title: Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil.
abstract: Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40-69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn't done de mammography in their lives and these women were principally from low socio-economic status (OR=2.99), low education (OR=3.00). The best strategies to include these women were mobile unit (OR=1.43) and Family Health Program (OR=1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.
authors.affiliation: Barretos Cancer Hospital, Brazil; Botucatu School of Medicine, UNESP, Brazil. Electronic address: posgrad@hcancerbarretos.com.br.
authors.forename: René Aloisio da Costa
authors.initials: RA
authors.lastname: Vieira
authors.affiliation: Botucatu School of Medicine, UNESP, Brazil; Prevention Department, Barretos Cancer Hospital, Brazil.
authors.forename: Tânia Silveira
authors.initials: TS
authors.lastname: Lourenço
authors.affiliation: Barretos Cancer Hospital, Brazil; Prevention Department, Barretos Cancer Hospital, Brazil.
authors.forename: Edmundo Carvalho
authors.initials: EC
authors.lastname: Mauad
authors.affiliation: Prevention Department, Barretos Cancer Hospital, Brazil.
authors.forename: Valter Gonçalves
authors.initials: VG
authors.lastname: Moreira Filho
authors.affiliation: Nucleus for Researcher Support, Barretos Cancer Hospital, Brazil.
authors.forename: Stela Verzinhasse
authors.initials: SV
authors.lastname: Peres
authors.affiliation: Prevention Department, Barretos Cancer Hospital, Brazil.
authors.forename: Thiago Buosi
authors.initials: TB
authors.lastname: Silva
authors.affiliation: Nucleus for Researcher Support, Barretos Cancer Hospital, Brazil; Department of Epidemiology, Faculty of Public Health, University of São Paulo, Brazil.
authors.forename: Maria do Rosário Dias de Oliveira
authors.initials: Mdo R
authors.lastname: Lattore
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Breast neoplasms; Cancer early detection; Community health planning; Developing countries; Mass screening