title: Factors Associated with Breast Cancer Screening in a Country with National Health Insurance: Did We Succeed in Reducing Healthcare Disparities?
abstract: The effectiveness of breast cancer screening programs in reducing mortality is well established in the scientific literature. The National Breast Cancer Screening Program in Israel provides biennial mammograms for women of average risk aged 50-74 and annual mammograms for women aged 40-49 at higher risk. Compliance is high, but differential. This study explores different factors associated with breast cancer screening attendance among women aged 40-74 years.
  
  
  
  Two main outcomes were studied: ever been screened and been screened in the 2 years preceding the study, using the cross-sectional Knowledge, Attitudes and Practices (KAP) Survey conducted in 2010-2012 among 2575 Israeli women aged 21+ years. The independent variables were sociodemographic characteristics, perceived health status, lifestyle habits, and healthcare fund membership. Bivariate and multivariable logistic regressions were conducted.
  
  
  
  Of the 943 participants aged 50-74, 87% had ever been screened and 74.8% had attended screening for breast cancer in the last 2 years. In multivariable models, Jewish compared to Arab women (adjusted prevalence ratio [APR] = 2.09, 95% confidence interval [CI]: 1.02-4.32), and unmarried compared to married women (APR = 2.9, 95% CI: 1.2-7.2), were more likely to have ever been screened. The only factor associated with breast cancer screening in the 2 years preceding the study was healthcare fund membership. In women aged 40-49 years, ethnicity was the only contributing factor associated with breast cancer screening, with higher screening rates in the 2 years preceding the study in Jewish versus Arab women (APR = 3.7, 95% CI: 1.52-9.3).
  
  
  
  Breast cancer screening attendance in Israel is high. However, significant differences are observed by membership of healthcare fund and by ethnicity, calling for better targeted outreach programs at this level.
authors.affiliation: 1 Israel Centre for Disease Control, Israel Ministry of Health , Ramat-Gan, Israel .
authors.forename: Samah
authors.initials: S
authors.lastname: Hayek
authors.affiliation: 1 Israel Centre for Disease Control, Israel Ministry of Health , Ramat-Gan, Israel .
authors.forename: Teena
authors.initials: T
authors.lastname: Enav
authors.affiliation: 1 Israel Centre for Disease Control, Israel Ministry of Health , Ramat-Gan, Israel .|2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Tamy
authors.initials: T
authors.lastname: Shohat
authors.affiliation: 1 Israel Centre for Disease Control, Israel Ministry of Health , Ramat-Gan, Israel .|3 School of Public Health, University of Haifa , Haifa, Israel .
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
mesh_terms: D000368:Aged; D018912:Arabs / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D007585:Jews / Q000706:statistics & numerical data; D008019:Life Style; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs / Q000191:economics; D011795:Surveys and Questionnaires
keywords: breast cancer screening; health disparities; mammography