title: Non-attendance in breast cancer screening is associated with unfavourable socio-economic circumstances and advanced carcinoma.
abstract: Our first objective was to assess changes in non-attendance, proportion of advanced breast cancer and survival in Malmö Mammographic Service Screening Program, MMSSP, compared to a former trial, Malmö Mammographic Screening Trial, MMST. Our second objective was to describe non-attenders in MMSSP in socio-economic terms and risk for advanced breast cancer compared to attenders. Information from hospital and national registers was used to identify 33,800 women invited to service screening in MMSSP 1990-93. Attendance rates at first screening, the proportion of advanced breast cancers (Stage II-IV) and survival among non-attenders in MMSSP were compared to the non-attenders and with the control group of the former trial, MMST. Various socio-economic factors were assessed as potential predictors of non-attendance in MMSSP. Odds ratios (OR) and 95% confidence interval (CI) were computed. Incidence of breast cancer during a 10-year-period, relative risks and 95% CI among non-attenders compared to attenders in MMSSP were computed. Attendance rates were significantly lower in MMSSP but a lower proportion of advanced breast cancers and a somewhat better survival among breast cancer cases (not significant) was seen in non-attenders in MMSSP compared to MMST. In MMSSP non-attendance was associated with being unmarried, being born abroad, being not currently employed, crowded housing conditions and low income. Incidence of advanced breast cancer was significantly higher among non-attenders than among attenders. Attendance has decreased over time and potential reasons are discussed. Stage distribution and survival among non-attenders seem to have improved. Several socio-economic factors predict non-attendance and non-attenders are at higher risk for advanced breast cancer.
authors.affiliation: Department of Community Medicine, Unit of Epidemiology, Lund University, Malmö University Hospital, Malmö, Sweden. sophia.zackrisson@smi.mas.lu.se
authors.forename: Sophia
authors.initials: S
authors.lastname: Zackrisson
authors.forename: Ingvar
authors.initials: I
authors.lastname: Andersson
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Lars
authors.initials: L
authors.lastname: Janzon
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D013548:Sweden