Strong association between cervical and breast cancer screening behaviour among Danish women; A register-based cohort study.

S H Larsen,L F Virgilsen,P Vedsted,B K Kristiansen,B Andersen

doi:10.1016/j.pmedr.2018.10.017

S H Larsen, L F Virgilsen + Show 3 more

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https://doi.org/10.1016/j.pmedr.2018.10.017

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Abstract

High coverage is essential for the effectiveness of national screening programmes. Identifying non-screeners across different screening programmes may help inform strategies to improve uptake. This study aims to analyse the association between previous cervical cancer screening (CCS) coverage and participation in breast cancer screening (BCS). This historical register-based cohort study included 91,787 Danish women aged 50–64 years who were invited to participate in the first organised round of BCS in the Central Denmark Region (CDR) in 2008–09. CCS coverage was defined as having a smear registered in the 5 1/2 years preceding the BCS, and BCS participants were divided into participants and non-participants and further categorised as active non-participants (ANP) if they cancelled and passive non-participants (PNP) if they abstained from the appointment. Of all 91,787 women included in the study, 62,391 (68%) were covered both by CCS and participated in BCS. Women not covered by CCS were more likely to be non-participants in BCS than women covered by CCS (PRRadjusted = 2.80, 95% CI: 2.68–2.93). Both PNP (PRRadjusted = 3.99, 95% CI: 3.80–4.19) and ANP (PRRadjusted = 2.50, 95% CI: 2.34–2.68) were more likely not to be covered by the CCS. In conclusion, non-coverage by CCS was strongly associated with nonparticipation in BCS. Specific groups of women only participated in one screening programme. To increase uptake, future interventions may specifically target these groups.

Highlights

Cancer is one of the most common causes of death in Western countries including Denmark (Naghavi et al, 2015) and represents a serious burden to society and challenge to the healthcare system
This study aims to analyse the association between previous cervical cancer screening (CCS) coverage and participation in breast cancer screening (BCS)
CCS coverage was defined as having a smear registered in the 5 1/2 years preceding the BCS, and BCS participants were divided into participants and non-participants and further categorised as active non-participants (ANP) if they cancelled and passive non-participants (PNP) if they abstained from the appointment

Summary

Introduction

Cancer is one of the most common causes of death in Western countries including Denmark (Naghavi et al, 2015) and represents a serious burden to society and challenge to the healthcare system. Many countries have introduced organised cancer screening programmes, e.g. cervical cancer screening (CCS) and breast cancer screening (BCS). Screening is associated with a reduced incidence and mortality of cervical cancer (CC) and in combination with improved treatment (Welch et al, 2016), screening has been shown to reduce mortality from breast cancer (BC) (Klint et al, 2010; Independent UK Panel on Breast Cancer Screening, 2012). In 2016, the participation rates were 64% for CCS and 82% for BCS in Denmark (Danish Quality Database for Cervical Cancer Screening, 2016; Danish Quality Database for Mammography Screening, 2016). Differences in participation in CCS and BCS may be due to age differences in the target groups, differences in the examination and sample collection, in invitations and in knowledge about the cancer types. Non-participation may be associated among others with linguistic or cultural barriers (Leinonen et al, 2017; Jensen et al, 2012; Harder et al, 2018), psychosocial barriers (Harder et al, 2018; Lagerlund et al, 2015), lack of resources (Leinonen et al, 2017; Jensen et al, 2012; Harder et al, 2018; Lagerlund et al, 2015) and fear of side effects (Glasgow et al, 2000)

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