title: European transnational ecological deprivation index and participation in population-based breast cancer screening programmes in France.
abstract: BACKGROUND
  We investigated factors explaining low breast cancer screening programme (BCSP) attendance taking into account a European transnational ecological Deprivation Index.
  
  
  METHODS
  Data of 13,565 women aged 51-74years old invited to attend an organised mammography screening session between 2010 and 2011 in thirteen French departments were randomly selected. Information on the women's participation in BCSP, their individual characteristics and the characteristics of their area of residence were recorded and analysed in a multilevel model.
  
  
  RESULTS
  Between 2010 and 2012, 7121 (52.5%) women of the studied population had their mammography examination after they received the invitation. Women living in the most deprived neighbourhood were less likely than those living in the most affluent neighbourhood to participate in BCSP (OR 95%CI=0.84[0.78-0.92]) as were those living in rural areas compared with those living in urban areas (OR 95%CI=0.87[0.80-0.95]). Being self-employed (p<0.0001) or living more than 15min away from an accredited screening centre (p=0.02) was also a barrier to participation in BCSP.
  
  
  CONCLUSIONS
  Despite the classless delivery of BCSP, inequalities in uptake remain. To take advantage of prevention and to avoid exacerbating disparities in cancer mortality, BCSP should be adapted to women's personal and contextual characteristics.
authors.affiliation: Breast and Gynaecologic Cancer Registry of Cote d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue Professeur Marion, 21000 Dijon, France; EA 4184, Medical School, University of Burgundy, 7 boulevard Jeanne d'Arc, 21000 Dijon, France. Electronic address: samioued@yahoo.fr.
authors.forename: Samiratou
authors.initials: S
authors.lastname: Ouédraogo
authors.affiliation: EA 4184, Medical School, University of Burgundy, 7 boulevard Jeanne d'Arc, 21000 Dijon, France; Biostatistics and Quality of Life Unit, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, 21000 Dijon, France. Electronic address: sdabakuyo@cgfl.fr.
authors.forename: Tienhan Sandrine
authors.initials: TS
authors.lastname: Dabakuyo-Yonli
authors.affiliation: Service de Biostatistique et d'Informatique Médicale, University Hospital of Dijon, 21000 Dijon, France. Electronic address: adroussot@laposte.net.
authors.forename: Adrien
authors.initials: A
authors.lastname: Roussot
authors.affiliation: Department of Epidemiological Research and Evaluation, CHU de Caen, France; EA3936, Medical School, Université de Caen Basse-Normandie, Caen, France; U1086 Inserm, Cancers and Preventions, Medical School, Université de Caen Basse-Normandie, Avenue de la Côte de Nacre, 14032 Caen Cedex, France. Electronic address: carole.pornet@inserm.fr.
authors.forename: Carole
authors.initials: C
authors.lastname: Pornet
authors.affiliation: Caisse Primaire d'Assurance maladie de la Côte d'Or, 8 rue du Dr Maret, 21000 Dijon, France. Electronic address: nathalie.sarlin@cpam-dijon.cnamts.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sarlin
authors.affiliation: Régime Social des Indépendants de Bourgogne, 41 rue de Mulhouse, 21000 Dijon, France. Electronic address: Philippe.Lunaud@bourgogne.rsi.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lunaud
authors.affiliation: Mutualité Sociale Agricole de Bourgogne, 14 rue Félix Trutat 21000 Dijon, France. Electronic address: desmidt.pascal@bourgogne.msa.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Desmidt
authors.affiliation: Service de Biostatistique et d'Informatique Médicale, University Hospital of Dijon, 21000 Dijon, France; Inserm U866, Medical School, University of Burgundy, 21000 Dijon, France. Electronic address: catherine.quantin@chu-dijon.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Quantin
authors.affiliation: Institut de Cancérologie Lucien Neuwirth, CIC-EC 3 Inserm, IFR 143, Saint-Etienne, France; Université Lyon 1, CNRS UMR 5558 and Hospices Civils de Lyon, Lyon, France. Electronic address: Franck.CHAUVIN@icloire.fr.
authors.forename: Franck
authors.initials: F
authors.lastname: Chauvin
authors.affiliation: Inserm U866, Medical School, University of Burgundy, 21000 Dijon, France; Association pour le Dépistage des Cancers en Côte d'Or et dans la Nièvre (ADECA 21-58), 16-18 rue Nodot, 21000 Dijon, France. Electronic address: vincent.dancourt@wanadoo.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dancourt
authors.affiliation: Breast and Gynaecologic Cancer Registry of Cote d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue Professeur Marion, 21000 Dijon, France; EA 4184, Medical School, University of Burgundy, 7 boulevard Jeanne d'Arc, 21000 Dijon, France. Electronic address: parveux@cgfl.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Arveux
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Breast cancer screening programmes; European Deprivation Index; Mammography screening; Prevention; Screening programme attendance; Socioeconomic inequalities