Abstract
Small geographic areas with lower mammography screening participation rates may reflect gaps in screening efforts. Our objective was to use spatial analyses to understand disparities in mammography screening use and to identify factors to increase its uptake in areas that need it in Lyon metropolitan area, France. Data for screened women between the ages of 50 and 74 were analyzed. Census blocks of screened and non screened women were extracted from the mammography screening programme 2015–2016 dataset. We used spatial regression models, within a generalized additive framework to determine clusters of census blocks with significantly higher prevalence of non-participation of mammography screening. Smoothed risk maps were crude and adjusted on the following covariates: deprivation index and opportunistic screening. Among 178,002 women aged 50 to 74, 49.9% received mammography screening. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived blocks, 45.2% vs. 51.4% p < 0.001. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas. Moreover, depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors seems to be important for implementing an appropriate prevention intervention.
Highlights
With 58,968 new cases in 2017, breast cancer is the most common cancer observed in women in France, as well as the European Union [1]
Non-participation in the National Mammography Screening Programme (NMSP) remained high in the city center of Lyon (Cluster 4), as, after adjusting for deprivation, we found similar maps, suggesting that the level of deprivation in the city of Lyon does not explain the spatial variation found for the participation of opportunistic screening
We demonstrated that except for the city center of Lyon, the socioeconomic deprivation explained a large portion of variation in the low participation of mammography screening, confirming previous research that reported a lower participation rate in the highly deprived area [18]
Summary
With 58,968 new cases in 2017, breast cancer is the most common cancer observed in women in France, as well as the European Union [1]. In 2017, breast cancer ranked first in mortality, with more than 12,000 deaths, it was closely followed by lung and colorectal cancer [1]. Mammography screening tests are important tools in combating cancer-related morbidity and mortality. Despite organized efforts to promote breast cancer screening, large disparities in rates of mammography persist in a Canadian [3,4,5], American [6,7,8,9,10,11] and European setting [12]. In France, the National Mammography Screening Programme (NMSP) has been generalized to the whole country since 2004, after pilot experiences. After 6 months, a reminder is sent to those who failed to attend
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