Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade

Abstract

Background Breast cancer (BC) is the most common cancer in women in the developed world. In order to find developing cancers in an early stage, BC screening is commonly used. In Flanders, screening is performed in and outside an organized breast cancer screening program (BCSP). However, the determinants of BC screening coverage for both screening strategies are yet unknown. Objective To assess the determinants of BC screening coverage in Flanders. Methods Reimbursement data were used to attribute a screening status to each woman in the target population for the years 2008–2016. Yearly coverage data were categorized as screening inside or outside BCSP or no screening. Data were clustered by municipality level. A generalized linear equation model was used to assess the determinants of screening type. Results Over all years and municipalities, the median screening coverage rate inside and outside BCSP was 48.40% (IQR: 41.50–54.40%) and 14.10% (IQR: 9.80–19.80%) respectively. A higher coverage rate outside BSCP was statistically significantly (P < 0.001) associated with more crowded households (OR: 3.797, 95% CI: 3.199–4.508), younger age, higher population densities (OR: 2.528, 95% CI: 2.455–2.606), a lower proportion of unemployed job seekers (OR: 0.641, 95% CI: 0.624–0.658) and lower use of dental care (OR: 0.969, 95% CI: 0.967–0.972). Conclusion Coverage rate of BC screening is not optimal in Flanders. Women with low SES that are characterized by younger age, living in a high population density area, living in crowded households, or having low dental care are less likely to be screened for BC in Flanders. If screened, they are more likely to be screened outside the BCSP.

Differences and Similarities in Breast and Colorectal Cancer Screening Uptake among Municipalities in Flanders, Belgium

“…Also, consistently with previous evidence [18], we found that a higher percentage of people who underwent at least 2 preventive dental visits in previous 3 years was associated with higher uptake of CRC and BC screening. Considering that dental visits are not fully covered by the health insurance system in Flanders, a higher dental care may be a strong indicator of predisposition towards preventive health behaviors.…”

“…To minimize possible collider biases [16], a causal directed acyclic graph (DAG) based on prior knowledge about the Flemish organized screening programs [17], ref. [18] was employed to identify covariates for adjustment when assessing the associations between municipal characteristics and profile of BC/CRC screening uptake. A multidisciplinary brainstorming session was organized between a medical doctor, two epidemiologists (amongst whom the program manager of the Flemish CRC screening program), and a sociologist to conceptualize the exposure-outcome relationship.…”

Differences and Similarities in Breast and Colorectal Cancer Screening Uptake Among Municipalities in Flanders, Belgium

“…Consistently with a previous study [18] , we found that preventive dental care was associated with higher BC (less chances of being in Group 3 vs. Group 1) or CRC (less chances of being in Group 2 vs. Group 1) screening uptake. Considering that dental visits are not fully covered by the health insurance system in Flanders, a higher dental care may be a strong indicator of predisposition towards preventive health behaviors.…”

“…Second, with the exception of age, the other independent variables were measured for the complete municipality population and used as a proxy for the communal target population. Despite the limitations, our results substantiate previous findings at both municipal [17], [18], [24], [25], [29] and individual [26] level.…”

“…In order to minimize possible collider biases [16] a causal directed acyclic graph (DAG) based on prior knowledge about the Flemish organised screening programs [17], [18] was employed to identify covariates for adjustment when assessing the associations between municipal characteristics and profile of BC/CRC screening uptake. A multidisciplinary brainstorming session was organized between a medical doctor, two epidemiologists (amongst whom the program manager of the Flemish CRC screening program) and a sociologist to conceptualize the exposure -outcome relationship.…”