Socioeconomic disparity trends in cancer screening among women after introduction of national quality indicators

Yiska Loewenberg Weisband*, Luz Torres, Ora Paltiel, Yael Wolff Sagy, Ronit Calderon-Margalit, Orly Manor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


PURPOSE Primary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care–based national quality indicator program. METHODS This repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data. RESULTS In 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening. CONCLUSIONS We found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel’s quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.

Original languageAmerican English
Pages (from-to)396-404
Number of pages9
JournalAnnals of Family Medicine
Issue number5
StatePublished - 1 Sep 2021

Bibliographical note

Publisher Copyright:
© 2021, Annals of Family Medicine, Inc. All rights reserved.


  • Cancer screening
  • Delivery of health care
  • Early detection of cancer
  • Health care research
  • Health status disparities
  • Healthcare disparities
  • Population health
  • Primary care
  • Quality indicators, health care
  • Quality of care
  • Socioeconomic disparities
  • Vulnerable populations
  • Women’s health


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