Not All Women Get the Same Cancer Care

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

“There are significant inequalities in the uptake of cancer screening programs among women, and this is a critical issue,” said Isabel Rubio, MD, head 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-chair of ECO’s prevention, early detection, and screening network. Rubio told Medscape Medical News that addressing these disparities is essential to ensuring 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,” Salvatore Vaccarella, PhD, a scientist at the International Agency for Research on Cancer, who was not involved in the ECO report, told Medscape Medical News. “And they are still understudied and overlooked.”

Low Breast and Cervical Cancer Screening Rates

In Europe, significant inequalities persist in cancer screening access and participation among women, particularly for the two most common cancers: Breast and cervical cancer.

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

Likewise, cervical cancer, which is responsible for 7.5% of all cancer deaths in women, sees similarly inadequate screening rates, with less than 30% of all eligible women tested in the past 3 years. “This is a cancer that has been affected a lot by inequalities between and within countries,” said Vaccarella. “[Cervical] cancer is almost completely preventable through vaccination and screening. And yet, in some countries in Eastern Europe and within some socioeconomic groups, mortality remains high, similar to what you see 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 lower 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 potentially improve screening accessibility among underserved populations.

Certain vulnerable groups experience 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 HPV vaccination. LGBTIQ people also experience  low screening rates, with only 10% of those surveyed in Europe saying they have had a mammography and 27% saying they had a cervical smear test compared with 36% in each case in the general population. Analyses of data in the United Kingdom showed that women from certain  ethnic backgrounds — particularly those of African or Asian descent — face  higher rates of late-stage diagnoses for cancers such as breast and ovarian cancer.

Rubio explained that a well-coordinated approach to screening is necessary to reach disadvantaged socioeconomic groups effectively, but it might 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 have a mammogram, an HPV vaccination, or a colorectal screening,” she said.

Improvement Comes From Entire Care Pathway

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

However, she said that 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, medication, and specialized treatments when necessary. Without coordinated care across all stages, screening alone cannot improve outcomes. “A positive screening experience should be backed by prompt and effective treatment,” she said.

National guidelines and standards of care are also essential for reducing inequalities. Although guidelines exist at the European level, they are inconsistently applied, leading to variability in cancer care quality across different regions. “Establishing and implementing national guidelines would ensure more consistent and equitable treatment for all patients across 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 experience 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.