Abstract
BackgroundIn Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. We evaluated factors associated with attendance to breast cancer screening in these two regions.MethodsWe analyzed the data of 50–69 year-old women (n = 2769) from the Swiss Health Survey 2012. Factors of interest included education level, place of residence, nationality, marital status, smoking history, alcohol consumption, physical activity, diet, self-perceived health, history of chronic diseases and mental distress, visits to medical doctors and cervical and colorectal cancer screening. Outcome measures were dichotomized into ≤2 years since most recent mammography versus >2 years or never.ResultsIn the German- and French-speaking regions, mammography attendance within the last two years was 34.9 % and 77.8 %, respectively. In the French region, moderate alcohol consumption (adjusted OR 2.01, 95 % CI 1.28–3.15) increased screening attendance. Compared to those with no visit to a physician during the recent year, women in both regions with such visits attended statistically significantly more often BC screening (1–5 times vs. no visit: German (adjusted OR 3.96, 95 % CI 2.58–6.09); French: OR 7.25, 95 % CI 4.04–13.01). Non-attendance to cervical screening had a negative effect in both the German (adjusted OR 0.44, 95 % CI 0.25–0.79) and the French region (adjusted OR 0.57, 95 % CI 0.35–0.91). The same was true for colorectal cancer screening (German (adjusted OR 0.66, 95 % CI 0.52–0.84); French: OR 0.52, 95 % CI 0.33–0.83). No other factor was associated with BC screening and none of the tests of interaction comparing the two regions revealed statistically significant results.ConclusionThe effect of socio-demographic characteristics, lifestyle, health factors and screening behavior other than mammography on non-attendance to BC screening did not differ between the two regions with mainly opportunistic and organized screening, respectively, and did not explain the large differences in attendance between regions. Other potential explanations such as public promotion of attendance for BC screening, physicians’ recommendations regarding mammography participation or women’s beliefs should be further investigated.
Highlights
In Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered
Statistical analyses We evaluated potential differences of attendance to BC screening in the German-speaking region with mainly opportunistic screening and in the French-speaking region of Switzerland with population based programs depending on socio-demographics, lifestyle and healthrelated factors as well as non-attendance to screening other than mammography
Of the German-speaking women, higher percentages reached the recommendations for physical activity (76.2 vs. 60.3 %), paid attention to their diet (86.6 vs. 64.8 %), declared themselves to be in good health (81.1 vs. 71.4 %) and had a cervical cancer screening test (90.8 vs. 78.3 %) compared to French-speaking women
Summary
In Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. Organized breast cancer (BC) screening is a free service offered periodically to asymptomatic women aged e.g. 50–69 years depending on the recommendations of various countries. These screening programs are performed according to guidelines for quality assurance [1, 2]. The Federal Office of Social Insurance decided in 1999 to reimburse biennial mammography screening for women aged 50 years and above through the Swiss compulsory health insurance system, when performed within a qualityassured program [3]. When the 2012 Swiss Health Survey (SHS) was carried out, mainly opportunistic BC screening existed in the German-speaking part of Switzerland [4]
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