The education gradient in cancer screening participation: a consistent phenomenon across Europe?

To extend the literature on educational inequalities in cancer screening participation (1) by simultaneously focusing on participation in screening for cervical, breast and colorectal cancer across 27 European countries and (2) by statistically testing whether these educational inequalities vary according to country-specific screening strategies: organised or opportunistic.

Self-reported data from Eurobarometer 66.2 (2006) on cancer screening participation in the preceding 12 months were used to outline cross-national variations in screening strategies, target populations and participation rates. Multilevel logistic regressions were applied.

Individuals with higher levels of education were more likely to participate in screening for cervical, breast and colorectal cancer than were those with less education. Educational inequalities in cancer screening participation were significantly smaller in countries with organised screening for cervical (OR = 0.696, 95% CI 0.531–0.912), breast (OR = 0.628, 95% CI 0.438–0.900) and colorectal (OR = 0.531, 95% CI 0.303–0.932) cancer than they were in countries with opportunistic screening. The same interaction was observed for participation in screening for breast and colorectal cancer, albeit with marginal significance.

This study clearly highlights the crucial role of educational level in the likelihood of participating in cancer screening. Countries can reduce educational inequalities by applying organised screening programmes.