Women Attending Research Articles

Emotional barriers pose the greatest threat to cervical cancer screening for young adult women in the United Kingdom

ObjectiveLow cervical screening coverage rate is the root-cause of cervical cancer mortality in the United Kingdom (UK), with 99 % of deaths being considered preventable. Research has consistently categorised reasons for non-attendance into emotional, practical, and cognitive barriers. Despite this, public health interventions have been unable to improve coverage rates. We propose a lifespan perspective is needed, to enable targeted interventions at appropriate milestones (i.e., common life events) during a woman's life. We start this lifespan perspective by investigating the perceived barriers young women report, who have and have not yet been invited to their first cervical screen (i.e., a common life event). MethodsTwenty-nine women not yet invited to their first cervical screen and twenty women who confirmed they received their invite and confirmed attendance status, rated the likelihood of emotional, practical, and cognitive barriers affecting their attendance at their next cervical screen. Data collected between January and April 2018. ResultsWomen who did not attend their first screen, rated emotional barriers significantly higher than all groups, and cognitive barriers higher than those women who did attend. Results highlight, for the first time, that commonly reported barriers are present up to seven years prior to a woman's first eligible cervical screen, with emotional barriers rated most strongly. ConclusionEmotional barriers pose the greatest threat to cervical screening attendance in young adult women. Interventions should start at school to encourage cervical screening to be viewed as routine healthcare. Future research should continue a lifespan perspective, indexed to common life events.

Uptake of cervical screening and acceptability of HPV self-sampling in Irish Traveller women

Abstract Introduction Irish Travellers are a minority ethnic group. The 2010 All-Ireland Traveller Health Study noted the life expectancy of Traveller women was 11 years shorter than women in the general population. Coverage of the CervicalCheck, the Irish cervical screening programme, is 78.7% overall, however, there is no recently published data on the attendance of Traveller women. This study sought to determine participation by eligible Traveller women in CervicalCheck and the acceptability of HPV self-sampling. Methodology A face-to-face cross-sectional survey, adapted from the National Cancer Control Programme’s 2022 National Survey on Cancer Awareness, was disseminated to Irish Travellers via Primary Health Care Travellers Project peer researchers, following ethical approval, May to December 2023. Results 451 Travellers participated; 286 (63.4%) were female. Of these, 178 (62.2%) were in the eligible age group for cervical screening. 134 (75.3%) advised they had received an invitation to screening; 121 (68% of all eligible; 90% of all receiving an invitation) advised they had attended at least once (regular attenders 88 (49.4%); 27 (15.2%) irregular attenders). Of all responders in the screening eligible age group, 36 (20.2%) reported HPV self-sampling as acceptable; 18 (50%) of these were non or irregular attenders at screening. Similar proportions of 25-45 year-olds (20.4%) and 46-65 year-olds (20%) reported HPV self-sampling as acceptable. Conclusions Irish Traveller women face barriers to accessing mainstream health services. Uptake of cervical screening overall is lower compared to the general population in this study; one issue may be unreliable postal service to Travellers and non-receipt of invitations. While the overall acceptability of HPV self-sampling was low at 20.2%, half of those who would self-sample did not attend or attended irregularly. HPV self-sampling has the potential to improve cervical screening rates among Traveller women. Key messages • Irish Traveller women’s uptake of cervical screening is lower than general population. • HPV self sampling has potential to improve cervical screening rates in Travellers.

Knowledge and Associated Factors Affecting the Use of Contraceptive Among Women Attending Two Selected Primary Health Care Centre in Ogun State

Knowledge and Associated Factors Affecting the Use of Contraceptive Among Women Attending Two Selected Primary Health Care Centre in Ogun State

Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records.

Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019-September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.

Antenatal Care Visits, Institutional Births, and Associated Risk Factors in Afghanistan: Insights from the Multiple Indicator Cluster Survey 2022-2023.

Insufficient use of antenatal care (ANC) services and institutional births services can elevate the maternal mortality risk in limited resource settings. Hence, the key objective of this study was to evaluate the potential association between the frequency of ANC visits and institutional birth services in Afghanistan, while also identifying other sociodemographic factors that may exert influence. Furthermore, we explored factors associated with the attendance of women at ANC visits during their pregnancy. We employed data from the most recent Multiple Indicator Cluster Survey conducted in Afghanistan in 2022 to 2023 with a total of 8096 women aged 15 to 49. A complex survey weight-adjusted logistic regression model was used to examine factors related to institutional births, and a multinomial logistic regression model was fitted to assess the relationships between sociodemographic factors and ANC visits, adjusting for survey weights, cluster effects, and strata. Approximately 40% of the sample (n = 3247) had undergone 4 or more ANC visits, and 74.4% (n = 6,022) had opted for institutional birth. Women's higher education was found to be associated with ANC visits. The area of residence, wealth index, education levels of women, ownership of mobile phones, number of children, and number of ANC visits were associated with institutional births. Compared with women with no or one ANC visit, those with more than 3 visits had 31% higher odds (adjusted odds ratio, 1.31; 95% CI, 1.10-1.57) of accessing institutional births. Our findings indicate a significant association between ANC visits and use of institutional birth care. These findings carry implications for advancing safe motherhood and childbirth by enhancing women's social status.

The determinants of stadium attendance in elite women’s football: evidence from the FA Women’s Super League

ABSTRACT Research question While increasing the number of spectators at women’s football matches is critical for the commercial growth of the sport, the academic literature offers limited evidence on the drivers of stadium attendance for women’s football. This study investigates the factors influencing fan interest in the English Football Association (FA) Women’s Super League (WSL). Research methods Analysing 476 WSL games played from 2013 to 2018/19, regression models are tested to determine the impacts of socioeconomic factors, product-specific variables, match outcome uncertainty, and the substitution effect. Results and findings Strong local economies increase attendance at FA WSL matches, with weekend games, favourable weather, and shorter travel distances also attracting more fans. Higher stadium capacity, outcome certainty, and home team winning odds are associated with increased fan interest. Fans of integrated clubs attend women’s matches less when these clash with games of the respective men’s team, except for double-headers. Implications Improving scheduling and matchday facilities is vital for women’s football. Harmonising the football calendar while considering men’s and women’s national and international competitions can enhance stadium attendance at FA WSL matches. Encouraging cross-fertilisation between men’s and women’s football supporters can create spillover effects and boost women’s game attendance.

Integrated women's football teams can attract larger stadium crowds

ABSTRACT Research Question Women's sports have seen a trend of diversification recently, with women's and men's teams merging to form integrated football clubs. While such integrated clubs (e.g. Paris Saint-Germain), in particular, have determined the media headlines with record attendances, governing bodies have begun drafting policies to accelerate such strategic integrations. However, empirical evidence on whether integrated women's football teams (which may benefit from brand spillover effects, among other things) attract larger crowds to their stadiums is limited at best. Naturally, this raises the question of whether being an integrated football club matters for women's football stadium attendance demand. Research Method Using ordinary least squares regression with season-level fixed effects with a dataset of 1,506 games played over 11 seasons before and after the COVID pandemic in Germany, France, and Sweden, we are the first to present robust evidence on the association between being an integrated football clubs and stadium attendance demand for European women’s football across multiple markets. Results and Findings We find that integrated women's football teams can attract larger crowds. Intriguingly, such demand synergies, however, are not a given emerging from a strong brand effect, per se. Instead, women's football club executives must proactively unlock these synergies to avoid adverse effects. Implications Our findings suggest that women’s football may achieve a higher potential through integration, but only if the women’s team is managed as more than an ancillary second team. As such, despite being formulated with the best intentions, forced integration policies might backfire.

Public health nurse perspectives on predicting nonattendance for cervical cancer screening through classification, ensemble, and deep learning models.

Women's attendance to cervical cancer screening (CCS) is a major concern for healthcare providers in community. This study aims to use the various algorithms that can accurately predict the most barriers of women for nonattendance to CS. The real-time data were collected from women presented at OPD of primary health centers (PHCs). About 1046 women's data regarding attendance and nonattendance to CCS were included. In this study, we have used three models, classification, ensemble, and deep learning models, to compare the specific accuracy and AU-ROC for predicting non-attenders for CC. The current model employs 22 predictors, with soft voting in ensemble models showing slightly higher specificity (96%) and sensitivity (93%) than weighted averaging. Bagging excels with the highest accuracy (98.49%), specificity (97.3%), and ideal sensitivity (100%) with an AUC of 0.99. Classification models reveal Naive Bayes with higher specificity (97%) but lower sensitivity (91%) than Logistic Regression. Random Forest and Neural Network achieve the highest accuracy (98.49%), with an AUC of 0.98. In deep learning, LSTM has an accuracy of 95.68%, higher specificity (97.60%), and lower sensitivity (93.42%) compared to other models. MLP and NN showed the highest AUC values of 0.99. Employing ensemble and deep learning models proved most effective in predicting barriers to nonattendance in cervical screening.

Human papillomavirus 16 specific immunoglobulin g antibodies and its correlates among women attendees of selected hospitals in Southern Kaduna, Kaduna State, Nigeria

Human papillomavirus type 16 (HPV-16) is one of the high-risk viruses that cause cervical cancers. Persistent infection with the virus leads to development of precancerous lesions of the cervix in infected women, which without medical intervention can progress to invasive cervical cancer. This study assessed HPV16-specific immunoglobulin G (IgG) antibodies in the serum of women attendees of General Outpatient Department (GOPD) at General Hospital Kafanchan and Kagarko in Kaduna State. This was a cross-sectional study. Structured, self-administered questionnaire was used to collect information and blood samples were also collected for testing. This was in addition to information collected from the laboratory analyzed. Five milliliters (5mls) of blood were aseptically collected from each of the 200 women, who had no history of HPV vaccination at the time of the study for the determination of HPV16-specific IgG antibodies using enzyme-linked immunosorbent assay method. The sero-positivity for HPV 16-specific IgG antibodies among the women was 24.5%. The sero-positivity among women who had their first sexual intercourse at age 13-19 years was 37.6%, and it was significantly different from those who had their sexual debut at ≥20 years (14.8 %) (p=0.001). Sero-positivity also increased from 9.2 % in women with one lifetime sexual partner to 60.0% in those with multiple sexual partners(p=0.001). The finding showed that the women in this study have been exposed to the HPV-16 virus. Further study with a larger population of women in this locality to determine the level of susceptibility or immunity to HPV-16 is strongly advocated, among others.

학부모 학교참여 휴가제 도입에 관한 학부모의 인식연구

The purpose of this study was to examine the current status of parents' participation in school and their perception of the School Activities Leave system for the introduction of the parent School Activities Leave system. The survey was conducted with 12,000 parents of kindergartens, elementary, middle, and high schools in Gyeonggi-do. Data analysis was performed using the SPSS Statistics 28.0 program, which included frequency analysis, descriptive statistics, and cross-tabulations. Additionally, text mining and emotional analysis were conducted using Orange 3 software to analyze further opinions on the parent School Activities Leave system. The survey results regarding the current status and perception of school participation are as follows. Firstly, approximately 78% of parents participated in their children's school events or meetings last year, with about 65% participating more than once a semester. This suggests a quantitative foundation for participation, but qualitative improvements are needed. Secondly, around 85% of respondents identified mothers as the main participants in parents' school involvement, reflecting a persistently high perception of women's attendance at their children's schools. Thirdly, parents recognized that participation in school would generally have positive effects, such as children's adaptation to school life and improvement of self-esteem. Nevertheless, over 70% of respondents cited lack of time as a barrier to participation, highlighting the ongoing need for time management solutions. Lastly, 86.5% of surveyed parents expressed a need for the introduction of a parental School Activities Leave system, underscoring a direct demand for such a system. Text mining analysis of additional opinions on the parent School Activities Leave system revealed a predominantly positive perception, as evidenced by the prevalence of positive words and emotions in comparison to negative ones.

Exploring Perceptions about Enablers of Women’s Attendance and Adherence to the Recommended Antenatal Care Visits in Rwanda: A Qualitative Study

BackgroundAntenatal care (ANC) helps ensure the best health conditions of the mother and foetus during pregnancy. However, achieving optimal ANC attendance and adherence to the World Health Organization (WHO) recommendations remains a global challenge, with significant disparities in attendance rates. A qualitative study was conducted exploring pregnant women's perspectives of various enablers to their attendance and adherence to recommended ANC visits in Rwanda. MethodsThis exploratory qualitative study involved 22 pregnant women attending ANC in four public health centres in the Eastern province, of Rwanda. An interview guide with semi-structured questions was used to gather information about the moderators of ANC attendance and adherence among pregnant women. Data were audio-recorded and transcribed verbatim, and thematic analysis was used to categorize themes under the five-level Social Ecological Model (SEM).ResultsEarly recognition of pregnancy, financial stability, and female participation in decision-making were identified as intrapersonal enabling factors of ANC attendance and adherence; spousal support was identified as an interpersonal enabling factor; community health workers, and community relationships as community enabling factors; availability and cost of ANC services as institutional enabling factors; and media campaign, community outreach as public policy enabling factors contributing to the pregnant women's attendance and adherence to ANC visits.ConclusionEnablers at multiple levels affect women’s attendance and adherence to ANC visits. It is essential to consider each level when implementing effective strategies to maximize ANC attendance and adherence to the WHO recommendations in order to improve maternal- foetal well-being in Rwanda.Rwanda J Med Health Sci. 2024;7(1):101-115

Factors Influencing Women's Attendance to Postnatal Clinics in the Primary Healthcare Centers in the Kingdom of Bahrain, 2023.

Despite the significance of postnatal care for maternal health, the attendance rate of mothers at postnatal clinics (PNCs) in primary healthcare (PHC) centers in Bahrain is low. This study aims to identify factors influencing women's attendance at PNC in PHC centers in the Kingdom of Bahrain and to propose strategies for service improvement. In January 2023, we conducted a cross-sectional study. We selected mothers who gave birth between six and 12 months before the survey and met inclusion criteria using systematic simple random sampling and obtained consent (n = 319). Data collection utilized an electronic, structured, interviewer-administered questionnaire, and analysis was carried out using SPSS version 28 (IBM Corp., Armonk, NY). Out of the 319 participants, 31% were unaware of the existence of PNC, 42% were aware but did not attend, and 27% were aware and had attended the clinic. Mother and child department clerks, doctors, health education boards, and midwives served as the primary sources of information about the PNC for only 34%, 16%, 16%, and 11% of participants, respectively. Understanding the importance of PNC, the services offeredby a healthcare worker,the booking process, having a vaginal delivery, and prior experience with a PNC visit were significantly associated with PNC attendance (p = 0.0046, p = 0.027, p < 0.001, p = 0.028, and p < 0.001, respectively). The attendance of 81 mothers, representing 94% of the total women who attended the clinic, was driven by their acknowledgment of the service's importance. Childcare responsibilities, perception of the visit as unimportant, and reluctance to undergo a pelvic examination were the top reasons for not attending the clinic, despite 41%, 38%, and 37% of participants being aware of it. Postnatal care attendance remains suboptimal for mothers in Bahrain. Awareness of the clinic's presence, counseling by healthcare providers, and prior experience with PNC visits were found to be significant determinants of attendance.

Does Location Matter? An Econometric Analysis of Stadium Location and Attendance at National Women’s Soccer League Matches

This study examines the impact of stadium locations on attendance in the National Women’s Soccer League (NWSL). We develop a match-level attendance model incorporating control variables such as market factors and consumer preferences to assess attendance for NWSL games. Our results indicate that attendance drops the further an NWSL stadium is from the city center. Specifically, the coefficients suggest an inverse relationship between attendance at NWSL matches and the distance to the city center, indicating that for every mile further an NWSL team was from the city center, attendance declined by about 6.6%. Our findings show that some of the perceived differences in demand for women’s soccer may be due to infrastructural inequalities such as stadium locations. Therefore, one way to boost demand and attendance in professional women’s sport, specifically soccer, is to move away from suburban stadiums and toward downtown locations.

Reducing Barriers and Strategies to Improve Appropriate Screening Mammogram Attendance in Women 75 Years and Older.

Although breast cancer death rates have persistently declined over the last 3 decades, older women have not experienced the same degree in mortality reduction as younger women despite having more favorable breast cancer phenotypes. This occurrence can be partially attributed to less robust mammographic screening in older women, the propensity to undertreat with advancing age, and the presence of underlying comorbidities. With recent revisions to breast cancer screening guidelines, there has been a constructive shift toward more agreement in the need for routine mammographic screening to commence at age 40. Unfortunately, this shift in agreement has not occurred for cutoff guidelines, wherein the recommendations are blurred and open to interpretation. With increasing life expectancy and an aging population who is healthier now than any other time in history, it is important to revisit mammographic screening with advanced age and understand why older women who should undergo screening are not being screened as well as offer suggestions on how to improve screening mammogram attendance in this population.

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study

BackgroundWomen referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AimsThis study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. MethodsA qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FindingsContinuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. ConclusionsContinuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.

Determining the Frequency and Influential Factors Impacting Antenatal Care Service Utilization Among Pregnant Women in Attendance at Mutara Health Centre III, Mitooma District, Uganda

Antenatal care (ANC) plays a pivotal role in curbing maternal mortality rates. This investigation sought to gauge the prevalence of and factors influencing antenatal care service utilization among pregnant women visiting Mutara Health Centre III's antenatal care clinic. The study involved 200 pregnant women in a cross-sectional analysis, employing an interview questionnaire to assess ANC service utilization determinants. Statistical Package for Social Sciences software was utilized for data analysis. The prevalence was determined by comparing the actual ANC attendance (from mid-July 2022 to mid-August 2022) against the projected monthly ANC attendance (300). The resulting attendance rate of 66.67% was categorized as inadequate, falling below the globally recommended coverage of 80%. Demographic findings revealed that the majority (57.5%) were peasants, while 47.5% of their partners had primary education. Alarmingly, 62.5% lacked knowledge regarding the appropriate timing for seeking ANC. Key conclusions drawn were that the attendance rate for ANC was notably low, coupled with inadequate knowledge among pregnant women about ANC and a prevalence of low socioeconomic status. Recommendations included tailored education programs for expectant mothers on ANC services by healthcare personnel at Mutara Health Centre III, public awareness campaigns by the Mitooma district health officer emphasizing the benefits of ANC attendance, governmental strategies to improve the livelihoods of those served by the health center, and a proposed study to assess maternal mortality prevalence specifically at Mutara Health Centre III. Keywords: Antenatal care, Pregnant women, maternal mortality, Healthcare workers.

Attitudes of Pregnant Women towards Husband’s Attendance in Delivery Room in Erbil City

Background and Objectives: Pregnancy is a beautiful and challenging time in a woman's life. A pregnant woman needs more care and support from her husband and family during this time because of physical and hormonal changes in her body. Husbands' attendance and support of women during labor can positively affect pregnant women and child’s health. The purpose of this study is to assess women’s attitudes towards the presence of their husbands during labor in Erbil city. Method: A descriptive cross-sectional study was conducted on pregnant women who visited primary health care and Maternity Teaching Hospital in Erbil city. Epi Info 7 was used to determine the sample size which Three hundred participants were the sample of the calculation. Statistical Package for Social Science (SPSS) version 26 was used to analyze and organize the data thorough using frequency, percentage, and chi-square test. Result: The study revealed that 62% of the participants were in the age group 20-30 years old. Most of the women obtained an elementary school certificate, with a percentage 23.3%. Most of the participants were urban residents, which was 81.3%. Regarding the income of the participants, the result indicated that most of them were in conditions sufficient for daily living, which was about 57.3%. Women expressed a good level of attitude towards husbands' attendance in the delivery room 80.3%. Conclusion: This survey illustrated that most pregnant women agreed to the husband's attendance in the delivery room. Pregnant women needed their husbands during labor which is important in their life.

FRI304 Prolactinomas In A Pituitary Center From Ecuador: Clinical Presentation With High Prevalence Of Giant Adenomas And Delayed Diagnosis

Abstract Disclosure: D.P. Quishpe Lopez: None. G.C. Freire Salazar: None. M.V. Villagomez Estrada: None. R.M. Ruiz Urbaez: None. S.A. Baquero Contreras: None. R.D. Mino Rodriguez: None. J.L. Salazar Vega: None. Background: Prolactinomas are the most common pituitary neuroendocrine tumors (PitNET) and account for about 50% of cases. Most of them respond favorably to pharmacological treatment (cabergoline). Epidemiological data in our country are scarce and more reports are needed. The aim of this study was to analyze the clinical presentation of patients with prolactinomas in a tertiary center. A cross-sectional study was performed (November 2021 - December 2022) analyzing information from clinical records. Results: Seventy-nine patients were included, mean age at diagnosis 29.5 years (SD 12.09, range 11-65) of which the majority were women (63.3%). Due multiple factors the diagnosis was delay with a mean of 45.63 months (range 2-216). As variables related with the clinical manifestations of prolactinomas, overweight/obesity was recorded in 79.6% of the cases. The predominant reasons of attendance in women were galactorrhea 48%, menstrual alteration 22% and headache 20%. In men, in the other hand, were visual alteration 48.3% and headache 31%. The main components of hypopituitarism identified were hypogonadism 46.8% and central hypothyroidism 27.8%. Serum prolactin levels at diagnosis differed between macroprolactinomas and microprolactinomas from 5617 ng/mL (136-47000) to 140.17 ng/mL (68-278) respectively. We identified 27 (34.2%) microadenomas, 39 (49.4%) macroadenomas and 13 (16.5%) giant adenomas. Giant prolactinomas predominated in men (76.9%). There was a linear correlation between tumor size and hyperprolactinemia (Spearman correlation 0.87). Regarding initial treatment: 94.9% received pharmacological treatment. Only 5.1% underwent surgery (100% macroadenomas). Conclusion: Several factors and limitations in the public health system of Ecuador delay the timely diagnosis and treatment of pituitary tumors, affecting the quality of life of these patients. Being a national referral center, we receive a high percentage of macroprolactinomas and giant prolactinomas (65.9%). Within public health, this study is a reference to motivate future research and the development of a national guideline to optimize the management of prolactinomas. Presentation: Friday, June 16, 2023

Beneficial effect of repeated participation in breast cancer screening upon survival.

The benefit of mammography screening in reducing population mortality from breast cancer is well established. In this paper, we estimate the effect of repeated participation at scheduled screens on case survival. We analysed incidence and survival data on 37,079 women from nine Swedish counties who had at least one to five invitation(s) to screening prior to diagnosis, and were diagnosed with breast cancer between 1992 and 2016. Of these, 4564 subsequently died of breast cancer. We estimated the association of survival with participation in up to the most recent five screens before diagnosis. We used proportional hazards regression to estimate the effect on survival of the number of scheduled screens in which subjects participated prior to the diagnosis of breast cancer. There was successively better survival with an increasing number of screens in which the subject participated. For a woman with five previous screening invitations who participated in all five, the hazard ratio was 0.28 (95% confidence interval (CI) 0.25-0.33, p < 0.0001) compared to a woman attending none (86.9% vs 68.9% 20-year survival). Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, p < 0.0001), an approximate three-fold reduction in the hazard of dying from breast cancer. For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival.

Beneficial effect of repeated participation in breast cancer screening upon survival.

552 Background: The benefit of mammography screening in reducing population mortality from breast cancer is well established. However, the effect of repeated participation at scheduled screens on case survival is less well documented. Methods: In this retrospective analysis of breast cancer survival, we analyzed incidence and survival data on 37,079 women ages 40-69 from nine Swedish counties who had between one and five invitations to mammography screening and were diagnosed with breast cancer between 1992 and 2016. Of these, 4,564 subsequently died of breast cancer. For each breast cancer diagnosed in each county’s period of observation, we obtained data on previous screening history, and subsequent death (or not) from breast cancer. Formal comparisons of survival with respect to numbers of screening exams attended prior to a diagnosis of breast cancer were carried out using Cox proportional hazards regression with time-varying covariates, ie, cumulative numbers of screens, yielding hazard ratios and 95% confidence intervals (CI). We corrected for potential self-selection using the method of Duffy et al, which gives a corrected estimate based on the proportion of participants, the uncorrected estimate, and the relative risk of breast cancer death for non-participants compared to an uninvited population. Results: Depending on number of invitations, 58-73% (average 65%) participated in all scheduled screens, and 73-96% (average 91%) participated in at least one examination. There was successively better survival among women with increasing numbers of screening exams. For a woman with five previous screening invitations who participated in all five screening exams, the hazard ratio was 0.28 (95% CI 0.25-0.33, p&lt;0.0001), a 72% risk of dying from breast cancer, compared to a woman attending none. Following a conservative adjustment for potential self-selection factors, the hazard ratio was 0.34 (95% CI 0.26-0.43, p&lt;0.0001). Conclusions: For those women who develop breast cancer, regular prior participation in mammography screening confers significantly better survival. Most women will not develop breast cancer in their lifetime. These results indicate that for those who do, regular participation in screening considerably improves the probability of surviving it. The distinction between the general, population benefit of mammography screening, and the benefit of regular participation in mammography screening should be clearly articulated in breast cancer screening messaging and decision aids. [Table: see text]