Cent Eur J Public Health 2025, 33(3):155-162 | DOI: 10.21101/cejph.a8486

Inequalities in cervical cancer screening use: results of the Serbian National Health Survey

Dragana Milijašević^{1, 2}, Tatjana Tamaš^{1, 3}, Sonja Čanković^{1, 2}, Snežana Ukropina^{1, 2}, Sonja Šušnjević⁴, Tanja Tomašević^{1, 2}, Dušan Čanković^{1, 2}, Vesna Mijatović Jovanović^{1, 2}

¹ Faculty of Medicine, University of Novi Sad, Autonomous Province of Vojvodina, Novi Sad, Serbia

² Institute of Public Health of Vojvodina, Autonomous Province of Vojvodina, Novi Sad, Serbia

³ Oncology Institute of Vojvodina, Autonomous Province of Vojvodina, Novi Sad, Serbia

⁴ Health Care District of Palm Beach County, West Palm Beach, Florida, United States of America

Objectives: Cervical cancer represents a significant public health concern worldwide, particularly among women of reproductive age. According to data from the Cancer Registry of the Republic of Serbia for the year 2022, cervical cancer is the fourth most common cancer in women, with an age-standardized incidence rate (ASIR) of 24.8/100,000 and the fourth leading cause of mortality, with an age-standardized mortality rate (ASMR) of 10.2/100,000. This study aimed to analyse the association between socio-demographic factors, unmet healthcare needs, and cervical cancer screening use among women in Serbia.

Methods: Research was conducted as a cross-sectional study on a sample of 3,980 women aged 25-64 in Serbia. Three types of questionnaires were used as a research instrument. The association of missed cervical smear tests in the last 3 years with independent variables was examined by univariate and binary logistic regression model.

Results: According to socio-demographic characteristics, the likelihood of missing a cervical smear test in the last 3 years increased with age, being highest among older women (OR = 1.91, 95% CI: 1.88-1.94), lower-income categories (OR = 1.76, 95% CI: 1.74-1.78), and women with the lowest levels of education (OR = 1.49, 95% CI: 1.47-1.52). The logistic regression model revealed significant territorial disparities, with the highest predicted probability for women from South and East Serbia (OR = 1.73, 95% CI: 1.70-1.76). Additionally, distance/transportation and financial constraints were significantly associated with missed cervical smear tests in the last 3 years (OR = 2.05, 95% CI: 1.99-2.11; OR = 1.10, 95% CI: 1.08-1.12, respectively).

Conclusions: Socioeconomic disparities in cervical cancer screening remain a challenge. This study highlights the need to allocate resources to areas in need of improvement and also to conduct comprehensive evaluations of screening systems, which can lead to significant reductions in cervical cancer incidence and mortality.

Keywords: women, healthcare inequalities, Pap test, cancer screening, assessment of healthcare needs

Received: December 10, 2024; Revised: September 5, 2025; Accepted: September 5, 2025; Published: September 30, 2025  Show citation