John Libbey Eurotext

Bulletin du Cancer


Access to preventative care, screening and treatment of women in vulnerable socio-economic groups presenting with cervical cancer Volume 96, issue 10, octobre 2009

Service de gynécologie et obstétrique, hôpital Xavier-Bichat, 42, rue Henri-Huchard, 75018 Paris, France, Service de gynécologie et obstétrique, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France, Département de chirurgie, institut Curie, 26, rue d’Ulm, 75005 Paris, France

AimThe object of this study was to evaluate access to preventative care, screening and treatment of women in vulnerable socio-economic groups presenting with cervical cancer and the progression of their disease.MethodThis is a retrospective study of 123 patients with cervical cancer treated at the hôpital Bichat (Paris) or the hôpital Verdier (Bondy) between 1st January 1996 and 31 December 2005.Results“CMU” or “AME” is the entitlement for fully state funded medical care and was used in this study to indicate social deprivation. Social deprivation is associated with homelessness (43.9 vs 1.23%; P = 0.0001) and unemployment (90 vs 30%; P = 0.0001). Women from deprived groups seldom enter screening programs (25 vs 56.1%; P = 0.008). Once symptomatic they delay seeking medical attention (1.8 months later than for non-deprived groups; P = 0.027), present more often to accident and emergency departments (51.22 vs 17.07%; P = 0.0003), and do not see any primary care practitioner (41.46 vs 8.64%; P < 0.0001). There was no significant difference with regard to treatment instituted in the two groups. The non-deprived patients residing in Bondy had similar access to care as the deprived patients treated in Paris. The average follow-up period was 30.43 months (± 26.64).ConclusionCervical screening is not taken up adequately throughout the general population. Access to health care is poorly tailored to the needs of the socially deprived. Social deprivation did not demonstrate an association with levels of pelvic recurrence, metastasis or death. The low doctor to patient ratio in certain geographical areas reduces access to medical care.