Occupational disparities in common cancer screening participation among workers: a nationwide cross-sectional study in Japan

Abstract Objective: Cancer screening is crucial for early detection and improved health outcomes. Limited evidence exists on the association between occupational class and cancer screening participation in Japan. Therefore, we aimed to examine screening participation rates and disparities among active workers across different occupational classes. Methods: This cross-sectional study analyzed data from a nationwide web-based survey conducted in Japan (September–November, 2023). Eligible participants included current workers aged 40–64 years for colorectal, lung, and stomach cancer screenings (n=7,038), 40–64 years for breast cancer screening (n=2,929), and 30–64 years for cervical cancer screening (n=4,252). Cancer screening participation rates across occupational classes (upper non-manual, lower non-manual, and manual workers) were compared using the chi-square test. Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for non-participation, adjusted for sex, age, educational attainment, household income, and workplace scale. Upper non-manual workers served as the reference group. Results: Manual workers consistently had lower cancer screening participation rates. Compared to upper non-manual workers, manual workers exhibited significantly higher PRs for non-participation in colorectal (PR=1.12, 95% CI: 1.04–1.22), lung (PR=1.22, 95% CI: 1.12–1.34), stomach (PR=1.14, 95% CI: 1.05–1.23), and cervical cancer screenings (PR=1.16, 95% CI: 1.02–1.33). The disparities were particularly pronounced among male workers. Conclusions: Manual workers had lower cancer screening participation rates, particularly for colorectal, lung, stomach, and cervical cancer. Targeted interventions are needed to improve screening, particularly among manual workers, and reduce occupational disparities in cancer prevention and outcomes.