Mammograms and cervical tests among Ukrainian refugees and main population: survey in Estonia, 2024

Issue

Mammograms and cervical tests aim to reduce cancer-related morbidity and mortality; however, socio-demographic inequalities in uptake persist. This study analysed use of mammography and HPV/PAP testing among 20-64-year-old Ukrainian refugees and main population In Estonia and factors influencing uptake in both groups.

Methods

Data from two cross-sectional surveys in 2024 covering Ukrainian refugees (n = 1060) and general population (n = 1117) of Estonia were used. Outcomes included: mammography within the past two years and never; HPV/Pap test within the past five years and never. Independent variables included age, marital status, education, household financial situation, place of residence, self-rated health, smoking status, body mass index, and health insurance coverage. Associations were estimated using negative log-binomial regression, results presented as prevalence rate ratios (PRR) with 95% confidence intervals (CI).

Results

Refugees were slightly younger (mean age 39.4 vs. 44.5 years), more often urban residents, reported more financial difficulties, and were less likely to have health insurance (13.9% vs. 3.3% uninsured; p < 0.001). There were more women who reported to have never had a mammogram (PPR 1.13; 95% CI:1.02-1.25), cervical Pap-smear or HPV test (PPR 1.93; 95% CI: 1.71-2.19%) among Ukrainian refugees than among the main population. Cervical tests in past five years and mammogram use in past two years was lower among refugees. The proportion of women who reported no cervical tests was higher among both Estonian and Ukrainian single women, women with secondary or vocational education, with poor self-rated health, and without health nsurance. Among refugees, ex-smokers were more likely to report no mammograms.

Lessons

Cancer screening should be provided to refugees free of charge. No big differences in the analysed background factors related to screening attendance between the main population and the refugees were found.

Key messages

• High use of free of charge preventive services emphasizes the need to provide cancer screening to refugees.

• Socio-economic background factors related to screening attendance did not significantly differ between the main population in Estonia and the Ukrainian war refugees.