2024/12/30 [最新預刊]

子宮頸癌與乳癌篩檢之城鄉差距探討

目標：台灣目前針對女性提供的癌症篩檢補助服務，包括子宮頸抹片檢查及乳房X光攝影檢查，雖為公費補助之篩檢項目，但是台灣有醫療資源分布不均之現象，癌症篩檢服務是否能觸及所有符合篩檢條件的女性乃是一值得探討的問題。本研究探討偏鄉婦女與城市婦女之乳癌與子宮頸癌篩檢情況是否存在差異。方法：本研究採用回溯性世代研究法（Retrospective Cohort study），利用全民健保資料庫進行次級資料分析。研究對象為2017年滿30歲及以上女性（子宮頸癌篩檢）及2017年45-69歲女性（乳癌篩檢）。利用承保檔中投保單位地區、保險單位類別、被保人身份、呼吸道感染門診就醫紀錄等推估居住地，之後再進行居住地城鄉劃分，並針對研究對象居住地（城/鄉）與篩檢情況進行雙變項卡方檢定及多變項羅吉斯迴歸分析，探討居住地不同是否造成癌症篩檢利用情況差異。結果：本研究發現，偏鄉地區婦女較城市婦女更可能進行子宮頸癌（OR = 1.017, p < 0.01）和乳癌篩檢（OR = 1.038, p < 0.01）。隨著年齡或地區教育程度增加，接受子宮頸癌篩檢之勝算比越低，但接受乳癌篩檢勝算比越高；而投保金額較高者，相較於投保金額低的組別，進行子宮頸癌篩檢與乳癌篩檢的勝算比均較高。結論：本研究發現2017至2019年，台灣婦女在子宮頸癌及乳癌篩檢利用上確實存在城鄉差距，但是偏鄉之篩檢狀況並不比城市差，反而出現城市篩檢狀況不及偏鄉的狀況。年齡、投保金額、地區教育程度及共病症情形也均為可預測研究對象篩檢行為之相關因素。本研究亦發現子宮頸癌及乳癌的篩檢率整體偏低，子宮頸癌篩檢率為48.02%，乳癌篩檢率為38.86%，與國家癌症防治計畫目標之間仍有差距，應設法國家提高整體篩檢率。

• 預定刊載卷期：台灣衛誌 2024；43(6)
• 原著 Original Article
•  
• 戴晨芝、林青青、程劭儀、董鈺琪
  Chen-Chih Tai, Ching-Ching Claire Lin, Shao-Yi Cheng, Yu-Chi Tung
• 城鄉差距、子宮頸抹片檢查、乳房X光攝影、癌症篩檢、預防醫療利用
  urban-rural difference, pap smear, mammography, cancer screening, preventive care
• 目標：台灣目前針對女性提供的癌症篩檢補助服務，包括子宮頸抹片檢查及乳房X光攝影檢查，雖為公費補助之篩檢項目，但是台灣有醫療資源分布不均之現象，癌症篩檢服務是否能觸及所有符合篩檢條件的女性乃是一值得探討的問題。本研究探討偏鄉婦女與城市婦女之乳癌與子宮頸癌篩檢情況是否存在差異。方法：本研究採用回溯性世代研究法（Retrospective Cohort study），利用全民健保資料庫進行次級資料分析。研究對象為2017年滿30歲及以上女性（子宮頸癌篩檢）及2017年45-69歲女性（乳癌篩檢）。利用承保檔中投保單位地區、保險單位類別、被保人身份、呼吸道感染門診就醫紀錄等推估居住地，之後再進行居住地城鄉劃分，並針對研究對象居住地（城/鄉）與篩檢情況進行雙變項卡方檢定及多變項羅吉斯迴歸分析，探討居住地不同是否造成癌症篩檢利用情況差異。結果：本研究發現，偏鄉地區婦女較城市婦女更可能進行子宮頸癌（OR = 1.017, p < 0.01）和乳癌篩檢（OR = 1.038, p < 0.01）。隨著年齡或地區教育程度增加，接受子宮頸癌篩檢之勝算比越低，但接受乳癌篩檢勝算比越高；而投保金額較高者，相較於投保金額低的組別，進行子宮頸癌篩檢與乳癌篩檢的勝算比均較高。結論：本研究發現2017至2019年，台灣婦女在子宮頸癌及乳癌篩檢利用上確實存在城鄉差距，但是偏鄉之篩檢狀況並不比城市差，反而出現城市篩檢狀況不及偏鄉的狀況。年齡、投保金額、地區教育程度及共病症情形也均為可預測研究對象篩檢行為之相關因素。本研究亦發現子宮頸癌及乳癌的篩檢率整體偏低，子宮頸癌篩檢率為48.02%，乳癌篩檢率為38.86%，與國家癌症防治計畫目標之間仍有差距，應設法國家提高整體篩檢率。
  
  Objectives: Taiwan currently provides subsidized cancer screening services, including pap smears and mammograms, for women under its national health-care system. However, the uneven distribution of medical resources in Taiwan raises concerns about these services' accessibility for all eligible women. Few studies have explored the differences in utilization rates of cervical and breast cancer screening services in Taiwan between women residing in urban and rural areas, and the extent to which these differences exist remains unclear. This study investigated variations in the utilization of breast and cervical cancer screening services among women residing in

  urban and rural areas in Taiwan. Methods: This study employed a retrospective cohort design and utilized secondary data from the National Health Insurance Research Database. The sample for cervical cancer screening comprised women aged 30 years and older, with data 2017-2019 analyzed; the sample for breast cancer screening comprised women aged 45–69 years, with data from 2017-2018 analyzed. The Registry for Benefciaries fle was used to estimate place of residence on the basis of the insurance unit’s region, the insurance unit type, the benefciary’s identity, and outpatient records for respiratory infections. Places of residence were categorized as urban or rural. Chi-square tests and multivariate logistic regression analyses were conducted to examine differences in cancer screening utilization by place of residence (urban/rural). Results: We have investigated 6,754,863 women in total, with 6,244,533 from urban area and 510,330 from rural area. The overall screening rates were low, being 48.02% for cervical cancer screening

  and 38.86% for breast cancer screening. Women in rural areas had higher odds of undergoing cervical cancer (OR = 1.017, p < .01) and breast cancer (OR = 1.038, p < .01) screening than those of women in urban areas. A higher age or education level was associated with lower odds of undergoing cervical cancer screening but higher odds of undergoing breast cancer screening. Additionally, individuals with higher insurance coverage had higher odds of undergoing both cervical and breast cancer screening than those of individuals with lower insurance coverage. Conclusions: This study identifed differences in cervical and breast cancer screening utilization between urban and rural residents from 2017 to 2019. The fndings reveal that women living in rural areas exhibited slightly higher screening rates than those of women living in urban areas. Factors such as age, insurance coverage, regional education level, and comorbidity status were associated with screening behaviors. However, the overall screening rates for cervical and breast cancer were below the targets set by Taiwan's National Cancer Control Program, underscoring the need for initiatives to improve these rates.
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• http://bit.ly/3r4HS9R