Effect of an organised screening program on socioeconomic inequalities in mammography practice, knowledge and attitudes

Abstract

BackgroundBreast cancer stands as the leading cause of cancer related mortality in women worldwide. Mammography screening has the potential to improve prognosis by reducing stage at diagnosis. Socioeconomic inequalities in mammography cancer screening have been widely reported. The influence of organised programs on socioeconomic disparities regarding mammography screening is to date unclear. We aimed to investigate the impact of an organised regional screening program on socioeconomic inequalities in terms of the uptake, knowledge and attitudes towards mammography screening.MethodsData were obtained from two cross-sectional surveys of women 50 to 69 years old conducted in 1998 and 2012, before and after the implementation of an organised breast cancer screening program in Geneva, Switzerland. Socioeconomic status was measured by monthly household income and education level. Logistic and linear regression multivariable models were used to investigate the evolution of socioeconomic gradients between 1998 and 2012 in terms of uptake, knowledge and attitudes towards mammography screening.ResultsIn 1998, before the implementation of an organised screening program, 44% of women from the lowest education category reported mammography practice conforming to recommendations versus 63% of the more educated participants. This socioeconomic gradient was no longer present in 2012 where reported mammography practice at guideline-recommended frequency were 83 and 82% in the lowest and highest education level categories respectively (change in education gradient over time, p = 0.018). The difference in mammography practice in agreement with recommendations between the lowest and the highest income category went from 27 percentage points in 1998 to 14 percentage points in 2012 (change in income gradient over time, p = 0.10). The socioeconomic gradient in negative attitudes towards mammography screening persisted in 2012 but was reduced compared to 1998. We did not observe a reduction in the socioeconomic disparities in knowledge regarding mammography screening over this period.ConclusionsThis study suggests that mammography screening programs may lessen socioeconomic inequities in mammography practice. Such programs should feature adapted communication tools to reach women of lower socioeconomic status to attempt to further reduce socioeconomic gradients in mammography screening.

Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Southern Italy

“…Several studies have investigated the impact of organized screening programs on the reduction of socioeconomic disparities in the attendance of cancer screening activities, using different approaches. Indeed, the role of mammography screening programs in lessening socioeconomic inequalities in mammography practice was revealed in a study reporting the results of two cross-sectional studies in Switzerland before and after the implementation of an organized screening program [ 32 ], and a pooled, cross-sectional time series analysis evaluating secondary data from 17 European countries found that where organized screening programs are available, socioeconomic variables, such as education, income and type of employment or unemployment, are not related to attendance to screening and concluded that organized screening programs may reduce the socioeconomic inequalities in attendance to these preventive interventions [ 7 ].…”

Systematic reviews as a “lens of evidence”: Determinants of participation in breast cancer screening

“…relationships between socio-economic variables and participation rate) should be informed not only by the pooled summaries but also by the national statistical data. Intervention studies show that removal of health system and financial barriers is positively associated with participation, and cancer disparities being reduced through organized screening, 43 – 46 although these efforts are not equally effective in all the jurisdictions.…”

Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006–2014

“…Equity aspects are also very important for successful implementation of BC screening; however, inequalities in attendance still exist in many countries [25,29,30]. Our data are consistent with previous results showing that a higher level of education is associated with the higher rates of participation in BC screening [18,19,20,30]. Better educated women have a greater interest in health, more knowledge about health issues, and better access to resources for health improvement [31].…”

“…Better educated women have a greater interest in health, more knowledge about health issues, and better access to resources for health improvement [31]. A study carried out in Switzerland revealed that less-educated women had worse knowledge and more negative attitudes regarding mammography screening compared to women with a higher level of education [30]. On the other hand, education may have an impact on health through work and economic conditions.…”