Adherence to Breast, Cervical, and Colorectal Cancer Screening Among Women in Spain: Evidence from the 2023 Spanish...

Background/Objectives: Cancer screening is a key strategy for reducing cancer-related morbidity and mortality. This study assessed adherence to breast, cervical, and colorectal cancer screening among Spanish women and identified factors independently associated with participation. Methods: A cross-sectional study was conducted using data from the 2023 Spanish Health Survey. Women eligible for mammography (40-69 years), cervical cytology (25-65 years), and fecal occult blood testing (FOBT; 50-69 years) were included. Weighted prevalence estimates were calculated, and multivariable logistic regression models were fitted separately for each screening test. Results: A total of 7454 women aged 25-69 years were analyzed. Adherence was highest for mammography (71.1%), followed by cervical cytology (64.1%) and FOBT (36.8%). Only 24.4% of women eligible for all three programs were adherent to all screening tests simultaneously. Across all screening programs, adherence was consistently associated with being born in Spain, living with a partner, greater social support, healthcare utilization, private health insurance coverage, and physical activity. Strong social support was independently associated with participation in mammography (OR 1.72; 95% CI 1.35-2.20), cervical cytology (OR 1.58; 95% CI 1.29-1.94), and FOBT uptake. Participation in one screening program was strongly associated with participation in the others, particularly between mammography and cervical cytology (OR 4.37; 95% CI 3.84-4.98). Conclusions: Adherence to cancer screening among Spanish women remains suboptimal, particularly for colorectal cancer. Participation appears to reflect a broader preventive health behavior pattern, with social support emerging as one of the strongest and most consistent determinants across all three screening programs.