Associations Between Regional Factors and Cervical Cancer Screening Coverage in Tokyo

Despite an increasing incidence of cervical cancer in Japan, screening coverage remains relatively low. This study aimed to elucidate regional variations in cervical cancer screening coverage in Tokyo, Japan, and to identify regional factors that influence screening coverage.

This retrospective ecological study was conducted using data from 53 municipalities in Tokyo, sourced from the Tokyo Bureau of Public Health's cancer screening statistics, population census, and official municipal government websites for the year 2018. We collected data on candidate regional factors in each municipality: including the proportion of working women, requirement for cancer screening appointments, and combination of cervical cytology and HPV testing, among others. The associations between screening coverage and these candidate factors were examined using a linear regression model with weighted least squares estimation.

The mean cervical cancer screening coverage in Tokyo was 18.6% (inter-municipal range: 8.1-85.8%). The following factors were significantly associated with cancer screening coverage: the number of medical institutions conducting screenings per 10,000 eligible women (β: 41.51, 95% CI: 23.66 to 59.36.0, P<0.001), proportion of working women (β: 1.03, 95% CI: 0.43 to 1.63, P<0.001), requirement for cancer screening appointments (reference: no requirement) (β: -5.56, 95% CI: -9.57 to -1.62, P=0.01), and inclusion of human papillomavirus testing (reference: no testing) (β: 12.89, 95% CI: 5.42 to 20.36, P<0.001).

Cervical cancer screening coverage can be enhanced by improving accessibility to medical institutions that provide screenings, simplifying appointment procedures, and incorporating HPV testing. These findings provide valuable insights for designing effective public health policies and local screening strategies.