title: Explaining variations in breast cancer screening across European countries.
abstract: OBJECTIVE
  In this study I aim to explore the statistical causes of country differences in mammography screening among women aged 50-69 years in 13 European countries. I focus on the relative importance of individual (e.g. age, education, etc.) and institutional (e.g. public screening programmes) factors in explaining these differences.
  
  
  METHODS
  I use individual level data from the first three waves (2004-2006-2009) of the SHARE as well as regional and country level data on institutional factors. The analytical approach is based on multilevel statistical models, which allow me to analyse the contribution of individual and institutional factors in explaining the variation in breast cancer screening across European countries.
  
  
  RESULTS
  I find that the standard deviation in screening rates across countries increases slightly from 19.5 to 20.8 per cent after controlling for individual factors. Observed individual factors such as age, education, health status, etc., do not significantly contribute to the explanation of cross-country differences. In contrast, after controlling for observed institutional factors such as the availability of an organised screening programme, the standard deviation drops from 20.86 to 12.92 per cent. These factors can statistically explain about 40 per cent of the between-country differences in screening rates. Moreover, I found that these institutional factors seem to prevent a woman from considering a mammogram "not necessary".
  
  
  CONCLUSIONS
  This analysis provides important insights about patient's attitudes and understanding of benefits of breast cancer prevention and highlights the importance of the availability of an organised screening programme for screening differences across European countries.
authors.affiliation: Department of Economics, Institutional Economics and Health Systems Management, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany, ansgar.wuebker@uni-wh.de.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Wübker
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D015438:Health Behavior; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D038622:Internationality; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors