title: Adherence to a breast cancer screening program and its predictors in underserved women in southern Brazil.
abstract: BACKGROUND
  Adherence to breast cancer screening is a key element to ensure effectiveness of programs aiming at downstaging of breast cancer. In this study, we evaluated adherence to a screening program and its predictors in underserved women in southern Brazil.
  
  
  METHODS
  Attendance to the program, which is based on yearly mammogram and clinical examination, was evaluated prospectively. Mean time frames between visits were calculated. Possible predictors of adherence (defined as mean intervals ≤18 mo), such as socioeconomic indicators and health/lifestyle behaviors, were investigated.
  
  
  RESULTS
  A total of 3,749 women (age 51 ± 8 y, illiteracy rate of 6.8%, 57.4% with parity ≥3) were analyzed. Median time between screening rounds was 16.5 months (interquartile range, 13.1-25.7), and median number of rounds attended was 3 (interquartile range, 2-4); 57.6% had mean intervals ≤18, and 71% ≤24 months. The most important independent predictors of adherence were high genetic risk [relative risk (RR), 1.25; 95% confidence interval (95% CI), 1.11-1.40], illiteracy (RR, 0.77; 95% CI, 0.67-0.90), parity ≥5 (RR, 0.89; 95% CI, 0.83-0.96), and smoking (RR, 0.82; 95% CI, 0.77-0.88).
  
  
  CONCLUSIONS
  Although the proposed screening interval was 1 year, compliance to biannual screening (accepted in several international programs) was high, especially when considering the low socioeconomic level of the sample.
  
  
  CONCLUSIONS
  This project aims to test a breast cancer screening model for underserved populations in limited-resource countries where adherence is an issue. The identification of worst adherence predictors can point to interventions to improve outcomes of similar public health screening strategies.
authors: Núcleo Mama Porto Alegre, Associação Hospitalar Moinhos de Vento, Brazil. maira@hmv.org.br
authors: Maira
authors: M
authors: Caleffi
authors: Rodrigo A
authors: RA
authors: Ribeiro
authors: Ademar J
authors: AJ
authors: Bedin
authors: Júlia M P
authors: JM
authors: Viegas-Butzke
authors: Fernanda D G
authors: FD
authors: Baldisserotto
authors: Giovana P
authors: GP
authors: Skonieski
authors: Juliana
authors: J
authors: Giacomazzi
authors: Suzi A
authors: SA
authors: Camey
authors: Patrícia
authors: P
authors: Ashton-Prolla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult