Abstract
BackgroundBreast cancer stands as the leading cause of cancer related mortality in women worldwide. Mammography screening has the potential to improve prognosis by reducing stage at diagnosis. Socioeconomic inequalities in mammography cancer screening have been widely reported. The influence of organised programs on socioeconomic disparities regarding mammography screening is to date unclear. We aimed to investigate the impact of an organised regional screening program on socioeconomic inequalities in terms of the uptake, knowledge and attitudes towards mammography screening.MethodsData were obtained from two cross-sectional surveys of women 50 to 69 years old conducted in 1998 and 2012, before and after the implementation of an organised breast cancer screening program in Geneva, Switzerland. Socioeconomic status was measured by monthly household income and education level. Logistic and linear regression multivariable models were used to investigate the evolution of socioeconomic gradients between 1998 and 2012 in terms of uptake, knowledge and attitudes towards mammography screening.ResultsIn 1998, before the implementation of an organised screening program, 44% of women from the lowest education category reported mammography practice conforming to recommendations versus 63% of the more educated participants. This socioeconomic gradient was no longer present in 2012 where reported mammography practice at guideline-recommended frequency were 83 and 82% in the lowest and highest education level categories respectively (change in education gradient over time, p = 0.018). The difference in mammography practice in agreement with recommendations between the lowest and the highest income category went from 27 percentage points in 1998 to 14 percentage points in 2012 (change in income gradient over time, p = 0.10). The socioeconomic gradient in negative attitudes towards mammography screening persisted in 2012 but was reduced compared to 1998. We did not observe a reduction in the socioeconomic disparities in knowledge regarding mammography screening over this period.ConclusionsThis study suggests that mammography screening programs may lessen socioeconomic inequities in mammography practice. Such programs should feature adapted communication tools to reach women of lower socioeconomic status to attempt to further reduce socioeconomic gradients in mammography screening.
Highlights
Breast cancer stands as the leading cause of cancer related mortality in women worldwide
Our aim was to investigate whether the running of an organised screening program limiting ‘out of pocket’ payments and featuring breast cancer awareness campaigns was accompanied by a change in socioeconomic gradients in terms of uptake, knowledge of and negative attitudes towards mammography screening
This is an exhaustive list of legal residents of the canton from which all women in the age group targeted by the screening program can be identified
Summary
Breast cancer stands as the leading cause of cancer related mortality in women worldwide. Mammography screening may be available as part of an organized program which invites the defined target group to undertake the screening test at regular intervals. Such programs should operate with standardized equipment and procedures, allowing for quality control. WHO recommends organized population-based mammography screening programs for women of age 50 to 69 [5] The benefit of such programs remains debated by some, mainly due to concerns of overdiagnosis and potential harm caused by false positive tests [6]
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