Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis

Abstract

ObjectiveAttendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance.DesignCINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987–June 2019, and reporting attendance in relation to at least one patient-level factor.Data synthesisIndependent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible.ResultsOf 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence.ConclusionsAttendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated.Trial registration numberCRD42016051597.

Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study

“…Indeed, although participation decreased among all socioeconomic groups, this decline was greater in low-income areas. A systematic review of studies conducted before the pandemic reported lower participation in low-income groups, immigrants, nonhomeowners, and women with a previous false-positive result ( Mottram et al, 2021 ). Furthermore, studies recently published in the United States have reported a decrease in participation, especially in underserved ethnic groups, with lower socioeconomic status, lack of insurance and longer travel time ( Amram et al, 2021 ; Miller et al, 2021 ).…”

The Impact of Morbidity and Disability on Attendance at Organized Breast Cancer–Screening Programs: A Systematic Review and Meta-Analysis

“…Similarly, interventions that have been developed to improve access to breast screening in general populations, for example, using social media engagement ( 49 ), may not be appropriate or even reach some of the morbidity cluster groups that have the greatest odds of non-attendance. Finally, because of the mixed reporting in the studies included in this review of potential sociodemographic confounders, such as ethnicity and deprivation ( 50 ), it is unclear whether interventions developed specifically to reduce inequity of access for these reasons would be effective if individuals also have morbidities. The identification of such research gaps can subsequently form the development and testing of theory-based interventions to increase equity of access to breast screening.…”

Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study

“…Nevertheless, it may well reflect a real phenomenon. A systematic review of studies conducted before the pandemic reported lower participation in low-income groups, immigrants, non-homeowners, and women with a previous false-positive result (24). Furthermore, studies recently published in the US have reported a decrease in participation, especially in underserved ethnic groups, with lower socioeconomic status, lack of insurance and longer travel time (25,26).…”