Cervical cancer screening: inequality of screening, inequality of medical practice?

Background Vulnerable social groups have more difficulty in accessing care and a lower quality of care. Health systems that focus on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care persist. We focused on primary care screening for cervical cancer by Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing incidence and mortality. To analyse the population screened by CUS and the health professionals who perform these tests, and to analyse differences in access to care in socio-economic and geographical terms.Methods This was a retrospective observational study based on data from the main health insurance schemes, allowing analysis of health care consumption according to socioeconomic level, and proximity to health care services. We included women (695,694) aged 25 to 64 years in 2012 relevant to CUS. The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed by using multinomial logistic regression.Results 202,271 (29%) patients underwent CUS, 68% by gynaecologists and 28% by general practitioners (GPs). However, inequalities in CUS were observed, with a decrease in the number of CUS performed with age, rural location, deprivation, and sparse health care provision. GPs’ practice seemed to penalize deprived populations less.Conclusions Screening should be conducted more by GPs in primary care, thus providing better access to deprived populations. Health care should be organised more around primary care than hospital care. The specific needs of deprived populations should be considered.