Organized Screening Research Articles

Development of breast cancer mortality considering the implementation of mammography screening programs \u2013 a comparison of western European countries

BackgroundTriggered by the successive implementation of organized mammography screening programs (MSPs) throughout western European countries over the last decades, there is an ongoing debate questioning their effectiveness. Since it is difficult to assess the effect of MSPs on a population level, we rather aim to assess the impact of the implementation itself on breast cancer mortality rates utilizing an ecological study design.MethodsWe analyzed age group-specific (50–59, 60–69 and 70–79 years) female breast cancer mortality rates in 14 western European countries between 1980 and 2017 using Joinpoint regression, interrupted time series (ITS) regression and multivariable Poisson regression.ResultsThe Joinpoint analysis demonstrated decreasing trends resulting in annual percentage changes ranging from − 1.5% to − 5.4% (50–59), − 0.2% to − 8.1% (60–69) and 0% to − 7.1% (70–79) depending on the country within 3 years after MSP implementation. The ITS analysis results in highly significant interaction terms (calendar year * binary MSP indicator) for all age groups. The multivariable regression using “calendar year”, “year of MSP implementation” and “years with MSP” as independent variables yielded a significant yearly decrease for “years with MSP” ranging from 0.9 to 1.2%.ConclusionsThe results of this study suggest a positive association between the implementation of MSPs and the (accelerated) reduction of breast cancer mortality rates. Measuring and quantifying the isolated effect of MSPs on a population level will require additional studies using individual data.

Risk of breast cancer by prior screening results among women participating in BreastScreen Norway.

A premalignant lesion in the breast is associated with an increased risk of breast cancer. The aim of this article was to identify women with an increased risk of breast cancer based on prior screening results (PSRs). This registry-based cohort study followed women who participated in the organized breast cancer screening program in Norway, BreastScreen Norway, in 1995-2016. Incidence rates and incidence rate ratios were used to estimate absolute and relative risks of breast cancer associated with PSRs. Histopathological characteristics of subsequent breast cancers were presented by PSRs. This study included 762,643 women with up to 21years of follow-up. In comparison with negatively screened women, increased incidence rate ratios of 1.8, 2.0, 2.9, and 3.8 were observed after negative additional imaging, for benign biopsy, for hyperplasia with atypia, and for carcinoma in situ, respectively. Subsequent breast cancers did not differ in tumor diameter or histological grade, whereas the proportion of lymph node-positive breast cancers decreased as the presumed malignancy potential of PSRs increased. The risk of subsequent breast cancer increased with the presumed malignancy potential of PSRs, whereas the tumor characteristics of subsequent cancers did not differ except for the lymph node status. Women with screen-detected benign lesions or hyperplasia with atypia might benefit from more frequent screening.

Assessing the impact of mailing self-sampling kits for human papillomavirus testing to unscreened non-responder women in Manitoba.

CervixCheck, Manitoba's cervical cancer screening program, conducted a pilot study to assess whether screening participation could be improved in unscreened women by offering a mailed self-sampling kit for human papillomavirus (hpv) testing instead of a Pap test. In a prospective cohort study design, a sample of unscreened women (n = 1052) who had been sent an invitation letter from CervixCheck in the past but who did not respond were randomized to either an intervention group or a control group. The intervention group received a mailed hpv self-sampling kit; the control group received no additional communication. Returned hpv self-sampling swabs were analyzed by a provincial laboratory. After 6 months, screening participation in the two study groups was compared using a logistic regression model adjusted for age and area of residence (urban or rural). Secondary outcomes included hpv positivity, specimen inadequacy, compliance with follow-up, and time to colposcopy. Screening participation was significantly higher in the intervention group than in the control group (n = 51, 9.6%, vs. n = 13, 2.5%; odds ratio: 4.7; 95% confidence interval: 2.56 to 8.77). Geographic area of residence (urban or rural) and age were not statistically significant. The study demonstrated that hpv self-sampling kits can enhance screening participation in unscreened non-responder women in the setting of an organized screening program. Next steps should include additional research to determine the best implementation strategy for hpv self-sampling in Manitoba.

Interobserver variability and accuracy of p16/Ki-67 dual immunocytochemical staining on conventional cervical smears

Backgroundp16/Ki-67 dual immunocytochemical staining (DS) has been proven as a sensitive and specific test for triage of HPV positive women with good reproducibility and accuracy. However, implementation of the test into an organized screening program (OSP) is not easy. The aims of this study were to compare the performance and agreement of DS results among three Slovenian cytopathological laboratories involved in the national OSP, and to define cases where staining results can be difficult to interpret.MethodsCervical smears were obtained for DS from 129 women referred to colposcopy. Smears were evaluated blindly in three laboratories by a cytotechnologist and a cytopathologist after initial training. Results were positive, suspicious, negative or inadequate. Five characteristics of DS staining were recorded. After primary evaluation, an extensive expert-led additional training was undertaken, including a discussion of difficult cases and a practical exam. Smears were re-evaluated and results compared to primary evaluation.ResultsAfter the additional training, the overall percentage of agreement among the three laboratories increased from 77.5 to 89.9% and kappa increased from 0.70 to 0.86. Sensitivity for CIN2+ increased in two laboratories, to 90.5 and 85.7%, without the loss of specificity (75.8%). In one laboratory, the sensitivity slightly decreased from 90.5 to 88.9%, but the specificity increased from 63.6 to 68.2%. Difficult cases had significantly less DS cells, weak intensity of p16 staining, suboptimal cell morphology and background staining compared to positive cases.ConclusionAdditional expert-led training and discussion of difficult cases are necessary for accurate interpretation of DS in laboratories involved in OSP. The most difficult cases were those with single stained cells and weak p16 staining. Training protocol for safe implementation of p16/Ki-67 DS in OSP is proposed.

Opportunistic off-target cancer screening in organized programs: The EDIFICE 6 survey.

1535 Background: The efficacy and benefit/risk ratio of organized nationwide cancer screening programs rely on the age range of eligible average-risk populations. We studied the characteristics of off-target populations who underwent opportunistic screening for colorectal (CRC), breast (BC) or cervical (CC) cancer, ≤5y prior to the recommended age. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online (June 26-July 28, 2017) on a core sample of 12 046 individuals (18-69y). Representativeness was ensured by quota sampling on age, sex, profession, and stratification by geographical area/type of urban district. Opportunistic screening for BC (in 533 women, age 45-49y), CRC (in 1331 individuals, age 45-49y) or CC (in 633 women, age 20-24y) was assessed in terms of smoking status (current, former/never smoker), marital status (single, living with a partner), type of residential area (urban, rural), having a close relative with cancer, social vulnerability (EPICES score), and self-reporting own cancer risk (higher, identical/lower than average). Results: In the off-target populations, screening rates were 78% for BC (N = 418, mammogram), 13% for CRC (N = 172, fecal test or colonoscopy) and 42% for CC (N = 264, cervical Pap smear test). Premature BC screening rates were significantly higher (P < 0.05) in non-vulnerable than in vulnerable individuals (84% vs 69%), and among those self-reporting their own BC risk as higher than average (84% vs 76% reporting own BC risk as identical/lower than average). Premature CC screening rates were correlated with: smoking status (66% in current smokers vs 35% in former/never smokers), and marital status (63% in those living with a partner vs 34% single). Lastly, factors correlated with premature CRC screening were: type of residential area (urban, 15% vs rural, 8%), and believing own risk of CRC to be higher than average (27% vs 8% of those who self-reported their own CRC risk as identical/lower than average). Conclusions: This analysis reveals several factors related to premature screening for BC, CRC and CC, provides clear insight into off-target cancer screening uptake profiles, and hints at new strategies to ensure the optimal risk/benefit ratio of screening practices.

Comparison between opportunistic and organised breast cancer mammography screening in the Swiss canton of Fribourg

BackgroundBreast cancer screening mammography is widespread in industrialised countries within the framework of public health program or opportunist form. Only few data exist on the comparison of effectiveness between organised and opportunistic screening. The aim of this study is to compare organised and opportunistic screening using population-based data from the Fribourg cancer registry, Switzerland.MethodsWe included all first primary breast adenocarcinoma diagnosed between 2006 and 2014 in women aged 50–69 years resident in the canton of Fribourg. We considered only breast cancer discovered by mammography screening. We compared patients, tumour characteristics and treatment modalities between breast cancer detected by the organised screening program versus opportunistic screening using logistic regression.ResultsOut of 989 patients diagnosed with breast cancer, 402 (40.6%) were diagnosed by organised and 205 (20.7%) by opportunistic screening. Women with breast cancer detected within the screening program were more likely to be from rural areas (P = 0.035) and lived less frequently in high favoured regions (P = 0.020). They presented more frequently in situ than invasive cancer (P = 0.022). For patients with invasive breast cancer, those detected by the program were less likely to undergo mastectomy (P = 0.06) and consequently, they were more likely to undergo radiation therapy (P = 0.003). Adjustment for area of residence and financial context of the region did not modify the results presented.ConclusionsThe present study reports an increased rate of detection of carcinoma in situ in organised screening program as compared to opportunistic screening mammographies, an indirect evidence of a higher radiologic sensitivity. Furthermore, the results show a trend towards more mastectomies among patients with breast cancer discovered after opportunistic than after organized mammography screening, reflecting lower treatment burden. Those results were independent of socio-economic factors which differed across screening groups.

Early prevention program for colon and rectal cancer. Data analysis

This article gives an overview on gastric cancer, focusing in particular on the most frequent type of malignancy in the stomach—gastric adenocarcinoma. Bacterial infection with Helicobacter pylori is today the biggest risk factor of developing this carcinoma. The epidemiology and pathobiology, along with its risk factors, are discussed.Hereditary gastric cancer is rare, but family predisposition can increase the risk. Treatment options include endoscopic management in early disease, and surgical and medical management in more advanced disease. Early detection is crucial; however, organized screening is only being used in Japan and Korea. Better screening tests are highly warranted.

Increasing participation in cervical screening by targeting long-term nonattenders: Randomized health services study.

High screening participation in the population is essential for optimal prevention of cervical cancer. Offering a high-risk human papillomavirus (HPV) self-test has previously been shown to increase participation. In this randomized health services study, we evaluated four strategies with regard to participation. Women who had not attended organized cervical screening in 10 years were eligible for inclusion. This group comprised 16,437 out of 413,487 resident women ages 33-60 (<4% of the screening target group). Among these 16,437 long-term nonattenders, 8,000 women were randomized to either (i) a HPV self-sampling kit sent directly; (ii) an invitation to order a HPV self-sampling kit using a new open source eHealth web application; (iii) an invitation to call a coordinating midwife with questions and concerns; or (iv) the standard annual renewed invitation letter with prebooked appointment time (routine practice). Overall participation, by arm, was (i) 18.7%; (ii) 10.7%; (iii) 1.9%; and (iv) 1.7%. The relative risk of participation in Arm 1 was 11.0 (95% CI 7.8-15.5), 6.3 (95% CI 4.4-8.9) in Arm 2 and 1.1 (95% CI 0.7-1.7) in Arm 3, compared to Arm 4. High-risk HPV prevalence among women who returned kits in study Arms 1 and 2 was 12.2%. In total, 63 women were directly referred to colposcopy from Arms 1 and 2; of which, 43 (68.3%) attended and 17 had a high-grade cervical lesion (CIN2+) in histology (39.5%). Targeting long-term nonattending women with sending or offering the opportunity to order self-sampling kits further increased the participation in an organized screening program.

Prevalence of hepatitis B surface antigen (HBsAg) positivity and its associated factors in Rwanda

BackgroundThe epidemiology of hepatitis B virus (HBV) infection in the general population in Rwanda is not well known. This study examined the prevalence of HBV surface antigen (HBsAg) positivity and associated risk factors among people aged 25 years and over in an organized national screening campaign.MethodsThis is a cross-sectional study using data from a nationwide HBV screening campaign organized by the Rwanda Biomedical Centre from March to October 2018. This campaign targeted individuals aged > 25 years old from 24 of 30 districts of Rwanda. Sensitization was done through multimedia announcements, community health workers and local church leaders. During the campaign, a structured interview was administered by trained healthcare workers to collect information on socio-demographic, clinical and behavioral characteristics of participants; HBV screening was performed with HBsAg using enzyme-linked immunosorbent assays (ELISA) testing. Bivariate and multivariate logistic regressions were used to assess factors associated with HBsAg positivity in the screened participants.ResultsA total of 327,360 individuals were screened during the campaign. Overall 12,865(3.9%) were HBsAg positive. The highest prevalence (4.2%) was found in the 35–44-year-old group, but the difference from other groups was not significant (Odds Ratio [OR = 1.057, 95% Confidence Interval(CI) (0.904–1.235)]. Being male [OR = 1.348, 95% CI (1.30,1.40)]; being single [OR = 1.092, 95% CI (1.10–1.16)] compared to married; a previous positive TB screening test [OR = 2.352, 95% CI (1.63–3.39)]; history of surgical operation [OR = 1.082, 95% CI (1.00,1.17)]; exposure to traditional operational practices and scarification [OR = 1.187, 95% CI (1.13, 1.24)]; and having a person in the family with viral hepatitis [OR = 1.367, 95% CI (1.21, 1.53)] were significantly associated with HBV infection.ConclusionsThese data provide the first national estimate of the prevalence of HBsAg seropositivity and its associated factors in Rwanda. The study identified people with the highest risk of HBV infection who should be the priority of future prevention efforts in Rwanda and in similar settings.

Benefits of Organized Mammographic Screening Programs in Women Aged 50 to 69 years: A Surgical Perspective

BackgroundThe benefits of organized mammographic screening programs (OMSPs) in reducing breast cancer mortality have been addressed by several studies. This study was designed to specifically evaluate the advantages of OMPSs in terms of surgical management of patients with breast cancer. Materials and MethodsSurgical treatment of 201 patients with breast cancer aged 50 to 69 years coming from OMSPs was compared with that of 532 non-OMSP patients in same age group. The likelihood of receiving BCS was analyzed through a multivariable regression model. ResultsThe mean tumor size was smaller in the OMSP patients (14 mm vs. 18 mm; P < .01). The proportion of patients having metastatic lymph nodes was higher in the non-OMSP group (33.3% vs. 17.9%; P < .01). Rates of breast-conserving surgery (BCS) were significantly higher in the OMSP group (89.1% vs. 59.1%; P < .01). Sentinel node biopsy was carried out in 84.1% and 62.5% of patients in the OMSP and non-OMSP groups, respectively (P < .01). Rates of axillary lymph node dissection were significantly different (24.9% in the OMSP group and 35.8% in the non-OMSP group; P = .02). Re-excisions for infiltrated margins after BCS were lower in the OMSP group (4.8% vs. 12.7%; P < .01). Hospital stay was shorter in the OMSP group (2.13 vs. 3.02 days; P < .01). OMPS women had a 3-fold higher probability of receiving BCS. ConclusionsPatients with breast cancer belonging to OMSPs had a higher probability to receive less invasive surgery and to have shorter hospital stay. Our results support the use of campaigns aimed at increasing adhesion to mammography screening.

PCN57 EXAMINATION OF HEALTH INSURANCE DISEASE BURDEN OF CERVICAL CANCER IN HUNGARY: A REAL WORLD STUDY

The burden of malignanttumour diseases is much higher in the Eastern European countries than in Western Europe because they have limited financial resources in health care. Therefore, it is especially important to evaluate cost-effectiveness of certain actions during the decision making processes. The aim of our analysis is to define the annual health insurance disease burden of cervical cancer for the National Health Insurance Fund of Hungary (NHIFH). The analysis was performed.by the funding database of 2014 data which covered all services and types of care funded by NHIFH. We analysed the in situ diseases (D06), the benign disorders (C53), and the malignant ones (D26.0). The treatment included the costs of the following: care by the general practitioner, outpatient care, caregivers’ fee, CT/MR, PET laboratory tests, home care, patient transportation, acute and chronic inpatient care, price subsidy of medicaments, and price subsidy to medical devices. In 2014 the NHIFH spent 1.05 billion Hungarian Forint (HUF) (3.41 million EUR) for the treatment of cervical cancer patients. The patients, and most of the funded cases (96.85%) were paid due to people treated with malignant cervical tumours while in situ (2.94%) and beningn (0.21%) cancers represents smaller proportion. The highest expense item appeared in the acute inpatient care, which was annually 700.87 million HUF (2.27 million EUR) representing 66.56% of total health insurance expenditure. Expenditures for CT/MRI examinations (108.59 million HUF; 351.82 thousand EUR), medical devices (92.12 million HUF; 298.46 thousand EUR) and outpatient care (58.85 million HUF; 190.65 thousand EUR) are also important cost elements accounting for 10.3%, 8.8% and 5.6% of total health insurance expenditures, respectively. Cervical cancer represents a significant burden for the Hungarian health insurance system.The increased participation on organized cervical screening might change the health insurance expenditures of cervical cancer.

High-Grade Cervical Intraepithelial Neoplasia in Human Papillomavirus Self-sampling of Screening Non-attenders

(Abstracted from Br J Cancer 2018;118:138–144) Denmark has an organized cervical cancer screening program; every 3 years, women aged 23 to 49 years are invited for screening, and every 5 years, women 50 to 65 years of age are invited. The large proportion of invited women who are not screened (nonattenders) is a major challenge in preventing cervical cancer.

Cervical cytology use in Portugal: Results from the National Health Survey 2014

Given the disparities across regional cervical cancer screening programs implemented in Portugal, understanding the patterns of cervical cytology use is essential to improve cervical cancer control. We aimed to describe the use of cervical cytology and identify factors associated with its non- and underuse. A total of 5884 women aged 25-64 years were evaluated as part of the National Health Survey 2014. Previous use of cervical cytology was classified as never or ever, and ever-users having undergone the latest testing more than 5 years before were considered under-users. We computed age- and education-adjusted prevalence ratios and corresponding 95% confidence intervals for non- and underuse. Overall, 13.2 and 12.0% of women reported nonuse and underuse of cervical cytology, respectively. The Norte region presented the lowest prevalence of nonuse and R.A. Açores the highest. Low socioeconomic status and unhealthy lifestyles were significantly associated with low cervical cytology use, whereas greater use was observed in those having more recent contact with health services. Cervical cytology use was shown to differ according to sociodemographic characteristics and access to/use of healthcare services. Large regional variations persist in Portugal despite organized screening programs that cover most of the country.

Integration of care for HIV and opioid use disorder.

We sought to identify optimal strategies for integrating HIV- and opioid use disorder-(OUD) screening and treatment in diverse settings. Systematic review. We searched Ovid MEDLINE, PubMed, Embase, PsycINFO and preidentified websites. Studies were included if they were published in English on or after 2002 through May 2017, and evaluated interventions that integrated, at an organizational level, screening and/or treatment for HIV and OUD in any care setting in any country. Twenty-nine articles met criteria for inclusion, including 23 unique studies: six took place in HIV care settings, 12 in opioid treatment settings, and five elsewhere. Eight involved screening strategies, 22 involved treatment strategies, and seven involved strategies that encompassed screening and treatment. Randomized controlled studies demonstrated low-to-moderate risk of bias and observational studies demonstrated fair to good quality. Studies in HIV care settings (n = 6) identified HIV-related and OUD-related clinical benefits with the use of buprenorphine/naloxone for OUD. No studies in HIV care settings focused on screening for OUD. Studies in opioid treatment settings (n = 12) identified improving HIV screening uptake and clinical benefits with antiretroviral therapy when provided on-site. Counseling intensity for OUD medication adherence or HIV-related risk reduction was not associated with clinical benefits. Screening for HIV can be effectively delivered in opioid treatment settings, yet there is a need to identify optimal OUD screening strategies in HIV care settings. Strategies integrating the provision of medications for HIV and for OUD should be expanded and should not be contingent on resources available for behavioral interventions. A protocol for record eligibility was developed a priori and was registered in the PROSPERO database of systematic reviews (registration number CRD42017069314).

A 3-step intervention to improve adherence to cervical cancer screening: The SCAN randomized controlled trial

The aim of this study was to test the effectiveness of a stepwise intervention with an increasing level of complexity and cost to increase adherence to organized cervical cancer screening. This was a randomized (1: 1) controlled trial, conducted among 13 Portuguese primary health care units. Participants (n = 1220) were women aged 25–49 years, eligible for cervical cancer screening, with a mobile phone number available. The tested intervention was a 3-step invitation to screening, based on automated text messages/phone calls (step 1), manual phone calls (step 2) and face-to-face interviews (step 3), applied sequentially to non-adherent women after each step. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women screened, which was assessed after step 1 (45 days after the initial invitation), steps 1 + 2 (90 days after the initial invitation) and steps 1 + 2 + 3 (150 days after the initial invitation). Adherence to cervical cancer screening was significantly higher among women assigned to the intervention than those in the control group for step 1 (39.9% vs. 25.7%, p < 0.001), steps 1 + 2 (48.6% vs. 30.7%, p < 0.001) and steps 1 + 2 + 3 (51.2% vs. 34.0%, p < 0.001). In conclusion, adherence to cervical cancer screening was higher by 17% among women invited through the 3-step intervention, compared to those receiving the standard invitation letter. The former strategy has the potential to be broadly implemented due to the low requirements of technology and training.Clinical Trial Registration: NCT03122275

Managing job performance, social support and work-life conflict to reduce workplace stress

PurposeWorkplace stress costs £3.7bn per annum in the UK and in excess of $300bn per annum in the USA. The purpose of this paper is to examine the existence, strength and direction of relationships between perceptions of social support, work–life conflict, job performance and workplace stress in an Irish higher education institution.Design/methodology/approachThe selected theoretical framework consisted of a combination of reward imbalance theory, expectancy theory and equity theory. An organizational stress screening survey instrument was used to survey the staff (n = 1,420) of an academic institution. Multiple linear regression analysis was used to evaluate the relationships between the independent variables (social support, work–life conflict, job performance), the covariates (staff category, direct reports, age, gender), and the dependent variable (workplace stress).FindingsThe results showed a negative correlation between social support and workplace stress, a positive correlation between work–life conflict and workplace stress, and a negative correlation between job performance and workplace stress (p < 0.05). The results also revealed significant relationships between the covariates direct reports and gender and the dependent variable workplace stress.Practical implicationsThe findings from this research can trigger an organizational approach where educational leaders can enable workplace change by developing and implementing social support and work–life strategies, and potential pathways to reduce levels of workplace stress and improve quality of life for employees and enhance performance.Originality/valueThe examination and establishment of particular relationships between social support, work–life conflict and job performance with workplace stress is significant for managers.

HPV testing for cervical cancer screening: technical improvement of laboratory logistics and good clinical performance of the cobas 6800 in comparison to the 4800 system

BackgroundEuropean guidelines for cervical cancer screening now recommend the use of clinically validated assays for high-risk HPV-DNA sequences as primary test in women older than 30 years, performed in centralized laboratories, and run on systems providing automated solutions for all steps.MethodsWe conducted a comparison study, according to the international guidelines, nested within the organized population-based cervical screening program, between the cobas 4800 and 6800 systems (Roche Diagnostics), to evaluate accuracy and reproducibility of HPV test results and laboratory workflow. In Italy implementation of HPV cervical screening is under way on a regional basis; in Veneto it started in June 2015, following a piloting phase; the assay in use in the three centralized laboratories is the cobas 4800 HPV test, run on the cobas 4800 system. Comparison of HPV results with a new version of the assay (cobas 6800/8800 HPV) run on the cobas 6800 system, and intra- and inter-reproducibility analyses have been conducted in samples collected in PreservCyt medium (Hologic) from women without and with a subsequent diagnosis of high-grade lesion.ResultsSamples from women older than 30 years attending organized cervical cancer screening were used. Clinical sensitivity and specificity were evaluated on 60 cases and 925 controls, respectively; intra-laboratory reproducibility and inter-laboratory agreement by the 6800 system were evaluated on 593 and 460 specimens, respectively. Our results showed a very high agreement (> 98%) for overall qualitative results between the two systems; clinical sensitivity and specificity of the HPV assay run on 6800 were non-inferior to those of the HPV assay run on 4800 (p = 0,0157 and p = 0,0056, respectively, at the recommended thresholds of 90 and 98%); kappa values of 0.967 and 0.969 were obtained for intra- and inter-laboratory reproducibility analyses in the 6800 system. The 6800 platform displayed several technological improvements over the 4800 system, with higher throughput and laboratory productivity, and lower operator’s hands-on time.ConclusionsThe new cobas 6800/8800 HPV assay run on the 6800 instrument is suitable for use in large centralized laboratories included within population-based cervical cancer screening programs.

Participation in a Swedish cervical cancer screening program among women with psychiatric diagnoses: a population-based cohort study

BackgroundIn Sweden, organized screening programs have significantly reduced the incidence of cervical cancer. For cancers overall, however, women with psychiatric diagnoses have lower survival rates than other women. This study explores whether women with psychiatric diagnoses participate in cervical cancer screening programs to a lesser extent than women on average, and whether there are disparities between psychiatric diagnostic groups based on grades of severity.MethodsBetween 2000 and 2010, 65,292 women within screening ages of 23–60 had at least two ICD-10 (International Statistical Classification of Diseases and Related Health Problems – Tenth Revision) codes F20*–F40* registered at visits in primary care or psychiatric care in Region Västra Götaland, Sweden. Participation in the cervical cancer screening program during 2010–2014 was compared with the general female population using logistic regression adjusted for age.ResultsRelative risk for participation (RR) for women diagnosed within psychiatric specialist care RR was 0.94 compared with the general population, adjusted for age. RR for diagnoses outside specialist care was 0.99. RR for psychoses (F20*) was 0.81.ConclusionsWomen with less-severe psychiatric diagnoses participate in the screening program to the same extent as women overall. Women who have received psychiatric specialist care participate to a lesser extent than women overall. The lowest participation rates were found among women diagnosed with psychoses.

QIM19-119: Validity of the French-Language Mammography Satisfaction Instrument Evaluating Women’s Satisfaction With an Organized Breast Cancer Screening Program: A Confirmatory Study

Background: To evaluate the quality of an organized mammography screening program based on the perception of screened women, we developed and validated the French-language Mammography Satisfaction Instrument (MSI). The study objective was to confirm the validity and reliability of the MSI. Methods: A confirmatory study was conducted among 529 women who had had a recent screening mammography under the Quebec Breast Cancer Screening Program (PQDCS). Eligible women from the Quebec City region completed the online MSI between January 14 and May 23, 2016. The MSI originally included 14 items evaluating 4 factors: satisfaction with (1) the technician’s skills; (2) the physical environment; (3) the staff’s communication skills; and (4) the information provided under the program. A fifth factor with 2 items, evaluating mammography accessibility, was added. A confirmatory factor analysis (CFA) was done and goodness of fit indices were generated (SRMR, CFI, RMSEA with its 90% CI). Item reliability and composite reliability were estimated. Variance extract estimates (VEEs) were generated to assess the amount of variance explained by the factors. Multivariate logistic regressions were done to test the sensitivity of each scale to identify subgroups of unsatisfied women. Odds ratios (OR) and their 95% CI were estimated. Results: Most women (62.0%) were aged 55–64, and 32.9% had university level education. The CFA demonstrated that the 5 factors fitted the data well (SRMR=0.044; CFI=0.969; RMSEA=0.055 with its 90% CI: 0.047–0.063). Item reliabilities (≥0.55) and composite reliabilities (≥0.87) were high. All VEEs were also high (≥0.70). Pain during compression, anxiety before the mammography, perception of not having an excellent health, and the radiologic centers were the factors the most consistently and significantly associated with the 5 scales of satisfaction. In addition, women with university level education were less satisfied with the staff’s communication skills (OR=0.64; 95% CI: 0.43–0.97) and those having had less than 10 lifetime mammograms were less satisfied with the physical environment (OR=0.52; 95% CI: 0.33–0.83) and the accessibility (OR=0.53; 95% CI: 0.31–0.92). Conclusions: This confirmatory study showed the good reliability and validity of the construct of the 16-item MSI with 5 factors. The MSI is useful to detect unsatisfied women and to improve the quality of organized breast cancer screening programs.

P088 - The impact of depression on adherence to organized and opportunistic breast cancer screening in Switzerland

P088 - The impact of depression on adherence to organized and opportunistic breast cancer screening in Switzerland