Original articleProfile of women not attending in the Swiss Mammography Screening Pilot Programme
Introduction
Between 1993 and 1998, a pilot mammography screening programme carried out in western Switzerland (French-speaking canton of Vaud) demonstrated the feasibility and acceptability of an organised screening intervention within the liberal healthcare system in Switzerland,1 where opportunistic breast cancer screening is widespread.2 This was the first ever organised cancer screening programme to be established in Switzerland, a country in which the breast cancer mortality rate is high.3 This experimental project contributed to the implementation of three canton-wide mammography screening programmes started in 1999.
This pilot programme was initiated and supported locally by leading physicians and public health authorities, and the service was free of cost to participants. This meant that the environment for screening promotion was more favourable than it would have been in a wider population-based programme. While screening attendance has been abundantly investigated, non-attendance has received less attention, and studies of predictors of participation have rarely addressed the contribution of these factors to non-participation (reviewed elsewhere4., 5.). Predictors of non-attendance have differed across studies, indicating a local, cultural component in non-attendance, or at least suggesting that the identification of factors affecting non-attendance is complicated. Apart from a few exceptions,6., 7. studies on non-attendance have relied on self-administered questionnaires and interviews of small samples, and have thus been subject to potential selection biases.
The aims of this study were two-fold. The first aim was to identify socio-demographic determinants of initial non-attendance in the Swiss pilot programme. Data routinely collected by the Swiss population registers made it possible to analyse socio-demographic characteristics for the whole target population. The second aim was to explore subsequent participation status among initial non-attendees and examine the factors associated with repeated non-attendance. In particular, we investigated what type of reaction/reply to the first-round invitation and what socio-demographic characteristics were related to repeated non-attendance. Determining what factors influence women's decisions to decline a screening invitation might suggest interventions that would increase participation. To our knowledge, predictors of initial and subsequent non-attendance in an organised mammography screening programme have not yet been simultaneously reported.
Section snippets
Materials and methods
In the Swiss pilot programme, about 15,000 women aged 50–69 and residing in the three districts of Aigle, Aubonne and Morges were personally invited every 2 years to attend a mammography examination. The screening test was cost free to each person invited but had to be carried out in one of two dedicated radiology centres located within public hospitals (in Morges for Aubonne and Morges districts residents, in Aigle for others). The recruitment, invitation and screening procedures have been
Results
Socio-demographic characteristics of the 10,783 eligible first-round invitees are presented in Table 1 along with odds ratios (ORs) for initial non-attendance. Non-attendance per se was highest among non-Swiss women and those who were single, separated or divorced. Non-attendance increased with increasing distance of the residence from the screening centre. Results derived from the multivariate analysis did not materially modify the ORs for non-attendance, although age was no longer indicative
Discussion
This study has identified relevant socio-demographic factors that influence non-attendance for screening within a free mammography screening programme in western Switzerland, where there had been no previous initiatives of this kind. Differences in the influence of socio-demographic factors on initial and repeated non-attendance were observed. However, the pattern of non-attendance might have been affected by the selective setting of this pilot programme.
Several socio-demographic
Acknowledgements
The staff of the Breast Cancer Screening Foundation of Lausanne is thanked for their collaboration throughout the project, Ms. C. Cesco for retrieving and compiling socio-demographic records, Mr. R. Leibenguth for extracting the screening datafile, and Mr. G. van Melle for statistical advice. The helpful comments of a peer reviewer are gratefully acknowledged.
References (25)
- et al.
Geographical disparities in self-reported use of mammography and breast self-examination according to the Swiss Health Survey (letter)
Ann Oncol
(2001) - et al.
Participation in breast screening programsa review
Soc Sci Med
(1990) - et al.
Mobile breast screeningfactors affecting uptake, efforts to increase response and acceptability
Public Health
(1990) - et al.
Predictive factors of enrollment and adherence in a breast cancer screening program in Barcelona (Spain)
Soc Sci Med
(1995) - et al.
Results from the Swiss Mammography Screening Pilot Programme
Eur J Cancer
(2003) - et al.
Worldwide patterns of cancer mortality, 1990–1994
Eur J Cancer Prev
(1999) - International Agency for Research on Cancer. Breast cancer screening. In: Vainio H, Bianchini F, editors. IARC...
- et al.
Sociodemographic predictors of non-attendance at invitational mammography. screening—a population-based register study (Sweden)
Cancer Causes Control
(2002) - et al.
Predictors of non-attendance for second round mammography in an Australian mammographic screening programme
J Med Screen
(2000) - Bulliard J-L, De Landtsheer J-P, Levi F. Reattendance in the Swiss Mammography Screening Pilot Programme. J Med Screen...
The impact of confounder selection criteria on effect estimation
Am J Epidemiol
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2016, Preventive MedicineCitation Excerpt :A variety of studies have investigated characteristics associated with participation in screening mammography. European national screening program registries have identified demographic characteristics including lower socio-economic status and older age as factors associated with non-attendance (Aarts et al., 2011; Bulliard et al., 2004a; Lagerlund et al., 2002). In the U.S., characteristics including non-white race, increased burden of co-morbid disease, and lower socio-economic status have been associated with lower rates of screening (Blanchard et al., 2004; Koya et al., 2011).
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2015, Preventive MedicineCitation Excerpt :However, the efficiency of population-based breast cancer screening programmes depends on high attendance (Health and Consumer Protection Directorate-General, 2006). Various factors have been linked to non-participation in breast cancer screening, including practical (Bulliard et al., 2004; Jensen et al., 2013) and social barriers (Farmer et al., 2007; Price et al., 2010) as well as psychological and demographic factors (Aro et al., 1999; Lagerlund et al., 2014; von Euler-Chelpin et al., 2008). The association between self-assessed health and non-participation in screening programmes has been studied, but often using only a single-item question (Courtney-Long et al., 2011; Donnelly et al., 2013; Font-Gonzalez et al., 2013; Gandhi et al., 2015; Taylor et al., 2003), and only few studies have applied validated scales (Farmer et al., 2007; Thorpe et al., 2006).
Variation in performance in low-volume mammography screening programmes: Experience from Switzerland
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Supported by a fellowship from the Swiss National Science Foundation (no. 32-63130.00). The Vaud screening pilot project received support from the Swiss and the Vaud Cancer Leagues.