Participation In Breast Screening Research Articles

Trajectories in mammographic breast screening participation in middle-age overweight and obese women: A retrospective cohort study using linked data

ObjectivesDespite the established benefits and availability of mammographic breast screening, participation rates remain suboptimal. Women with higher BMIs may not screen regularly, despite being at increased risk of postmenopausal breast cancer and worse outcomes. This study investigated the association between prospective changes in BMI and longitudinal adherence to mammographic screening among women with overweight or obesity. MethodsRetrospective cohort study of women (N = 2822) participating in the Australian Longitudinal Study on Women's Health with an average follow-up of 20 years, with screening participation enumerated via BreastScreen NSW, Australia clinical records over the period 1996–2016. Association between BMI and subsequent adherence to screening was investigated in a series of marginal structural models, incorporating a time variant/invariant socio-demographic, clinical, and health behaviour confounders. Models were also stratified by a proxy measure of socio-economic status (education). ResultsParticipants with overweight/obesity were less adherent to mammography screening, compared to healthy/underweight participants (OR=1.29, 95 % CI=1.07, 1.55). The association between overweight/obesity and non-adherence was higher among those who ever had private health insurance (OR=1.30, 95 % CI=1.05, 1.61) compared to those who never had private health insurance and among those with lower educational background (OR=1.38, 95 % CI=1.08, 1.75) compared to those with higher educational background. ConclusionsLong-term impacts on screening participation exist among women with higher BMI, who are less likely to participate in routinely organised breast screening. Women with a higher BMI should be a focus of efforts to improve breast screening participation, particularly given their increased risk of breast cancer and association of higher BMI with worse breast cancer outcomes among older women.

Factors associated with private or public breast cancer screening attendance in Queensland, Australia: A retrospective cross-sectional study.

This study aimed to estimate participation in private breast screening in Queensland, Australia, where public-funded screening is implemented, and to identify factors associated with the screening setting, using an online survey (999 female respondents aged 40-74). Screening-specific and socio-demographic factors were collected. Multivariable logistic regression was used to identify factors associated with screening setting (public vs private) and screening recency (<2 vs ≥2 years). Participation estimates were 53.2% (95% confidence interval, CI: 50.0%-56.3%) and 10.9% (9.0%-13.0%) for national screening program and private screening, respectively. In the screening setting model, participation in private screening was significantly associated with longer time since last screening (>4 versus <2 years, odds ratio (OR) = 7.3, 95%CI: 4.1-12.9, p < 0.001), having symptoms (OR = 9.5, 5.8-15.5, p < 0.001), younger age (40-49 versus 50-74 years, OR = 1.8, 1.1-3.0, p = 0.018) and having children <18 years in household (OR = 2.4, 1.5-3.9, p < 0.001). In the screening recency model, only screening setting was statistically significant and private screening was associated with screening recency ≥2 years (OR = 4.0, 2.8-5.7, p < 0.001). Around one in nine women screen outside of the BreastScreen Queensland program. Clinical and socio-demographic factors associated with participation in private screening were identified, providing knowledge relevant to the program's endeavours to improve screening participation.

Exploring Disparities in Breast Cancer Screening: An Ecological Analysis of Australian Data.

The objective of this study is to analyse the socio-spatial patterns of breast cancer screening across Australian regions. The research is an ecological study. Data for breast screening participation and associated social and demographic factors are obtained from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics. The unit of measurement for the analysis is spatially aggregated regions (Statistical Area 3). Geographically weighted regression is used to analyse the relationship between a dependent variable and one or more independent variables while considering the spatial or geographic relationships among the data points. Globally, there was a significant (p<0.05) association between screening participation and income, English ability, education level, Indigenous background, and transport availability. The geographically weighted regression model represented an improved fit with a higher R2 (R2=0.89) and the Akaike information criterion (AIC) has improved, (AIC= 391.92). The Monte-Carlo tests for spatial variability were significant for all independent variables (p<0.05). Visually, there was marked spatial variation in the association between breast cancer screening rates and the significant independent variables from the global model. The identification of significant spatial variability in the association between breast cancer screening participation and important social and demographic factors provides important input into the design of programs aimed at increasing participation in screening regimes.

Breast cancer screening and its associating factors among hungarian women aged 45–65: a cross-sectional study based on the European health interview surveys from 2009 to 2019

BackgroundIn 2020, globally 685,000 people died, and 2.3 million women were diagnosed with breast cancer. The main cause of cancer deaths among women is breast cancer, which account for 15.5% of all cancer deaths. Most of these could have been avoided with timely diagnosis.The aim of our study was to determine the proportion of breast screening participation in Hungary, and to identify possible factors that may influence breast screening attendance.MethodsOur data were gathered from the cross-sectional European Health Interview Surveys conducted in Hungary in 2009, 2014, and 2019. In terms of categorical characteristics, Pearson’s chi-square test was performed to evaluate the differences between people who have attended breast screening within two years and who have only attended more than two years ago. To determine the factors that may have an impact on the uptake of screening, generalized linear model with logit link function regarding binomial probability distribution was executed.ResultsThe responses of 2626 women between the age 45-65 were included in our study. In 2009 85% (n=741), in 2014 90% (n=851) and in 2019 87% (n=699) of the respondents claimed to have ever attended a breast screening in their life. In 2009 68% (n=594), in 2014 66% (n=630) and in 2019 64% (n=515) said that they have taken part in breast screening within two years (p=0.331). From 2014 to 2019 (AOR=0.72 [0.57-0.89]) the chance of attending breast screening was decreasing. We observed that both secondary (AOR=1.97 [1.60-2.44]) and tertiary educational level (AOR=2.23 [1.67-3.00]), higher perceived income (AOR=1.54 [1.25-1.90]), and more frequent meeting with the doctor (AOR=1.77 [1.39-2.27]) and with the specialist (AOR=1.88 [1.54-2.28]) appeared as protective factors of breast screening attendance.ConclusionsOur results show that the lifetime prevalence of breast screening participation is high, however the recommended biennial rate is relatively low. To increase the participation rate, various initiatives would be needed, especially for women in identified risk groups, which are lower educational level, lower perceived income, and less frequent meeting with the doctor and with the specialist.

Breast screening participation and degree of spread of invasive breast cancer at diagnosis in mental health service users: A population linkage study.

Women living with mental health conditions may not have shared in improvements in breast cancer screening and care. No studies have directly examined the link between reduced screening participation and breast cancer spread in women using mental health (MH) services. Population-wide linkage of a population cancer register, BreastScreen register, and mental health service data set in women aged 50 to 74 years in New South Wales, Australia, from 2008 to 2017. Incident invasive breast cancers were identified. Predictors of degree of spread (local, regional, metastatic) at diagnosis were examined using partial proportional odds regression, adjusting for age, socioeconomic status, rurality, and patterns of screening participation. A total of 29 966 incident cancers were identified and included 686 (2.4%) in women with MH service before cancer diagnoses. More than half of MH service users had regional or metastatic spread at diagnosis (adjusted odds ratio, 1.63; 95% CI, 1.41-1.89). MH service users had lower screening participation; however, advanced cancer was more common even when adjusting for screening status (adjusted odds ratio, 1.53; 95% CI, 1.32-1.77). Advanced cancer was more common in women with severe or persistent MH conditions. Low screening participation rates explain only small part of the risk of more advanced breast cancer in women who use MH services. More study is needed to understand possible mechanisms contributing to more advanced breast cancer in women living with MH conditions. Health systems need strategies to ensure that women living with MH conditions enjoy population gains in breast cancer outcomes.

Breast cancer screening participation in women using mental health services in NSW, Australia: a population study

PurposePopulation screening programs have contributed to reduced breast cancer mortality, but disadvantaged or vulnerable groups may not have shared these improvements. In North American and European studies, women living with mental health conditions have reduced breast screening rates. There are no current Australasian data to support health system planning and improvement strategies.MethodsThe New South Wales (NSW) BreastScreen program offers free screening to NSW women aged 50–74. We compared 2-year breast screening rates for mental health service users (n = 33,951) and other NSW women (n = 1,051,495) in this target age range, after standardisation for age, socioeconomic status and region of residence. Mental health service contacts were identified through linkage to hospital and community mental health data.ResultsOnly 30.3% of mental health service users participated in breast screening, compared with 52.7% of other NSW women (crude incidence rate ratio 0.57, 95% CI 0.56–0.59). Standardisation for age, socioeconomic disadvantage or rural residence did not alter this screening gap. Around 7000 fewer women received screening than would be expected from comparable population rates. Screening gaps were largest in women over 60 and in socioeconomically advantaged areas. Women with severe or persistent mental illness had slightly higher screening rates than other mental health service users.ConclusionsLow breast cancer screening participation rates for NSW mental health service users suggest significant risk of later detection, possibly leading to more extensive treatment and premature mortality. Focussed strategies are needed to support greater breast screening participation for NSW women who use mental health services.

Inequalities in cancer screening participation between adults with and without severe mental illness: results from a cross-sectional analysis of primary care data on English Screening Programmes

BackgroundPeople with severe mental illness (SMI) are 2.5 times more likely to die prematurely from cancer in England. Lower participation in screening may be a contributing factor.MethodsClinical Practice Research Datalink data for 1.71 million, 1.34 million and 2.50 million adults were assessed (using multivariate logistic regression) for possible associations between SMI and participation in bowel, breast and cervical screening, respectively.ResultsScreening participation was lower among adults with SMI, than without, for bowel (42.11% vs. 58.89%), breast (48.33% vs. 60.44%) and cervical screening (64.15% vs. 69.72%; all p < 0.001). Participation was lowest in those with schizophrenia (bowel, breast, cervical: 33.50%, 42.02%, 54.88%), then other psychoses (41.97%, 45.57%, 61.98%), then bipolar disorder (49.94%, 54.35%, 69.69%; all p-values < 0.001, except cervical screening in bipolar disorder; p-value > 0.05). Participation was lowest among people with SMI who live in the most deprived quintile of areas (bowel, breast, cervical: 36.17%, 40.23%, 61.47%), or are of a Black ethnicity (34.68%, 38.68%, 64.80%). Higher levels of deprivation and diversity, associated with SMI, did not explain the lower participation in screening.ConclusionsIn England, participation in cancer screening is low among people with SMI. Support should be targeted to ethnically diverse and socioeconomically deprived areas, where SMI prevalence is greatest.

Impact of BMI on breast screening participation: a data linkage study

Abstract Background Regular mammographic screening can reduce breast cancer morbidity and mortality. Participation rates are suboptimal in Australia’s fully funded biennial breastscreening program (BreastScreen) for women aged 50-74. Despite obesity being a well-established risk factor for post-menopausal breast cancer, cross sectional data suggests obesity may be a risk factor for non-participation in recommended screening, due to adverse screening experiences. This research aimed to ascertain the link obesity and non-participation by using data linkage of routinely collected data. Methods Data for women age eligible for breast screening were linked between the NSW Cancer Registry and the Australian Longitudinal Study of Women’s Health (ALSWH) to create a cohort of women who either participated in screening as recommended or not. Women from the 1946-1951 ALSWH birth cohort were included in the study. These women reported BMI via 8 survey waves. The primary outcome was adherence to breast screening measured by frequency of screening over the follow-up period (1998-2016). Unadjusted risk ratios were calculated using mixed-effects logistic regression for the association between BMI and screening participation. Results The study included 2804 linked records of age eligible women (mean age of 52.37[SD 5.47]). 22.8% of the cohort were obese (BMI&amp;gt;30kg/m2). Obesity was significantly associated with non-recommended screening participation (screening within 3 years of last breast screen); odds ratio 1.63 (95% confidence interval 1.32 to 2.00, p &amp;lt; 0.0001). Conclusions Obesity has a significantly impact on recommended participation in a nationally provided breast screening program, despite obesity being a risk factor for post- menopausal breast cancer. Optimising participation among higher risk and under-screened women in under utilised breast cancer screening programs is warranted. Development of targeted interventions to increase screening participation among these higher risk women is needed. Key messages • Women living with obesity and less likely to participate in recommended breast screening. • Targeted interventions are needed to optimise participation in breast screening to ensure these higher risk women are not at higher risk of adverse outcomes due to breast cancer.

Randomised trial of population-based BRCA testing in Ashkenazi Jews: long-term secondary lifestyle behavioural outcomes.

Ashkenazi-Jewish (AJ) population-based BRCA testing is acceptable, cost-effective and amplifies primary prevention for breast & ovarian cancer. However, data describing lifestyle impact are lacking. We report long-term results of population-based BRCA testing on lifestyle behaviour and cancer risk perception. Two-arm randomised controlled trials (ISRCTN73338115, GCaPPS): (a) population-screening (PS); (b) family history (FH)/clinical criteria testing. North London AJ-population. AJ women/men >18 years. prior BRCA testing or first-degree relatives of BRCA-carriers. Participants were recruited through self-referral. All participants received informed pre-test genetic counselling. The intervention included genetic testing for three AJ BRCA-mutations: 185delAG(c.68_69delAG), 5382insC(c.5266dupC) and 6174delT(c.5946delT). This was undertaken for all participants in the PS arm and participants fulfilling FH/clinical criteria in the FH arm. Patients filled out customised/validated questionnaires at baseline/1-year/2-year/3-year follow-ups. Generalised linear-mixed models adjusted for covariates and appropriate contrast tests were used for between-group/within-group analysis of lifestyle and behavioural outcomes along with evaluating factors associated with these outcomes. Outcomes are adjusted for multiple testing (Bonferroni method), with P< 0.0039 considered significant. Lifestyle/behavioural outcomes at baseline/1-year/2-year/3-year follow-ups. 1034 participants were randomised to PS (n= 530) or FH (n= 504) arms. No significant difference was identified between PS- and FH-based BRCA testing approaches in terms of dietary fruit/vegetable/meat consumption, vitamin intake, alcohol quantity/ frequency, smoking behaviour (frequency/cessation), physical activity/exercise or routine breast mammogram screening behaviour, with outcomes not affected by BRCA test result. Cancer risk perception decreased with time following BRCA testing, with no difference between FH/PS approaches, and the perception of risk was lowest in BRCA-negative participants. Men consumed fewer fruits/vegetables/vitamins and more meat/alcohol than women (P< 0.001). Population-based and FH-based AJ BRCA testing have similar long-term lifestyle impacts on smoking, alcohol, dietary fruit/vegetable/meat/vitamin, exercise, breast screening participation and reduced cancer risk perception.

Breast cancer screening practices and associated factors among Chinese-Australian women living in Sydney: A cross-sectional survey study.

This study aimed to investigate breast cancer screening practices and associated factors among Chinese‐Australian women. A cross‐sectional quantitative survey method including convenience and snowball sampling was used to recruit 115 Chinese‐Australian women living in Sydney, using a self‐administered survey. In all, 69.8% of participants reported recent clinical breast examinations and 73.3% had mammograms. Age, religion, employment status, and length of residence were associated with having a clinical breast examination. Income was related to having a mammogram. Associations between knowledge of breast cancer, cancer‐related beliefs, and screening participation were found. Length of residence in Australia was the strongest predictor of having a clinical breast examination and mammogram. The most common barrier to mammography was if women felt that doctors did not recommend it to them. Chinese‐Australian women need to be educated about awareness of their usual breast health to be aware of any changes, especially if women are not eligible for mammography or have difficulty in accessing health services. Tailored programs, improving screening experiences, and minimizing perceived barriers are needed to promote early detection of breast cancer among Chinese–Australian women.

Clinical Radiology Orals

Purpose: The Coronavirus Disease (COVID-19) pandemic has led to changes in healthcare globally. In order to limit the transmission of COVID-19, BreastScreen New South Wales had a temporary closure from late March 2020 to May 2020.1 BreastScreen Sydney Local Health District (SLHD) screens between 19,000 to 20,000 women per year. The service had a closure period of eight weeks. Since BreastScreen re-opened, social-distancing measures remained in place.2 Other countries have reported a reduction in the number of breast imaging studies performed during the COVID-19 pandemic.3-8 A study from the United States showed breast screening encounters and the incidence of breast cancer reduced by 89% and 50.5%, respectively, in April 2020 compared to April 2019.3 This study investigates the impact of the COVID-19 pandemic on participation in breast screening and the number of screen-detected breast malignancies at BreastScreen SLHD. Methods and Materials: Retrospective data collection was performed on the BreastScreen Information System (BIS). Monthly numbers at SLHD of the following were extracted for January to September 2018 and 2020: clients attending breast screening;clients in age groups of 40-49, 50-69, 70-74, and 75 or above;clients with screen-detected malignancy;clients with lymph node involvement. BreastScreen Australia is a two-yearly programme, therefore, monthly numbers of 2020 were compared with 2018. Results: 15,470 women attended breast screening at SLHD from January to September 2018, compared to 11,768 women from January to September 2020. The screening number reduced by 100% in April 2020 compared to April 2018 due to service closure, gradually improved after re-opening (75% reduction in May 2020) and rebounded with relative increase of 28% in September 2020 compared to September 2018. The participation recovery rate was faster for those having their second or subsequent mammogram compared to those having their first screening mammogram. The recovery rate was also faster for clients aged between 50-74, compared to the other clients. The monthly number of screen detected malignancies between January and September varied between 6-21 in 2020 (excluding April) and 9-23 in 2018, while the percentage varied between 0.59-1.13% in 2020 (excluding April) and 0.46-1.09% in 2018. Conclusion: There has been a recovery of screening mammogram numbers since BreastScreen SLHD re-opened. Further research is required to assess the long term effects of COVID-19 on breast screening and screen-detected malignancies.

Barriers and Facilitators of Breast Cancer Screening amongst Culturally and Linguistically Diverse Women in South Western Sydney: A Qualitative Explorative Study.

Breast cancer is the most common cause of cancer amongst Australian women and the second most common cause of cancer mortality. Despite the proven effectiveness of early intervention, screening rates remain subpar across many regions in New South Wales (NSW). Screening rates are particularly low within the culturally and linguistically diverse (CALD) area of South Western Sydney (SWS). The objective of this study was to qualitatively explore barriers and facilitators to breast screening from the perspectives of CALD women from SWS. CALD women aged ≥40 who resided in SWS were invited to participate in a semi-structured interview to explore barriers and facilitators to breast cancer screening. Interviews were recorded, transcribed verbatim and analysed thematically to identify recurring patterns in the data. Sixteen women from CALD backgrounds participated. Women in this study reported absence of symptoms, fatalistic beliefs and embarrassment during the procedure to be the primary reasons for reluctance to screen. Lack of general practitioner (GP) endorsement, transport issues and pain associated with the procedure were also reported as additional barriers to screening. Common facilitators to screening included encouragement from family and friends, family history of cancer and media adverts. CALD women have distinctive barriers to mammography, which lead to poor breast screening participation rates. Opportunistic health promotion in this area is warranted and may lead to better health outcomes amongst this population.

"Whilst you are here…" Acceptability of providing advice about screening and early detection of other cancers as part of the breast cancer screening programme.

ObjectivesThis research aimed to assess women's willingness to receive advice about cervical and bowel cancer screening participation and advice on cancer symptom awareness when attending breast cancer screening.MethodsWomen (n = 322) aged 60–64 years, living in the United Kingdom, who had previously taken part in breast cancer screening were recruited via a market research panel. They completed an online survey assessing willingness to receive advice, the potential impact of advice on breast screening participation, prospective acceptability and preferences for mode and timing of advice.ResultsMost women would be willing to receive information about cervical (86%) and bowel cancer screening (90%) and early symptoms of other cancers (92%) at a breast cancer screening appointment. Those who were not up to date with cervical cancer screening were less willing. Prospective acceptability was high for all three forms of advice and was associated with willingness to receive advice. Women would prefer to receive advice through a leaflet (41%) or discussion with the mammographer (30%) either before the appointment (27%), at the appointment (44%) or with their results (22%).ConclusionsWhile there is high willingness and high acceptability towards using breast cancer screening as a teachable moment for advice about prevention and early detection of other cancers, some women find it unacceptable and this may reduce their likelihood of attending a breast screening appointment.Patient or Public ContributionThis study focused on gaining women's insights into potential future initiatives to encourage screening and early diagnosis of cancer. Members of the public were also involved in piloting the questionnaire.

COVID-19 and cancer screening in Scotland: A national and coordinated approach to minimising harm

Screening is an important component of cancer control internationally. In Scotland, the National Health Service Scotland provides screening programmes for cervical, bowel and breast cancers. The COVID-19 pandemic resulted in the suspension of these programmes in March 2020. We describe the integrated approach to managing the impact of the pandemic on cancer screening programmes in Scotland throughout 2020. We outline the policy context and decision-making process leading to suspension, and the criteria and framework informing the subsequent, staggered, restart in subsequent months.The decision to suspend screening services in order to protect screening invitees and staff, and manage NHS capacity, was made after review of numbers of screening participants likely to be affected, and the potential number of delayed cancer diagnoses. Restart principles and a detailed route map plan were developed for each programme, seeking to ensure broad consistency of approach across the programmes and nationally. Early data indicates bowel, breast and cervical screening participation has increased since restart. Primary care has had to adapt to new infection prevention control measures for delivery of cervical screening. Cancer charities provided cancer intelligence and policy briefs to national bodies and Scottish Government, as well as supporting the public, patients and screening invitees through information and awareness campaigns.Emerging from the pandemic, there is recognition of the need and the opportunity to transform and renew both cancer and screening services in Scotland, and in particular to address long-standing workforce capacity problems through innovation and investment, and to continue to prioritise addressing health inequalities.

Beyond language: Motivators and barriers to breast cancer screening among Korean-speaking women in Sydney Metropolitan, Australia.

There are persistent disparities in breast screening participation rates between Australian-born women and women from culturally and linguistically diverse (CALD) backgrounds. Cancer Institute NSW statistics from 2015 show Korean speaking women had the second lowest breast screening participation rates when compared across all language groups. The study aimed to gain a better understanding of the motivators and barriers associated with participation in breast cancer screening among women from a Korean background living in the Sydney metropolitan area. Semi-structured individual interviews (n=32) and small focus groups (n=28) were conducted. Data from interviews and focus group discussions were analysed using thematic analysis. The findings highlight the barriers to access breast screening services extend beyond language to include perception, a lack of knowledge and understanding of the services offered, unfamiliarity with the Australian healthcare system and distrust in breast screening services. Supporting Korean women to understand and navigate the Australian healthcare system plays an important role in increasing breast screening participation rates. Key strategies to provide this support include the delivery of culturally sensitive health promotion and community engagement as well as the provision of translated health information.

Barriers and facilitators to participation in breast, bowel and cervical cancer screening in rural Victoria: A qualitative study.

Issue addressedPopulation cancer screening rates are around 50% for the general population and even lower in rural areas. This study aimed to explore knowledge, attitudes, behaviours, motivators and barriers to breast, bowel and cervical screening participation in under‐screened men and women.MethodsWe used a qualitative research design. Focus groups were segmented by age, sex and screening participation. Participants were under‐screened in at least one of the cancer screening programs, with separate groups for each of the programs. The discussion guides were designed around the Health Belief Model and group discussions were coded using a thematic content analysis approach.ResultsFourteen focus groups were held with 80 participants. Key themes were that the concept of cancer screening was not well understood, a low priority for preventive health behaviours, issues relating to local general practitioners (GP) and screening was unpleasant, embarrassing and/or inconvenient. A key determinant of participation in cancer screening was exposure to prompts to action, and it was evident that participants often required multiple prompts before they took action.ConclusionsOpportunities that develop attitudes to health that place disease prevention as a high priority; improve understanding of the benefit of screening in terms of early detection and treatment; improve GP availability and the patient‐practitioner relationship; and the development of messages for each of the screening programs should be further explored as factors that may influence rural population screening rates.So what?Addressing health attitudes, beliefs, knowledge, health practitioner and test‐related barriers and improving messaging may increase cancer screening participation in under‐screened rural populations.

Cervical screening attendance and cervical cancer risk among women who have sex with women.

ObjectivesTo describe cervical cancer screening participation among women who have sex exclusively with women (WSEW) and women who have sex with women and men (WSWM) compared with women who have sex exclusively with men (WSEM), and women who have never had sex and compare this with bowel (colorectal) and breast screening participation. To explore whether there is evidence of differential stage 3 cervical intraepithelial neoplasia (CIN3) or cervical cancer risk.MethodsWe describe cervical, bowel and breast cancer screening uptake in age groups eligible for the national screening programmes, prevalent CIN3 and cervical cancer at baseline, and incident CIN3 and cervical cancer at five years follow-up, among 218,674 women in UK Biobank, a cohort of healthy volunteers from the UK.ResultsCompared with WSEM, in adjusted analysis [odds ratio (95% confidence interval)], WSEW 0.10 (0.08–0.13), WSWM 0.73 (0.58–0.91), and women who have never had sex 0.02 (0.01–0.02) were less likely to report ever having attended cervical screening. There were no differences when considering bowel cancer screening uptake (p = 0.61). For breast cancer screening, attendance was lower among WSWM 0.79 (0.68 to 0.91) and women who have never had sex 0.47 (0.29–0.58), compared with WSEM. There were incident and prevalent cases of both CIN3 and cervical cancer among WSEW and WSWM. Compared with WSEM with a single male partner, among WSEW there was a twofold increase in CIN3 1.91 (1.01 to 3.59); among WSWM with only one male partner, this was 2.25 (1.19 to 4.24).ConclusionsThese findings highlight the importance of improving uptake of cervical screening among all women who have sex with women and breast screening among WSWM and women who have never had sex.

Information About Overdetection Improves Knowledge Without Affecting Participation in Breast Cancer Screening: Two-Year Outcomes of a Randomised Controlled Trial

Background: Supporting women to make well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Our trial investigated the effects of informing women about overdetection on their breast screening knowledge and participation over 2 years. Methods: This community-based, parallel-group, randomised controlled trial in New South Wales, Australia, recruited women aged 48–50, without personal or strong family history of breast cancer, who had not undergone mammography in the past 2 years. A computer program randomised 879 women to receive the intervention decision aid (evidence-based information on overdetection, breast cancer mortality reduction, and false positives; n=440) or a control decision aid (identical but without overdetection information; n=439). Participants and interviewers were blinded to group assignment. 838 women completed telephone interviews post-intervention (when we assessed our primary outcome, informed choice) and were contacted for follow-up at 6 months, 1 and 2 years. Outcomes were analysed in all women who completed relevant follow-ups. Main outcomes for this report are breast screening knowledge and participation. This trial is registered with ANZCTR.org.au, ACTRN12613001035718. Findings: We followed up 790 participants at 6 months, 756 at 1 year, and 712 at 2 years. Knowledge was superior in the intervention group at all time points. After 2 years, 123 (34%) of 358 women in the intervention group demonstrated adequate conceptual knowledge compared with 71 (20%) of 354 in the control group (odds ratio 2·04, 95% CI 1·46-2·85). Screening attendance over 2 years was similar between groups (200 [50%] vs 204 [51%]; odds ratio 0·97, 95% CI 0·73-1·29). Interpretation: A brief decision aid produced lasting improvement in women’s understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening. Trial Registration: This trial is registered with ANZCTR.org.au, ACTRN12613001035718. Funding Statement: Australian National Health and Medical Research Council. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The University of Sydney Human Research Ethics Committee approved the trial (2012/1429), and the NSW Population & Health Services Research Ethics Committee additionally approved the linkage with BreastScreen NSW data (2018HRE0203).

Attending to the Psychosocial Needs of Older Hispanic, Black and Non-Hispanic White Women and Their Breast Cancer Screening Behaviors

BackgroundCancer risk increases with age. Despite breast cancer screening guidelines, older minorities are less likely to obtain screenings. Many factors influence cancer screening participation, though the literature rarely examines factors influencing cancer screening in older adult minority populations. MethodsUsing 2008 and 2012 waves of data from the Health and Retirement study, we examined and compared the relationships between psychosocial factors and breast screening participation among older African American, Hispanic and non-Hispanic White women. We utilized logistic regression to determine the influence of psychosocial factors (satisfaction with aging, religiosity, perceived control, emotions, purpose in life) in 2008 predicting breast cancer screening participation in 2012, given the increasing importance of understanding health behaviors as predicted by prior circumstances. While controlling for other variables, the major findings demonstrated that the odds of having a mammogram among Hispanics decreased as feelings that ‘things were getting worse’ with age intensified; and screening was more likely among Hispanic religious women. The odds of obtaining a mammogram increased with increasing purpose in life for Hispanics. Conclusions and ImplicationsThese findings suggest the need for comprehensive geriatric assessments to understand the perspectives of older minority women, and provides formative data to inform shared decision-making interventions.

Understanding the participation of breast screening among women born in predominantly Muslim countries living in Victoria, Australia from record-linkage data.

BackgroundEarly detection of breast cancer can improve survival rates and decrease mortality rates. This study investigates whether there are significant differences in participation in breast screening among women born in Muslim countries compared to women born in Non-Muslim countries and Australia.MethodsScreening data from January 1st, 2000 to December 31st, 2013 from the Breast Screen Victoria Registry (BSV) was linked with hospital records from the Victorian Admitted Episodes Dataset (VAED). Countries having more than 50% of their population as Muslim were categorised as Muslim countries. Age adjusted rates were calculated for women born in Muslim and Non-Muslim countries and compared with the Australian age adjusted rates. Logistic regression assessed the association between screening status and other factors which include country of birth, marital status, age and socio-economic status.ResultsWomen born in Muslim countries (Odds Ratio (OR) = 0.70, 95%CI = 0.68–0.72) and in other Non-Muslim countries (OR = 0.87, 95%CI = 0.86–0.88) had lower odds of participation in breast screening than Australian born women. Women aged 60–64 years (OR = 1.42, 95%CI = 1.40–1.44) had higher odds of participation in the BreastScreen program than 50–54 age group.ConclusionThis study provides valuable insights to understanding breast screening participation among women born in Muslim countries residing in Victoria. This population level study contributes to the broader knowledge of screening participation of women born in Muslim countries, an understudied population group in Australia and across the world. This study has implications for breast screening programs as it highlights the need for culturally sensitive approaches to support breast screening participation among women born in Muslim countries.