# Impact of commune level social inequalities on time to diagnosis and follow-up in women with high-grade cervical lesions in Isère, France: Evidence from the French cervical cancer screening program

## TL;DR

The study found that women in socioeconomically disadvantaged areas in France face longer delays in cervical lesion diagnosis, but not treatment.

## Contribution

This study provides evidence of socioeconomic disparities in cervical cancer screening and diagnosis delays in France.

## Key findings

- Women from disadvantaged socioeconomic quintiles had significantly longer diagnostic delays.
- No significant association was found between socioeconomic factors and treatment initiation delays.
- Over half of women received high-grade cervical lesion diagnoses within two months.

## Abstract

To assess the impact of commune level social inequality characteristics on delays in access to cervical cancer screening, diagnosis, and initial treatment of high-grade cervical intraepithelial lesions.

We conducted a retrospective cross-sectional study among asymptomatic women living in Isère (department in France) who had undergone at least one cervico-uterine smear between January 1, 2010 and December 31, 2018. Patients with positive screening results were referred for further diagnostic procedures. Social disparities were assessed using the French Deprivation Index.

3060 cases of high-grade cervical intraepithelial lesions with complete diagnosis dates were included in the analysis. Women from the most socioeconomically disadvantaged quintiles experienced significantly longer diagnostic delays than women from more advantaged groups (quintile 2: 0.72 [95% confidence interval: 0.58, 0.91]; quintile 3: 0.76 [95% confidence interval: 0.60, 0.98]). No significant association was found between socioeconomic factors and delays in treatment initiation.

Our findings indicate significantly longer times to diagnostic procedures for women from socioeconomically disadvantaged backgrounds and those with low-grade cytological abnormalities. Given the potential progression to invasive cervical cancer, it may be advisable to allocate specific resources to ensure appropriate follow-up for women with low-grade cytological lesions, particularly those residing in socioeconomically disadvantaged areas.

•How social inequality affects delays in access to diagnosis of cervical lesions.•Women from the most disadvantaged quintiles experienced longer delays to diagnosis.•No significant link found between social inequality and time to treatment.•Over half of women received high-grade cervical lesion diagnoses within two months.•Allocate resources to follow up women with low-grade cytology in underserved areas.

How social inequality affects delays in access to diagnosis of cervical lesions.

Women from the most disadvantaged quintiles experienced longer delays to diagnosis.

No significant link found between social inequality and time to treatment.

Over half of women received high-grade cervical lesion diagnoses within two months.

Allocate resources to follow up women with low-grade cytology in underserved areas.