title: Geographic access to mammography screening centre and participation of women in the Quebec Breast Cancer Screening Programme.
abstract: BACKGROUND
  This study evaluated the impact of distance between women's residences and designated screening centres (DSC) on participation in the Quebec Breast Cancer Screening Programme, whether this impact varied according to the rural-urban classification and the proportion of participants who used the DSC nearest to their home.
  
  
  METHODS
  Travel distance between the residence of 833 856 women and the nearest DSC (n=85) was estimated. Data were obtained from administrative and screening programme databases. The analysis made use of a log-binomial regression model adjusting for age and material and social deprivation. The proportions of participants who used the DSC nearest to their residence were measured.
  
  
  RESULTS
  Compared to women living <2.5 km from a DSC, absolute decreases of 6.3% and 9.8% in participation rate were observed for distances of 50.0 to <75.0 km (rate ratios (RR)=0.88, 95% CI 0.86 to 0.89) and ≥75.0 km (RR=0.81, 95% CI 0.79 to 0.83), respectively. The lowest participation (42%) was observed in Montreal Island. The distance at which participation started to decrease materially varied according to rural-urban classification. Participation rates decreased at distances of ≥25.0 km in the Montreal suburbs and midsize cities, at ≥12.5 km in small cities and at ≥50.0 km in rural areas (interaction p<0.0001). The proportion of participants who had their mammography at the nearest DSC decreased with increasing distance.
  
  
  CONCLUSIONS
  Distance affects participation and this effect varies according to rural-urban classification. The lower participation in Montreal Island, where all women lived <12.5 km from a DSC, argues for a major impact of other characteristics or other dimensions of accessibility.
authors.affiliation: Direction de l'Analyse et de l'Évaluation des Systèmes de Soins et Services, Institut National de Santé Publique du Québec, , Québec, Québec, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: St-Jacques
authors.forename: Mathieu D
authors.initials: MD
authors.lastname: Philibert
authors.forename: André
authors.initials: A
authors.lastname: Langlois
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Daigle
authors.forename: Eric
authors.initials: E
authors.lastname: Pelletier
authors.forename: Diane
authors.initials: D
authors.lastname: Major
authors.forename: Jacques
authors.initials: J
authors.lastname: Brisson
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D012959:Socioeconomic Factors; D014195:Travel
keywords: ACCESS TO HLTH CARE; CANCER: BREAST; SCREENING