Mammography Attendance Research Articles

Effect of screening mammography on the risk of breast cancer deaths and of all-cause deaths: a systematic review with meta-analysis of cohort studies

ObjectivesObservational cohort studies are used to evaluate the effectiveness of screening mammography in women offered screening. Because screening mammography has no effect on causes of death other than breast cancer (BC), cohort studies should show reductions in the risk of BC death substantially greater than possible reductions in the risk of all-cause death. We assessed the risk of BC deaths and of all-cause (or of nonBC) deaths associated with screening mammography attendance reported in cohort studies. Study Design and SettingCohort studies published from 2002 to 2022 on women invited to screening mammography were searched in PubMed, Web of Sciences, Scopus, and in review articles. Random effect meta-analyses were performed using relative risks (RRs) of death between women who attended screening compared to women who did not attend screening. ResultsEighteen cohort studies were identified, nine that reported RRs of BC deaths only, five that reported RRs of all-cause deaths only, and four that reported RRs for both BC deaths and all-cause deaths. The latter four cohort studies reported 12–76 times more all-cause deaths than BC deaths. The random-effect summary of RR for BC mortality in screening attendees vs nonattendees was 0.55 (95% CI: 0.50–0.60) in 13 cohort studies. The summary of RR for all-cause mortality was 0.54 (0.50–0.58) in 10 cohort studies. In the four cohort studies that evaluated both outcomes, the summary of RRs were 0.63 (0.43–0.83) for BC mortality and of 0.54 (0.44–0.64) for all-cause mortality. ConclusionThe similar relative reductions in breast- and all-cause (or nonBC) mortality indicates that screening mammography attendance is an indicator of characteristics associated with a lower risk of dying from any cause, including from BC, which observational studies have falsely interpreted as a screening effect.

The use of text messages as an alternative invitation method for breast cancer screening: A randomized controlled trial (M-TICS study).

This study aimed to determine whether a text message is as good as a postal letter as an invitation method for previous screenees in a breast cancer screening program, considering a non-inferiority margin of -2 percent points on participation rate. A non-inferiority randomized control trial was conducted. Women in the intervention group (n = 5,362) were invited by text message, and women in the control group (n = 5,482) were invited by letter, which is the standard invitation procedure of the program. In both groups, the invitation included a fixed appointment for mammography and a text message reminder 96 hours before the appointment. The primary outcome was screening participation rate (completing mammography within 12 weeks of invitation). Secondary outcomes included mammography attendance to initial or rescheduled appointments and cancellation rate. The intention-to-treat analysis showed a participation rate of 87.3% and 86.6% in the control and intervention groups, respectively. The difference in participation rate was -0.7 percentage points (95% confidence interval [CI], -1.8 to ∞), indicating non-inferiority of text messages compared to letter invitations. The per-protocol analysis showed similar results. Attendance at the initial appointment was higher in women who received the text message invitation compared to those in the control group (P<0.002). Women who received the invitation by letter canceled more the initial appointment scheduled compared to the text message group (21.1% and 15.1%, P<0.007). In conclusion, we found that a text message invitation for women who had previously participated in breast cancer screening was not inferior to the standard letter. This randomized controlled trial provides valuable insights into the use of alternative invitation methods for population-based cancer screening programs. However, further research is needed to determine the best timing and frequency of text messages for better outcomes and identify strategies for facilitating rescheduling or cancellation. Trial Registration: Clinicaltrials.gov NCT04343950, (04/09/2020).

Assessing the impact of binaural and non-binaural auditory beat intervention to pain and compression in mammography

IntroductionPain and discomfort has a negative impact on a patient's overall experience and may impact on subsequent re-attendance to mammography. Pain during mammography remains a significant issue. Assessment of interventions to reduce levels of pain associated with mammography are essential to increase attendance to breast services and improve user experience. MethodsParticipants (n = 60) were invited to take part in the study at one hospital Trust within the UK. Postal invitations were sent 2 weeks prior to appointment to patients older than 40 years with previous mammography attendance at the same Trust to allow for comparison of previous and current pain scores/compression values. Patients were randomised into 3 groups: Binaural music (BM), non-binaural music (NBM) and standard care (C). A numerical rating scale (NRS) was used to rate pain. ResultsPatient tolerance is increased by the application of both the non-binaural and binaural music. Binaural music was most effective in improving patient tolerance (p = 0.02). When applied compression increased some patients recorded less pain, which may have implications to image quality and radiation dose for patients. Binaural music reduces the perception of mammographic pain within this data set. Conclusion5 min exposure to binaural music improves patient experience and tolerance for mammography which could be utilised to improve attendance rates in screening and symptomatic services. Implications for practiceThere is an indication for further research looking at application prior and during interventional biopsies. Music intervention can be offered to patients in the severe pain category who refuse mammography. It is acknowledged from these findings that the introduction of BM and NBM prior to mammography would be a low risk, cost effective intervention within the hospital setting.

An update on the status of breast cancer screening in Brazil after the covid-19 pandemic.

ABSTRACTWe have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50–69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years.

Mammography screening is associated with more favorable breast cancer tumor characteristics and better overall survival: Case-only analysis of 3,739 Asian breast cancer patients.

e22500 Background: Early detection of breast cancer (BC) through mammography screening (MAM) is known to reduce mortality. We examined the differential effect that mammography has on BC characteristics and overall survival and the sociodemographic determinants of MAM utilisation in a multi-ethnic Asian population. Methods: This study included 3,739 BC patients from the Singapore Breast Cancer Cohort (2010–2018). Self-reported socio-demographic characteristics were collected using a structured questionnaire. Clinical data were obtained through medical records. Patients were classified as screeners (last screening mammogram ≤two years before diagnosis), non-screeners (aware but did not attend or last screen &gt; 2years) and those unaware of MAM. Associations between MAM behaviour (MB) and sociodemographic factors and MB and tumour characteristics were examined using multinomial regression. Ten-year overall survival was modelled using Cox regression. Results: Patients unaware of screening were more likely diagnosed with late stage (ORstage III vs stage I(Ref) [95%CI]:4.94[3.45-7.07], p &lt; 0.001), high grade (ORpoorly- vs well-differentiated(reference): 1.53 [1.06-2.20], p = 0.022), nodal-positive, large size (OR&gt; 5cm vs ≤2cm(reference): 5.06 [3.10-8.25], p &lt; 0.001), and HER2-positive tumors (ORHER2-negative VS -positive(reference): 0.72[0.53-0.97], p = 0.028). Similar trends were observed between screeners and non-screeners with smaller effect sizes. Overall survival was significantly shorter than screeners in the both groups(non-screeners HR: 1.89 [1.22-2.94], p = 0.005; unaware HR: 2.90[1.69-4.98], p &lt; 0.001). Non-screeners and those unaware were less health-conscious, older, of Malay ethnicity, less highly educated, of lower socioeconomic status, more frequently ever smokers and less physically active. Among screeners, there were more reported personal histories of benign breast surgeries or gynaecological conditions and positive family history of breast cancer. Conclusions: Mammography attendance is associated with more favourable BC characteristics and overall survival. Disparities in the utility of MAM services suggest that different strategies may be needed to improve MAM uptake.

Non-attendance to Mammography Screening: A Qualitative Study among Nonattendees in Malta

Background: There is limited qualitative research exploring reasons for underutilisation of breast screening and the broader contexts that affect health-seeking behaviour among women who do not respond to breast screening invitations. This study aims to advance understanding of factors that influence breast screening non-attendance among lifetime nonattendees in Malta. Methods: Twenty face-to-face qualitative interviews were conducted with women in Malta. These explored women’s illness perceptions regarding breast cancer, knowledge on screening, mammography beliefs, past health-related experiences, medical help seeking behaviour, health and social interactions, and effective interventions that would facilitate mammography attendance. Data were analysed using thematic analysis. Results: Four themes emerged: 1) attitudes, feelings, beliefs and perceptions; 2) knowledge; 3) social network experiences and 4) perceived effective interventions. Fear of breast cancer and screening emerged as barriers to mammography. The majority of participants had not received physician advice. Previous familial cancer diagnosis prompted lifestyle changes in women, but it was not the primary motivator to attendance. Participants talked about fear of death and traumatic histories from experiences of relatives with cancer or personal traumas. Practical and emotional support are important to non-attendees. Conclusions: The impact of physical and psychosocial variables on personal resilience and self-confidence should inform the planning of screening interventions. Professionals must refer to patients’ wider support networks and make the necessary referrals, while policy makers should ensure services providing psychological, social and emotional support are accessible.

The Impact of Morbidity and Disability on Attendance at Organized Breast Cancer-Screening Programs: A Systematic Review and Meta-Analysis.

Individuals with morbidity experience worse breast cancer outcomes compared with those without. This meta-analysis assessed the impact of morbidity on breast cancer-screening attendance and subsequent early detection (PROSPERO pre-registration CRD42020204918). MEDLINE, PsychInfo, and CINAHL were searched. Included articles published from 1988 measured organized breast-screening mammography attendance using medical records by women with morbidity compared with those without. Morbidities were assigned to nine diagnostic clusters. Data were pooled using random-effects inverse meta-analyses to produce odds ratios (OR) for attendance. 25 study samples (28 articles) were included. Data were available from 17,755,075 individuals, including at least 1,408,246 participants with one or more conditions;16,250,556 had none. Individuals with any morbidity had lower odds of attending breast screening compared with controls [k = 25; OR, 0.76; 95% confidence interval (CI), 0.70-0.81; P = <0.001; I2 = 99%]. Six morbidity clusters had lower odds of attendance. The lowest were for neurological, psychiatric, and disability conditions; ORs ranged from 0.45 to 0.59 compared with those without. Morbidity presents a clear barrier for breast-screening attendance, exacerbating health inequalities and, includes a larger number of conditions than previously identified. Consensus is required to determine a standardized approach on how best to identify those with morbidity and determine solutions for overcoming barriers to screening participation based on specific morbidity profiles.

Does Women's Screening History Have Any Impact on Mammography Screening Attendance After Tailored Education?: A Systematic Review and Meta-analysis.

Many ethnic minority women have low attendance at breast cancer screening. This brief report explores whether women's screening histories impact mammography screening attendance after tailored education. Systematic searches were conducted in 5 databases. Randomized controlled trials of educational interventions tailored to ethnic minority women that measured attendance at mammography screening were eligible for inclusion. Data extraction and risk of bias assessment were performed independently. Data were combined in a meta-analysis by using random effects models. Heterogeneity was estimated by using I2 statistics. Six studies with 3521 women were eligible for inclusion. The D+L pooled risk ratio (RR) for mammography attendance for never screened participants was 1.54 (95% confidence interval, 1.24-1.91; P<0.001), with low heterogeneity (I2=27.1%, P=0.231). The D+L pooled risk ratio for attendance for ever screened participants was 1.26 (95% confidence interval, 1.11-1.43; P<0.001), with low heterogeneity (I2=35.5%, P=0.213). Tailored education increased attendance at mammography by 54% among never screened women and 26% among ever screened women. Although these findings must be interpreted with caution, the findings suggest that women's screening history is an important and ignored variable that affects how effective tailored education is on mammography screening attendance.

Racial differences in no‐show rates for screening mammography

Differences in utilization of screening mammography partly explain the increased breast cancer mortality observed in African American (AA) women compared with non-Hispanic White women. However, the contribution of noncompliance from women who do not come for their scheduled screening mammography appointment (ie, no-shows) is unknown. The purpose of this study was to investigate racial differences in no-show rates for screening mammography. Women scheduled for routine screening mammograms between January 2018 and March 2018 were identified from the Joanne Knight Breast Health Center at Siteman Cancer Center in St. Louis, Missouri. Using a case-control design, this study retrospectively identified patients who no-showed for their mammograms (cases) and randomly sampled an equal number of patients who completed their mammograms (controls). These participants were compared by race. The main outcome measure was whether AA race was associated with no-shows for screening mammography. During the study period, 5060 women were scheduled for screening mammography, and 316 (6.2%) did not keep their appointment (ie, they no-showed). Women who no-showed were more likely to be AA than women who kept their appointment (odds ratio, 2.64; 95% confidence interval, 1.90-3.67). Even after adjustments for marital status, insurance type, and place of residence, AA race was still significantly associated with no-shows for screening mammography. This study identified a no-show rate of 6.2% for screening mammography at the authors' institution. Women who no-showed were more likely to be AA than women who completed their mammogram even after adjustments for multiple factors. These data can be leveraged for future studies aimed at improving mammography attendance rates among AA women.

Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model

BackgroundMammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography.MethodsCross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05.ResultsMultivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β = − 0.22, p = 0.001), lower response efficacy of mammography screening (β = − 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β = − 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β = − 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001).ConclusionsThe study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women’s decision to attend the screening, but also to counter factors that contribute to women’s decision to avoid it.

Effect of culturally tailored education on attendance at mammography and the Papanicolaou test.

ObjectivesTo determine the effectiveness of culturally tailored education on attendance at breast and cervical cancer screening among ethnic minority women.Data SourcesSystematic database searches in Ovid MEDLINE, ProQuest, PubMed, PsycINFO, and Cochrane CENTRAL.Study DesignRandomized controlled trials (RCTs) of culturally tailored educational interventions to ethnic minority women in Western countries were investigated for a meta‐analysis. RCTs that assessed attendance at mammography or the Papanicolaou test (Pap test) were eligible for inclusion.Data Collection MethodsStudy characteristics and results were extracted separately. Independent raters assessed risk of bias by using Cochrane Collaboration's tool.Principal FindingsSeven RCTs (n = 4246) were included in the meta‐analysis of mammography attendance, and four RCTs (n = 1750) were included in the meta‐analysis of Pap test attendance. The effect of culturally tailored educational interventions on attendance at mammography was an increase of 18 percent (RR = 1.18, 95% CI, 1.09‐1.28, P < .001), with low heterogeneity (I 2 = 30.0, P = .237), and a 54 percent increase at the Pap test (RR = 1.54, 95% CI, 1.14‐2.09, P = .005), with substantial heterogeneity (I 2 = 75.9%, P = .001).ConclusionsInterpreted within the limitations set by the low number of studies and substantial heterogeneity for the Pap test, findings from the current meta‐analyses indicate that culturally tailored educational interventions may increase attendance of ethnic minority women at breast and cervical cancer screenings. There is a need for more studies, in particular RCTs conducted outside the United States, to determine if such findings are similar in other countries.

Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence.

The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. Sixty-five studies were included. Never having had cervical screening (d=-.72, p<.001) and higher perceived barriers to mammography (d=-.40, p<.001) were associated with lower levels of screening attendance. Possessing health insurance (d=.49, p<.001), greater perceived benefits (d=.31, p<.001) and motivation (d=.36, p=.003) towards screening, and higher perceived seriousness (d=.24, p=.019) and susceptibility (d=.20, p=.024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d=.32, p<.001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.

Women’s Knowledge of Health Promotion in the Prevention of Breast and Cervical Cancer in Oshakati Health District, Namibia

PURPOSE: The study aimed to explore and describe the knowledge of women regarding health promotion in the prevention of breast and cervical cancer. This study was carried out in the Oshakati district at the Intermediate Hospital Oshakati.&#x0D; &#x0D; METHODOLOGY: A quantitative approach was used for this study. This approach was chosen in order to provide a comprehensive picture and understanding of the women&amp;rsquo;s knowledge or awareness of health promotion in the prevention of breast and cervical cancer. The study population consisted of all women of child-bearing age, aged 15 to 49, in the Oshakati health district, that is, 41,985. The research sample was identified as 10% of the study population, thus numbering 419 respondents. The researcher personally distributed 419 questionnaires to every second woman of child-bearing age admitted to the Intermediate Hospital Oshakati.&#x0D; &#x0D; RESULTS: The findings indicate that awareness of information relating to breast and cervical cancer exists in Oshakati Health District. However, overall knowledge on the causes of breast and cervical cancer, risk factors for breast cancer and warning signs of cervical cancer was very poor. The findings also revealed that while many respondents were informed about breast self-examination (BSE) and had practised it, very few respondents acknowledged clinical breast examination (CBE) attendance once a year, or the use of mammography and sonar attendance as additional screening methods.&#x0D; &#x0D; RECOMMENDATIONS &amp;amp; CONCLUSION: Based on the findings the study recommends that women should share information with their peers; in addition, radio should be used to disseminate such information as it is the most reliable source of information in the rural areas. Information, education and communication materials on the prevention of breast and cervical cancer should be developed and disseminated to the public. Women should be encouraged to develop a reading culture in order to increase their knowledge.

A national cross-sectional study of adherence to timely mammography use in Malta

BackgroundRoutine mammography improves survival. To achieve health benefits, women must attend breast screening regularly at recommended time intervals. Maltese women are routinely invited to undergo mammography at three-year intervals at an organized breast screening programme (MBSP) or can opt to attend a private clinic. Previous research shows that health beliefs, particularly perceived barriers, were the most significant predictors of uptake to the first MBSP invitation. Whether these beliefs and other factors are predictive of adherence with recommended time intervals for mammography at organized or private screening in Malta is unknown. For the first time, this paper explores the predictors for Maltese women screened within or exceeding the recommended three-year frequency in organized or private screening in Malta.MethodsInformation was obtained from a cross-sectional survey of 404 women, aged 50 to 60 years at the time of their first MBSP invitation, where women’s characteristics, knowledge, health beliefs and illness perceptions were compared. The main variable of interest was women’s mammography attendance within a three-year interval (ADHERENT) or exceeding three years (NON-ADHERENT). Data were analysed using descriptive statistics, chi-square test, Mann Whitney test, Independent Samples t-test and Shapiro Wilk test.ResultsAt the time of the survey, 80.2% (n = 324) had been screened within three years (ADHERENT), 5.9% (n = 24) had exceeded the three-year frequency (NON-ADHERENT) while 13.9% (n = 56) never had a mammogram. No significant associations were found between ADHERENT or NON-ADHERENT women in relation to sociodemographic or health status variables (p > 0.05). Knowledge of screening frequency was significantly associated with women’s mammography adherence (χ2 = 5.5, p = 0.020). Health beliefs were the strongest significant predictors to describe the variance between ADHERENT and NON-ADHERENT screeners. When Mann Whitney test and Independent Samples t-test were applied on mammography adherence, perceived barriers and cues to action were found to be the most important predictors (p = 0.000, p = 0.039 respectively).ConclusionsTo increase routine and timely mammography practices, women who are non-adherent to recommended time frequency guidelines should be targeted, together with their health beliefs, predominantly perceived barriers and cues to action.

Signed family physician reminder letters to women overdue for screening mammography: A randomized clinical trial.

To determine whether signed family physician reminder letters to women overdue for screening mammography prompts rescreening. A randomized double-blind trial conducted in 2013 among women aged 51-73 and overdue for screening by 6-24 months. The study was carried out by the publicly funded British Columbia Cancer Agency Screening Mammography Program, which routinely sends standard reminder postcards to women who are due for mammography. Participating family physicians signed letters for the overdue women in their practices. The overdue women were mailed either the signed reminder letter and the standard reminder postcard, or the standard reminder postcard alone. The primary endpoint was the proportion of overdue women that attended a screening mammogram appointment within six months of mailing the study letters. The analysis was by intention to treat. In total, 822 family physicians participated and 5638 women were randomized. Mammography attendance by six months after mailing the reminders was 34.4% (947/2749) for women in the signed family physician letter arm, compared with 24.0% (660/2749) for women in the control arm (p < 0.0001). Adjusting for age, number of previous screening mammograms, and months overdue, women in the signed letter arm were significantly more likely to return for screening than women in the control arm (RR 1.41; 95% confidence interval: 1.30-1.54). A signed family physician reminder letter improved mammography attendance for women who were overdue for screening mammography.

Impact of selected environmental factors on attendance in the Breast and Cervical Cancer Early Detection Programme in the Wielkopolska Province of Poland during 2007-2012.

Breast and cervical cancer represent a significant health and economic issue for Polish society, although if detected early, both can be cured successfully. For this reason, since 2006, according to the National Cancer Combat Programme, population-based screening programmes have been implemented, aimed at reducing the mortality and morbidity for breast and cervical cancer. The aim of this study is to determine which of the selected four environmental factors affect attendance for screening mammography and cytology. Analysis included data from questionnaires filled in during mammography by 582,959 women aged 50-69 years, and 288,142 women during cytology, aged 25-59 years, in 2007-2012 in the Wielkopolska Province of Poland. It was found that the impact of medical staff on the attendance for cytological screening was the strongest statistically significant factor (p = 0,0001). Invitation by name (p=0,001) and other factors (p= 0,0001) also affected the attendance. In the cytological screening, medical staff was the factor that had the greatest impact on attendance. Other factors, such as self-reporting, increased participation in the next screening rounds, although the factors that affect attendance changed over time. Their constant analysis is essential for the efficient and effective evaluation of screening programsme.

The impact of breast cancer awareness interventions on breast screening uptake among women in the United Kingdom: A systematic review.

The impact of breast screening awareness campaigns on mammography attendance among British women was explored. British Nursing Index, Medline, PsycINFO, Embase and Cumulative Index to Nursing and Allied Health were searched between October 2012 and February 2013. Searches identified research on breast cancer awareness interventions and breast self-examination. In total, 867 articles were identified and 14 met criteria for review. Breast cancer awareness interventions were found to increase the uptake of breast self-examination behaviours and increase the likelihood of breast cancer screening attendance. Predicting the impact of these interventions on survivability and general morbidity/mortality outcomes remains a challenge due to a shortage of suitably evaluated campaigns.

Breast cancer screening attendance in two Swiss regions dominated by opportunistic or organized screening.

BackgroundIn Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. We evaluated factors associated with attendance to breast cancer screening in these two regions.MethodsWe analyzed the data of 50–69 year-old women (n = 2769) from the Swiss Health Survey 2012. Factors of interest included education level, place of residence, nationality, marital status, smoking history, alcohol consumption, physical activity, diet, self-perceived health, history of chronic diseases and mental distress, visits to medical doctors and cervical and colorectal cancer screening. Outcome measures were dichotomized into ≤2 years since most recent mammography versus >2 years or never.ResultsIn the German- and French-speaking regions, mammography attendance within the last two years was 34.9 % and 77.8 %, respectively. In the French region, moderate alcohol consumption (adjusted OR 2.01, 95 % CI 1.28–3.15) increased screening attendance. Compared to those with no visit to a physician during the recent year, women in both regions with such visits attended statistically significantly more often BC screening (1–5 times vs. no visit: German (adjusted OR 3.96, 95 % CI 2.58–6.09); French: OR 7.25, 95 % CI 4.04–13.01). Non-attendance to cervical screening had a negative effect in both the German (adjusted OR 0.44, 95 % CI 0.25–0.79) and the French region (adjusted OR 0.57, 95 % CI 0.35–0.91). The same was true for colorectal cancer screening (German (adjusted OR 0.66, 95 % CI 0.52–0.84); French: OR 0.52, 95 % CI 0.33–0.83). No other factor was associated with BC screening and none of the tests of interaction comparing the two regions revealed statistically significant results.ConclusionThe effect of socio-demographic characteristics, lifestyle, health factors and screening behavior other than mammography on non-attendance to BC screening did not differ between the two regions with mainly opportunistic and organized screening, respectively, and did not explain the large differences in attendance between regions. Other potential explanations such as public promotion of attendance for BC screening, physicians’ recommendations regarding mammography participation or women’s beliefs should be further investigated.

Overweight, obesity, and breast cancer screening: results from the 2012 Swiss Health Survey.

Obesity is associated with poor breast cancer (BC) prognosis. Larger tumor size and more advanced disease stage at diagnosis could partly explain this outcome and nonadherence of obese women to BC screening may play a role. We examined the relationship between BMI (kg/m) and the use of mammography in Switzerland as well as separately in the German-speaking part with mainly opportunistic screening and in the French-speaking part with organized programs. We analyzed the data of 50-69-year-old women (n=3121) of the Swiss Health Survey 2012. Study participants were classified as underweight (BMI<18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29), or obese (BMI≥30). Outcome measures were dichotomized into 2 years or less since most recent mammography versus more than 2 years or never. We carried out multivariable logistic regression analyses, adjusting for sociodemographics, lifestyle, and self-perceived health. In Switzerland, 47% of women aged 50-69 years had had BC screening within the last 2 years, 35% of women in the German-speaking and 78% of women in the French-speaking part. In the total group, mammography use was higher in overweight than in normal-weight women (adjusted odds ratio 1.21, 95% confidence interval 0.98-1.49). Stratified by region, this effect was only maintained in women of the German-speaking part (adjusted odds ratio 1.41, 95% confidence interval 1.08-1.85; P-interaction<0.001). There were no differences in mammography attendance between normal-weight and obese and underweight women. In the 2012 Swiss Health Survey, overweight, obesity, and underweight were no barriers to mammography. In the German-speaking part, overweight women even attended mammography screening more often than normal-weight women.

Health-related lifestyle factors and mammography screening attendance in a Swedish cohort study.

To determine whether health-related lifestyle factors are associated with attendance at a population-based invitational mammography screening program in southern Sweden, data on health-related lifestyle factors (smoking, alcohol use, physical activity, BMI, diet, self-rated health, and stress) were obtained from the Malmö Diet and Cancer Study and linked to the Malmö mammography register (Sweden, 1992-2009). Women (n=11 409) who were free from breast cancer at study entry were included in the cohort, and mammography attendance was followed from cohort entry to 31 December 2009. Generalized estimating equations were used to account for repeated measures within patients. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported. Nonattendance occurred in 8% of the 69 746 screening opportunities that were observed. Nonattendance was more common among women who were current or former smokers [OR=1.60 (1.45-1.76) and OR=1.15 (1.05-1.28)], had not used alcohol in the past year [OR=1.55 (1.32-1.83)], were less physically active outside of work [OR=1.10 (1.00-1.20)], had high physical activity at work (OR=1.13, 95% CI: 1.00-1.28), were vegetarians or vegans [OR=1.49 (1.11-1.99)], had not used dietary supplements [OR=1.11 (1.01-1.21)], had poor self-rated health [OR=1.24 (1.14-1.36)], and were experiencing greater stress [OR=1.25 (1.14-1.36)]. In this cohort, nonattendance was associated with smoking, alcohol abstinence, physical activity, poor self-rated health, stress, and following a vegetarian/vegan diet. These findings generally support the notion that women with less healthy lifestyles are less likely to engage in mammography screening.