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Direct and indirect effects of cancer screening invitations on participation in Europe: A quasi-experimental analysis

Author

Listed:
  • Guthmuller, Sophie
  • Carrieri, Vincenzo
  • Wübker, Ansgar

Abstract

Organized cancer screening programs (OSPs) in Europe for breast, cervical, and colorectal cancers aim to improve early detection and reduce mortality. This study measures the effects of OSPs on participation and examines cross-program spillovers, as women are often invited to multiple screenings. We construct a regional-level dataset on OSP availability, merged with individuallevel data from the European Health Interview Survey (EHIS) covering 122,000 women in 27 countries. We exploit cross-region and age-based variations in eligibility and employ a quasiexperimental difference-in-differences model to measure the causal effect of OSPs. OSPs substantially increase screening participation: mammography rises by 33.20 percentage points (pp) (95% CI: 24.56-41.85), fecal occult blood test (FOBT) by 19.41 pp (95% CI: 13.95-24.88), and pap test by 9.33 pp (95% CI: 5.26-13.41). Positive spillover effects occur when women are invited to two screenings (10 pp (95% CI: 4.81-15.20) for mammography, 3.35 pp (95% CI: 0.56-6.15) for pap test, 7.44 pp (95% CI:2.34-12.55) for FOBT) but targeting three cancers does not yield additional statistically significant gains. These findings highlight the strong impact of OSPs on participation and the value of coordinated screening and communication strategies as Europe expands organized screening to new cancer sites.

Suggested Citation

  • Guthmuller, Sophie & Carrieri, Vincenzo & Wübker, Ansgar, 2025. "Direct and indirect effects of cancer screening invitations on participation in Europe: A quasi-experimental analysis," Ruhr Economic Papers 1188, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    • Handle: RePEc:zbw:rwirep:335896
    DOI: 10.4419/96973373
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    References listed on IDEAS

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    1. Vincenzo Carrieri & Ansgar Wuebker, 2016. "Quasi-Experimental Evidence on the Effects of Health Information on Preventive Behaviour in Europe," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 78(6), pages 765-791, December.
    2. Francetic, Igor & Meacock, Rachel & Sutton, Matt, 2022. "Understanding Concordance in Health Behaviours among Couples: Evidence from the Bowel Cancer Screening Programme in England," Journal of Economic Behavior & Organization, Elsevier, vol. 201(C), pages 310-345.
    3. Marianne P. Bitler & Christopher S. Carpenter & Danea Horn, 2021. "Effects of the Colorectal Cancer Control Program," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2667-2685, November.
    4. Christopher S. Carpenter & Emily C. Lawler, 2019. "Direct and Spillover Effects of Middle School Vaccination Requirements," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 95-125, February.
    5. Guthmuller, Sophie & Carrieri, Vincenzo & Wübker, Ansgar, 2023. "Effects of organized screening programs on breast cancer screening, incidence, and mortality in Europe," Journal of Health Economics, Elsevier, vol. 92(C).
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    JEL classification:

    • D90 - Microeconomics - - Micro-Based Behavioral Economics - - - General
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy

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