title: Urban-rural differences in a population-based breast cancer screening program in Croatia.
abstract: OBJECTIVE
  To investigate urban-rural differences in the distribution of risk factors for breast cancer.
  
  
  METHODS
  We analyzed the data from the first round of the "Mamma" population based-screening program conducted in Croatia between 2007 and 2009 and self-reported questionnaire results for 924 patients with histologically verified breast cancer. Reproductive and anthropometric characteristics, family history of breast cancer, history of breast disease, and prior breast screening history were compared between participants from the city of Zagreb (n = 270) and participants from 13 counties with more than 50% of rural inhabitants (n = 654).
  
  
  RESULTS
  The screen-detected breast cancer rate was 4.5 per 1000 mammographies in rural counties and 4.6 in the city of Zagreb, while the participation rate was 61% in rural counties and 59% in Zagreb. Women from Zagreb had significantly more characteristics associated with an increased risk of breast cancer (P<0.001 in all cases): no pregnancies (15% vs 7%), late age of first pregnancy (≥ 30 years) (10% vs 4%), and the most recent mammogram conducted 2-3 years ago (32% vs 14%). Women from rural counties were more often obese (41% vs 28%) and had early age of first live birth (<20 years) (20% vs 7%, P<0.001 for both).
  
  
  CONCLUSIONS
  Identification of rural-urban differences in mammography use and their causes at the population level can be useful in designing and implementing interventions targeted at the reduction of inequalities and modifiable risk factors.
authors.affiliation: Department for Project and Programmes, Ministry of Health and Social Welfare, Zagreb, Croatia. valerija.stamenic@mzss.hr
authors.forename: Valerija
authors.initials: V
authors.lastname: Stamenić
authors.forename: Marija
authors.initials: M
authors.lastname: Strnad
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D017523:Croatia / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000592:standards*; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008327:Mammography; D008423:Maternal Age; D009765:Obesity / Q000150:complications; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health; D014932:Women's Health Services / Q000592:standards