Revisiting the Effects of Organized Mammography Programs on Inequalities in Breast Screening Uptake: A Multilevel Analysis of Nationwide Data From 1997 to 2017

Abstract

This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997–2017 period and comprising data on 14,267 women aged 50–70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions—e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women.

Breast cancer patients enrolled in the Swiss mammography screening program “donna” demonstrate prolonged survival

“…A study from the Netherlands [ 30 ] showed that women of low SES were less likely to participate in MSPs than women with high SES (odds ratio of 1.8), and further had less favorable tumor stages—and thus were more likely to die from BC. Similar studies from Switzerland demonstrated significant differences of the tumor stage distribution of BC diagnosed in patients of lower compared to higher SES [ 32 ] as well as higher screening uptake of women with higher SES [ 33 , 34 ]. While we controlled for tumor stage distribution in our analyses, other unobserved differences in survival relevant factors between the groups might have affected the differences in survival, and would, if systematic, lead to an overestimation of the survival effect from participating in MSPs.…”

Identify risk factors affecting participation of Turkish women in mammography screening for breast cancer prevention

“…The adherence to mammography scanning intervals among single women in the present study was found to be lower in comparison to unmarried participants. Married women are more likely to participate in breast cancer screening programs than unmarried women [ 35 , 36 ]. A higher likelihood of not undergoing mammography was reported for single women in the literature [ 22 ].…”

Regional inequalities of tumour size at diagnosis in Germany: An ecological study in eight federal states

“…It is possible that associations can be detected in Germany when considering tumour stage according to the UICC classification and making full use of information on T, N, and M. Moreover, there might have been an effect of the mammography‐screening programme that could have led to a reduction of area socioeconomic inequalities. Observational research from Switzerland and Germany has suggested that systematic mammography screening may reduce social inequalities in stage at diagnosis or screening uptake 45,46 . To add evidence to this hypothesis, however, research that includes a period before the implementation phase (2005‐2009) of the mammography screening programme is needed.…”

“…Observational research from Switzerland and Germany has suggested that systematic mammography screening may reduce social inequalities in stage at diagnosis or screening uptake. 45,46 To add evidence to this hypothesis, however, research that includes a period before the implementation phase (2005-2009) of the mammography screening programme is needed. Finally, our finding of an association of area socioeconomic deprivation with tumour size of colorectal cancer and malignant melanoma is in line with findings from numerous international studies.…”