Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample

BackgroundInequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance.MethodsThe study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county’s municipalities, aggregated data for women in the age range 40–74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests.ResultsThe results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening.ConclusionsAge and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.

[1]  P. Gøtzsche,et al.  Breast cancer mortality in organised mammography screening in Denmark: comparative study , 2010, BMJ : British Medical Journal.

[2]  P. Vedsted,et al.  Identifying specific non-attending groups in breast cancer screening - population-based registry study of participation and socio-demography , 2012, BMC Cancer.

[3]  D. Altman,et al.  The benefits and harms of breast cancer screening: an independent review , 2012, British Journal of Cancer.

[4]  L. Reay,et al.  The effect of access factors on breast screening attendance on two Scottish islands. , 1997, Health bulletin.

[5]  J. Otten,et al.  Effective biennial mammographic screening in women aged 40-49. , 2010, European journal of cancer.

[6]  C. Berterö,et al.  GETTING NO RESPECT: BARRIERS TO MAMMOGRAPHY FOR A GROUP OF SWEDISH WOMEN , 2003, Health care for women international.

[7]  D O Slosman,et al.  Prevention and early detection , 1996 .

[8]  Ingvar Andersson,et al.  Long-term effects of mammography screening: updated overview of the Swedish randomised trials , 2002, The Lancet.

[9]  J. Wardle,et al.  Women's preferences for the delivery of the National Health Service Breast Screening Programme: a cross-sectional survey , 2010, Journal of medical screening.

[10]  C. Mathers,et al.  Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 , 2010, International journal of cancer.

[11]  P. Vedsted,et al.  Distance to screening site and non-participation in screening for breast cancer: a population-based study. , 2014, Journal of public health.

[12]  C. Mathers,et al.  GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer , 2013 .

[13]  J. Hyndman,et al.  Effect of distance and social disadvantage on the response to invitations to attend mammography screening , 2000, Journal of medical screening.

[14]  Claus Rydahl Torp,et al.  [Where is the National Board of Health and Welfare?]. , 2003, Ugeskrift for laeger.

[15]  Elena B. Elkin,et al.  Geographic Access and the Use of Screening Mammography , 2010, Medical care.

[16]  Håkan Jonsson,et al.  Effectiveness of population‐based service screening with mammography for women ages 40 to 49 years , 2011, Cancer.

[17]  S. Feig.  Screening mammography: a successful public health initiative. , 2006, Revista panamericana de salud publica = Pan American journal of public health.

[18]  I. Kawachi,et al.  A glossary for health inequalities , 2002, Journal of epidemiology and community health.

[19]  M. Whitehead,et al.  Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe , 1991 .

[20]  M. Finkelstein.  Preventive screening. What factors influence testing? , 2002, Canadian family physician Medecin de famille canadien.

[21]  S. Zackrisson,et al.  Social predictors of non-attendance in an urban mammographic screening programme: A multilevel analysis , 2007, Scandinavian journal of public health.

[22]  K. Kerlikowske,et al.  Efficacy of screening mammography among women aged 40 to 49 years and 50 to 69 years: comparison of relative and absolute benefit. , 1997, Journal of the National Cancer Institute. Monographs.

[23]  R. Pfeiffer,et al.  Impact of geography on mammography use in California , 2009, Cancer Causes & Control.

[24]  S. Zackrisson,et al.  Non‐attendance in breast cancer screening is associated with unfavourable socio‐economic circumstances and advanced carcinoma , 2004, International journal of cancer.

[25]  D. Berry,et al.  Effect of screening and adjuvant therapy on mortality from breast cancer. , 2006, The New England journal of medicine.

[26]  E. Thurfjell,et al.  Sociodemographic predictors of non-attendance at invitational mammography screening – a population-based register study (Sweden) , 2002, Cancer Causes & Control.

[27]  R. Hendrick,et al.  Benefit of screening mammography in women aged 40-49: a new meta-analysis of randomized controlled trials. , 1997, Journal of the National Cancer Institute. Monographs.

[28]  M. Plummer,et al.  International agency for research on cancer. , 2020, Archives of pathology.

[29]  E. Ellerbeck,et al.  Impact of Geographic Barriers on the Utilization of Mammograms by Older Rural Women , 2002, Journal of the American Geriatrics Society.

[30]  Gopal K Singh,et al.  Sociodemographic variations in breast cancer screening behavior among Australian women: results from the 1995 National Health Survey. , 2002, Preventive medicine.

[31]  Joshua Rolnick,et al.  Aggregate health data in the United States: Steps toward a public good , 2013, Health Informatics J..

[32]  M. Doescher,et al.  Trends in cervical and breast cancer screening practices among women in rural and urban areas of the United States. , 2009, Journal of public health management and practice : JPHMP.

[33]  Roger A Forsyth,et al.  Treatment of pituitary neoplasms with temozolomide , 2011, Cancer.

[34]  Ravi Maheswaran,et al.  Socioeconomic deprivation, travel distance, location of service, and uptake of breast cancer screening in North Derbyshire, UK , 2006, Journal of Epidemiology and Community Health.

[35]  S. Zackrisson,et al.  Psychosocial factors and attendance at a population-based mammography screening program in a cohort of Swedish women , 2014, BMC Women's Health.

[36]  Bin Huang,et al.  Does distance matter? Distance to mammography facilities and stage at diagnosis of breast cancer in Kentucky. , 2009, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[37]  M. Dignan,et al.  Access to Mammography Facilities and Detection of Breast Cancer by Screening Mammography: A GIS Approach. , 2009, International journal of cancer prevention.

[38]  L. Nyström,et al.  Service screening with mammography in Northern Sweden: effects on breast cancer mortality – an update , 2007, Journal of medical screening.

[39]  Jay Parikh,et al.  Improved prognosis of women aged 75 and older with mammography-detected breast cancer. , 2014, Radiology.

[40]  Profile of women not attending in the Swiss Mammography Screening Pilot Programme. , 2004, Breast.

[41]  Håkan Jonsson,et al.  Reduction in Breast Cancer Mortality from Organized Service Screening with Mammography: 1. Further Confirmation with Extended Data , 2006, Cancer Epidemiology Biomarkers & Prevention.

[42]  T. Perneger.  What's wrong with Bonferroni adjustments , 1998, BMJ.

[43]  J Leung,et al.  Effect of rurality on screening for breast cancer: a systematic review and meta-analysis comparing mammography. , 2014, Rural and remote health.

[44]  M Lambe,et al.  Attitudes, beliefs, and knowledge as predictors of nonattendance in a Swedish population-based mammography screening program. , 2000, Preventive medicine.

[45]  M. Dignan,et al.  Factors influencing adherence to guidelines for screening mammography among women aged 40 years and older. , 2003, Ethnicity & disease.