Does a national screening programme reduce socioeconomic inequalities in mammography use?

Abstract

To investigate possible changes in socioeconomic inequalities in mammography use among women aged 50-69 years between the start of the Belgian national screening programme in 2001 and three years later (2004), and to assess if the implementation of an organised screening programme has been successful in reducing socioeconomic inequalities in the uptake of mammography. Data was obtained from the 2001 and 2004 Health Interview Survey. Data were analysed by logistic regression with educational level as proxy for the socioeconomic status. The gradient of socioeconomic inequalities was estimated with the relative index of inequality. Despite a substantial increase in the use of mammography from 59% in 2001 to 71% in 2004, a variation in the coverage according to educational level was detected: women with lower education were less likely to undergo mammography than those with higher education [(OR 1.93 (95% CI 1.21-3.09 in 2001 and 2.21 (95% CI 1.37-3.56) in 2004]. Socioeconomic inequalities in breast screening uptake seem to persist 3 years after the implementation of the national screening programme. Although the national programme improved the coverage, it could not counteract the socioeconomic gradients in the use of mammography. Additional work is needed to identify effective methods of decreasing socioeconomic inequalities in mammography use.