Self-assessed health, perceived stress and non-participation in breast cancer screening: A Danish cohort study.
OBJECTIVE
Population-based cancer screening is offered in many countries to detect early stages of cancer and reduce mortality. Screening efficiency and equality is susceptible due to a group of non-participants. We investigated associations between self-assessed health, perceived stress and subsequent non-participation in breast cancer screening.


METHODS
This population-based cohort study included 4512 women who had participated in a Health Survey in 2006 and who were also the target group (aged 50-69 years) for the first organised breast cancer screening programme -3 years later in the Central Denmark Region in 2008-2009.


RESULTS
A U-shaped association was observed for physical health assessment as women with the highest (PR=1.28, 95% CI: 1.06-1.55), and the lowest (PR=1.41, 95% CI: 1.18-1.68) physical health scores were less likely to participate in the programme than women with physical health scores in the middle range. Women with low mental health assessment were more likely not to participate than women with mental health scores in the middle range (PR=1.44, 95% CI: 1.22-1.69). Higher non-participation propensity was also observed for women with the highest perceived stress scores (PR=1.27, 95% CI: 1.07-1.51) compared with women scoring in the middle range.


CONCLUSIONS
Women with highest and lowest self-assessed physical health, with lowest mental health or highest perceived stress were significantly more likely not to participate in breast cancer screening 2-3 years later than women who reported average health. Interventions targeting these groups may promote equal participation in future breast cancer screening programmes.
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Department for Public Health Programs, Randers Regional Hospital, Central Denmark Region, Skovlyvej 1, Randers, NE 8930, Denmark. Electronic address: line.jensen@ph.au.dk.
Line Flytkjær
LF
Jensen
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark.
Anette Fischer
AF
Pedersen
Department for Public Health Programs, Randers Regional Hospital, Central Denmark Region, Skovlyvej 1, Randers, NE 8930, Denmark.
Berit
B
Andersen
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark.
Peter
P
Vedsted
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D015331:Cohort Studies; D003718:Denmark; D059026:Diagnostic Self Evaluation; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data; D008403:Mass Screening; D008603:Mental Health; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D013315:Stress, Psychological
Breast cancer; Denmark; Organised breast cancer screening; Perceived stress; SF12; Screening participation; Self-assessed health