Geographical relationships between sociodemographic factors and incidence of cervical cancer in the Netherlands 1989-2003.

In many industrialized countries, with some degree of screening, cervical cancer nowadays is most frequent among women of lower socioeconomic status (SES), partly owing to their lower participation in screening. This study aims to provide support for specification of mass screening policy for cervical cancer by describing relationships between sociodemographic factors and the incidence of cervical cancer in the Netherlands based on geographical differences and by analysing the relationship between SES of neighbourhood and individual tumour characteristics. Municipality-specific, age-adjusted incidence rates for cervical cancer were calculated from the Netherlands Cancer Registry, and data on sociodemographic factors were obtained from Statistics Netherlands. Logistic regression analysis was performed to investigate determinants of variations in incidence at the ecological level. An additional analysis linked individual tumour characteristics to SES estimates at the postal code level by calculating relative risks (RR). The incidence was higher in municipalities with a high prevalence of immigrants [odds ratios 7.9, 1.4-47 95% confidence intervals (CI)] and with more individuals on welfare (odds ratios 8.6, 1.7-43 95% CI). Patients residing in neighbourhoods with lower SES had higher Federation of Gynecology and Obstetrics stages (RR 1.4, 1.2-1.6 95% CI) and fewer adenocarcinomas (RR 0.7, 0.6-0.9 95% CI), and were younger at diagnosis (P<0.001). Cervical cancer is more common among women of lower SES and immigrant women. This, together with the finding that lower SES is associated with more advanced cancer and consequently worse survival, emphasizes the importance of future cervical cancer prevention programmes targeted at women of lower SES who do not participate in opportunistic screening.