Abstract

Background: In Flanders, breast cancer (BC) screening is performed in a population-based breast cancer screening program (BCSP), as well as in an opportunistic setting. Women with different socio-demographic characteristics are not equally covered by BC screening.Objective: To evaluate the role of socio-demographic characteristics on the lowest 10th and highest 90th quantile levels of BC screening coverage.Methods: The 2017 neighborhood-level coverage rates of 8,690 neighborhoods with women aged 50–69 and eligible for BCSP and opportunistic screening were linked to socio-demographic data. The association between socio-demographic characteristics and the coverage rates of BCSP and opportunistic screening was evaluated per quantile of coverage using multivariable quantile regression models, with specific attention to the lowest 10th and highest 90th quantiles.Results: The median coverage in the BCSP was 50%, 33.5% in the 10th quantile, and 64.5% in the 90th quantile. The median coverage of the opportunistic screening was 12, 4.2, and 24.8% in the 10th and 90th quantile, respectively. A lower coverage of BCSP was found in neighborhoods with more foreign residents and larger average household size, which were considered indicators for a lower socioeconomic status (SES). However, a higher average personal annual income, which was considered an indicator for a higher SES, was also found in neighborhoods with lower coverage of BCSP. For these neighborhoods, that have a relatively low and high SES, the negative association between the percentage of foreign residents, average household size, and average personal annual income and the coverage in the BCSP had the smallest regression coefficient and 95% confidence interval (CI) values were −0.75 (95% CI: −0.85, −0.65), −13.59 (95% CI: −15.81, −11.37), and −1.05 (95% CI: −1.18, −0.92), respectively, for the 10th quantile. The neighborhoods with higher coverage of opportunistic screening had a relatively higher average personal annual income, with the largest regression coefficient of 1.72 (95% CI: 1.59, 1.85) for the 90th quantile.Conclusions: Women from relatively low and high SES neighborhoods tend to participate less in the BCSP, whereas women with a relatively high SES tend to participate more in opportunistic screening. For women from low SES neighborhoods, tailored interventions are needed to improve the coverage of BCSP.

Highlights

  • Worldwide, breast cancer is the most common cause of cancer death in women [1]

  • 8,690 of the 9,490 neighborhoods in Flanders that provided the data of screening coverage rate in the breast cancer screening program (BCSP) and the opportunistic screening were included in this study

  • The median percentage of single-parents, the median percentage of foreign residents, and the median average personal annual income decreased with increasing quantiles of BCSP coverage: for Q10–Q90 of the BCSP coverage, the median per quantile decreased from 3.8 to 3.0%, 11.1 to 3.9%, and e21,100 to 19,500, respectively (Table 1)

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Summary

Introduction

Breast cancer is the most common cause of cancer death in women [1]. In 2018 the global age-standardized incidence and mortality rates of breast cancer were 54.4 and 11.6 per 100,000 women, respectively [1]. The European guideline for quality assurance in breast cancer screening and diagnosis suggests to strive for 70% screening coverage in order to have a significant effect on breast cancer burden in the population. This percentage is not obtained in many countries where a breast cancer screening program (BCSP) has been established. In Europe, the mean screening coverage is about 50% (range 28–92%), meaning that a large proportion of women who are eligible for screening are not covered by the population breast cancer screening programs. Women with different socio-demographic characteristics are not covered by BC screening

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