title: Inequalities in uptake of breast cancer screening in Spain: analysis of a cross-sectional national survey.
abstract: OBJECTIVE
  Breast cancer remains a public health problem worldwide. Early detection through mammography practice has been shown to be effective in improving survival among women. Nevertheless, it is necessary to have high participation in mammography screening to achieve that goal. The aim of this study is to estimate the adherence to recommended preventive practices for breast cancer (mammography) in Spain and to identify predictors of uptake according to sociodemographic variables, health related variables and lifestyles.
  
  
  METHODS
  This is a descriptive cross-sectional study based on data from the European Health Interview Survey for Spain. Breast cancer screening included self-reported mammography in the last two years. The age target range was 40-69 years (n = 5771). The following independent variables were analysed: sociodemographic (marital status, educational level, monthly income, and nationality), visit to a general practitioner, chronic conditions and lifestyles. Predictors of mammography adherence were explored using multivariate logistic regression.
  
  
  RESULTS
  The screening coverage in the target population was 67.7% (95% CI: 66.2-69.1). Mammography uptake was positively associated with being married, higher educational and income levels, Spanish nationality, having visited a general practitioner in the previous four weeks and suffering from musculoskeletal disease. Otherwise, the youngest age group studied (40-49 years) and obesity was associated with lower adherence to mammography.
  
  
  CONCLUSIONS
  Compliance with mammography practice in Spain is acceptable to achieve the goal of reducing mortality from breast cancer among women. However significant inequalities in uptake of breast screening in Spain were found. Future campaigns must aim to improve participation especially among women with disadvantaged socio-economic situations and immigrants.
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Martín-López
authors.forename: R
authors.initials: R
authors.lastname: Jiménez-García
authors.forename: A
authors.initials: A
authors.lastname: Lopez-de-Andres
authors.forename: V
authors.initials: V
authors.lastname: Hernández-Barrera
authors.forename: I
authors.initials: I
authors.lastname: Jiménez-Trujillo
authors.forename: A
authors.initials: A
authors.lastname: Gil-de-Miguel
authors.forename: P
authors.initials: P
authors.lastname: Carrasco-Garrido
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D008019:Life Style; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology
keywords: Adherence; Breast cancer screening; Compliance; Inequalities; Mammography; Predictors