Vaccarella, a scientist at the International Agency for Research on Cancer who was not involved in the ECO report. Medscape Medical News. “And they’re still understudied and overlooked.”

Low screening rates for breast and cervical cancer

In Europe, significant inequalities persist in women’s access to and participation in cancer screening, particularly for the two most common cancers: breast and cervical cancer.

Breast cancer screening rates remain low despite accounting for 25% of all cancers in women, with only 54% of eligible women in low- and middle-income European countries ever having a mammogram.

Also, cervical cancer, which is responsible for 7.5% of all cancer deaths in women, has similarly inadequate screening rates, with less than 30% of all eligible women screened in the past 3 years. “This is a cancer that has been greatly affected by inequalities between and within countries,” Vaccarella said. “(Cervical) cancer is almost completely preventable through vaccination and screening. And yet, in some Eastern European countries and within some socioeconomic groups, mortality remains high, similar to what is seen in sub-Saharan Africa.”

Across Europe, these disparities are influenced by socioeconomic status, geography and the availability of health services. Rural and marginalized communities face additional challenges, with less access to the latest screening technologies and limited healthcare services. Only seven European Union countries – Denmark, Finland, France, Germany, the Netherlands, Portugal and Sweden – currently offer self-sampling for cervical cancer screening, which could improve accessibility to screening among disadvantaged populations .

Certain vulnerable groups face particularly pronounced disparities.

In Italy, a study found that only 13.5% of eligible incarcerated women reported ever having been screened for cervical cancer, and none had received an HPV vaccination. LGBTIQ people experience it too low screening ratesjust 10% of those surveyed in Europe saying they had a mammogram and 27% saying they had a cervical smear test, compared to 36% each in the general population. Analyzes of data from the United Kingdom showed that women in certain ethnic backgrounds — especially those of African or Asian descent — face higher rates of late-stage diagnostics for cancers such as breast and ovarian cancer.

Rubio explained that a well-coordinated approach to screening is necessary to effectively reach disadvantaged socioeconomic groups, but may not be sufficient. Low health literacy and lack of awareness limit access to screening, even where infrastructure exists. “There is a communication challenge in explaining what it means to get a mammogram, an HPV vaccination or a colorectal screening,” she said.

Improvement comes from the entire care pathway

Primary care physicians are usually the first point of contact with health systems, including for marginalized and disadvantaged groups. Rubio said she plays an important role in raising awareness, educating patients about screening options and explaining the benefits of early detection.

However, she said improving patient prognosis requires addressing the entire patient pathway, not just initial detection. Comprehensive care must include high-quality follow-up services, such as timely access to surgery, medications, and specialized treatments when needed. Without coordinated care at all stages, screening alone cannot improve outcomes. “A positive screening experience should be supported by prompt and effective treatment,” she said.

National guidelines and standards of care are also key to reducing inequalities. Although guidelines exist at European level, they are applied inconsistently, leading to variability in the quality of cancer care in different regions. “Establishing and enforcing national guidelines would ensure more consistent and equitable treatment for all patients in all countries,” Rubio said. “The problem of inequity is well known. We need to take some action to raise awareness and help all those women who face barriers to screening and care.”

Vaccarella and Rubio reported no relevant financial relationships.

Manuela Callari is a freelance science journalist specializing in human and planetary health. Her words have been published in The Medical Republic, Rare Disease Advisor, The Guardian, MIT Technology Review and others.