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Collin LJ, Waller LA, Cronin-Fenton DP, Ahern TP, Goodman M, McCullough LE, Kjærsgaard A, Woolpert KM, Silliman RA, Christiansen PM, Ejlertsen B, Sørensen HT, Lash TL. The Population-level Effect of Adjuvant Therapies on Breast Cancer Recurrence: Application of the Trend-in-Trend Design. Epidemiology 2024; 35:660-666. [PMID: 39109817 PMCID: PMC11309577 DOI: 10.1097/ede.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE Breast cancer has an average 10-year relative survival reaching 84%. This favorable survival is due, in part, to the introduction of biomarker-guided therapies. We estimated the population-level effect of the introduction of two adjuvant therapies-tamoxifen and trastuzumab-on recurrence using the trend-in-trend pharmacoepidemiologic study design. METHODS We ascertained data on women diagnosed with nonmetastatic breast cancer who were registered in the Danish Breast Cancer Group clinical database. We used the trend-in-trend design to estimate the population-level effect of the introduction of (1) tamoxifen for postmenopausal women with estrogen receptor (ER)-positive breast cancer in 1982, (2) tamoxifen for premenopausal women diagnosed with ER-positive breast cancer in 1999, and (3) trastuzumab for women <60 years diagnosed with human epidermal growth factor receptor 2-positive breast cancer in 2007. RESULTS For the population-level effect of the introduction of tamoxifen among premenopausal women diagnosed with ER-positive breast cancer in 1999, the risk of recurrence decreased by nearly one-half (OR = 0.52), consistent with evidence from clinical trials; however, the estimate was imprecise (95% confidence interval [CI] = 0.25, 1.85). We observed an imprecise association between tamoxifen use and recurrence from the time it was introduced in 1982 (OR = 1.24 95% CI = 0.46, 5.11), inconsistent with prior knowledge from clinical trials. For the introduction of trastuzumab in 2007, the estimate was also consistent with trial evidence, though imprecise (OR = 0.51; 95% CI = 0.21, 22.4). CONCLUSIONS We demonstrated how novel pharmacoepidemiologic analytic designs can be used to evaluate the routine clinical care and effectiveness of therapeutic advancements in a population-based setting while considering some limitations of the approach.
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Affiliation(s)
- Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Deirdre P Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Thomas P Ahern
- Department of Surgery, The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten M. Woolpert
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rebecca A. Silliman
- Department of Medicine, Boston University School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Peer M Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Rigshospitalet, Copenhagen, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Stephanopoli JP, Bouazzi L, Guerbaz-Sommi M, Graesslin O, Hurtaud A, Ilardo S, Chrusciel J, Barbaret C, Bertrand C, Sanchez S. Factors associated with deferral or non-performance of an organized breast cancer screening program during the COVID-19 pandemic in France. Cancer Med 2024; 13:e7444. [PMID: 39192606 DOI: 10.1002/cam4.7444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Delays in detection and treatment of breast cancer can lead to increased mortality. To date, participation in organized breast cancer screenings (OBCS) has been suboptimal worldwide. The objective of this study was to investigate the factors associated with deferral or non-performance of mammography during the COVID-19 pandemic for women who had previously participated in OBCS. METHODS A retrospective observational study was conducted on a cohort of 6282 women from the Aube Department of France, who were invited to an OBCS in 2020. Participants were divided into women who promptly underwent screening after receiving an invitation (between 22 and 25 months elapsed since the last mammogram), women who underwent late screening (≥26 months since the last mammogram), and those who were never screened. Data were collected from a self-reported questionnaire. Comparative and multivariable analyses modeling the probability of each type of attendance were performed using these data. RESULTS In total, 2301 women (aged 50-74 years) returned a valid questionnaire. Compared to women who promptly underwent mammography, non- and late-screening participants were younger, had less frequent gynecological follow-up and a less frequent history of colorectal cancer screening. Women with higher education status and those residing in socially disadvantaged areas were more likely to attend late. CONCLUSION The absence of regular gynecological follow-up and the absence of colorectal cancer screening were significant factors associated with deferral of or non-attendance at OBCS.
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Affiliation(s)
- Jean Papadacci Stephanopoli
- Department of General Medicine, Université de Reims Champagne-Ardenne, Reims, Marne, France
- Médecine générale, Maison de Santé Pluriprofessionnelle de la Forêt d'Orient, Piney, Aube, France
| | - Leila Bouazzi
- Comité Universitaire de Ressources pour la Recherche en Santé,, Université de Reims Champagne-Ardenne, Reims, Marne, France
| | - Myriam Guerbaz-Sommi
- CRCDC, Centre Régional de Coordination des Dépistages des Cancers du Grand Est, Troyes, Aube, France
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, Marne, France
| | - Aline Hurtaud
- Department of General Medicine, Université de Reims Champagne-Ardenne, Reims, Marne, France
| | - Salvatore Ilardo
- Médecine générale, Maison de Santé Pluriprofessionnelle de la Forêt d'Orient, Piney, Aube, France
| | - Jan Chrusciel
- Department of Public Health and Performance, Centre Hospitalier de Troyes, Troyes, France
| | - Cécile Barbaret
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG,, Univ. Grenoble Alpes,, Grenoble, isère, France
| | - Camille Bertrand
- CRCDC, Centre Régional de Coordination des Dépistages des Cancers du Grand Est, Troyes, Aube, France
| | - Stéphane Sanchez
- Comité Universitaire de Ressources pour la Recherche en Santé,, Université de Reims Champagne-Ardenne, Reims, Marne, France
- Department of Public Health and Performance, Centre Hospitalier de Troyes, Troyes, France
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Kawamura C, Iwagami M, Sun Y, Komiyama J, Ito T, Sugiyama T, Bando H, Tamiya N. Factors associated with non-participation in breast cancer screening: analysis of the 2016 and 2019 comprehensive survey of living conditions in Japan. Breast Cancer 2023; 30:952-964. [PMID: 37488365 DOI: 10.1007/s12282-023-01486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The participation rate for breast cancer screening remains to be suboptimal in Japan. Therefore, it is important to identify factors associated with non-participation and identify people at high risk for non-participation. METHODS We carried out a cross-sectional study using the data of women aged 40-74 years from the 2016 and 2019 Comprehensive Survey of Living Conditions. We selected candidate predictor variables from the survey sheets and conducted a multivariable logistic regression for non-participation in breast cancer screening for the past 2 years. In addition, using data from 2016, we created an integer risk score for non-participation and tested its predictive performance in 2019. RESULTS The proportion of participants in breast cancer screening in 2016 and 2019 were 46.7% (50,177/107,513) and 48.7% (49,498/101,716), respectively. In multivariable logistic regression analysis, age over 50 years, single/divorced/widowed, lower education level, lower household expenditure, being insured for National Health Insurance, employed to small/middle scale company, non-regularly employed, current smoker, never/quit drinking or middle/high-risk drinking, lower self-rated health status, higher Kessler Psychological Distress Scale score, non-participation in the annual health checkups for diseases other than cancer, not constantly visiting hospitals/clinics showed a positive association with non-participation. The 9-item risk score (age, marital status, education, health insurance plan, employment, smoking, drinking, non-participation in the annual health checkups for diseases other than cancer, and not constantly visiting hospitals/clinics) and 3-item risk score (age, health insurance plan, non-participation in the annual health checkups for diseases other than cancer) showed the area under the receiver operating characteristic curve of 0.744 and 0.720, respectively. CONCLUSION We identified factors associated with non-participation in breast cancer screening. The simple risk score would be useful for public health sectors to identify people at risk for non-participation.
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Affiliation(s)
- Chitose Kawamura
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Masao Iwagami
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
| | - Yu Sun
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Jun Komiyama
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Tomoko Ito
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Takehiro Sugiyama
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroko Bando
- Department of Breast and Endocrine Surgery, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
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Pett L, Hollenberg B, Mahoney J, Paz J, Siu N, Sun A, Zhang R, von Euler-Chelpin M. Participation and adherence to mammography screening in the Capital Region of Denmark: The importance of age over time. PLoS One 2023; 18:e0280790. [PMID: 36689434 PMCID: PMC9870097 DOI: 10.1371/journal.pone.0280790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/05/2022] [Indexed: 01/24/2023] Open
Abstract
Mammography screening's effectiveness depends on high participation levels. Understanding adherence patterns over time is important for more accurately predicting future effectiveness. This study analyzed longitudinal adherence to the biennial invitations in the Capital Region of Denmark from 2008-2017. We analyzed participation rates for five-year age groups along with their percent changes in each invitation round using linear regressions. Participation in the mammography screening program increased from 73.1% to 83.1% from 2008-2017. The participation rate among all age groups increased from the first to the fifth round, with the oldest age group having the largest increase (average percent change = 3.66; p-value = 0.03).
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Affiliation(s)
- Lindsay Pett
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Becky Hollenberg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Mahoney
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jake Paz
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nathan Siu
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Sun
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rachel Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Pokora RM, Büttner M, Schulz A, Schuster AK, Merzenich H, Teifke A, Michal M, Lackner K, Münzel T, Zeissig SR, Wild PS, Singer S, Wollschläger D. Determinants of mammography screening participation-a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS). PLoS One 2022; 17:e0275525. [PMID: 36197888 PMCID: PMC9534433 DOI: 10.1371/journal.pone.0275525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/18/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We investigated the association between social inequality and participation in a mammography screening program (MSP). Since the German government offers mammography screening free of charge, any effect of social inequality on participation should be due to educational status and not due to the financial burden. METHODS The 'Gutenberg Health Study' is a cohort study in the Rhine-Main-region, Germany. A health check-up was performed, and questions about medical history, health behavior, including secondary prevention such as use of mammography, and social status are included. Two indicators of social inequality (equivalence income and educational status), an interaction term of these two, and different covariables were used to explore an association in different logistic regression models. RESULTS A total of 4,681 women meeting the inclusion criteria were included. Only 6.2% never participated in the MSP. A higher income was associated with higher chances of ever participating in a mammography screening (odds ratios (OR): 1.67 per €1000; 95%CI:1.26-2.25, model 3, adjusted for age, education and an interaction term of income and education). Compared to women with a low educational status, the odds ratios for ever participating in the MSP was lower for the intermediate educational status group (OR = 0.64, 95%CI:0.45-0.91) and for the high educational status group (0.53, 95%CI:0.37-0.76). Results persisted also after controlling for relevant confounders. CONCLUSIONS Despite the absence of financial barriers for participation in the MSP, socioeconomic inequalities still influence participation. It would be interesting to examine whether the educational effect is due to an informed decision.
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Affiliation(s)
- Roman M. Pokora
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,* E-mail:
| | - Matthias Büttner
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander K. Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hiltrud Merzenich
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andrea Teifke
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Karl Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sylke Ruth Zeissig
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,Regional Centre Würzburg, Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Würzburg, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Susanne Singer
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,University Cancer Center Mainz, Mainz, Germany
| | - Daniel Wollschläger
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Bozhar H, McKee M, Spadea T, Veerus P, Heinävaara S, Anttila A, Senore C, Zielonke N, de Kok I, van Ravesteyn N, Lansdorp-Vogelaar I, de Koning H, Heijnsdijk E. Socio-economic Inequality of Utilization of Cancer Testing in Europe: A Cross-Sectional Study. Prev Med Rep 2022; 26:101733. [PMID: 35198362 PMCID: PMC8850331 DOI: 10.1016/j.pmedr.2022.101733] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/06/2021] [Accepted: 02/06/2022] [Indexed: 12/27/2022] Open
Abstract
There are currently screening programmes for breast, cervical and colorectal cancer in many European countries. However, the uptake of cancer screening in general may vary within and between countries. The aim of this study is to assess the inequalities in testing utilization by socio-economic status and whether the amount of inequality varies across European regions. We conducted an analysis based on cross-sectional data from the second wave of the European Health Interview Survey from 2013 to 2015. We analysed the use of breast, cervical, and colorectal cancer testing by socio-economic position (household income, educational level and employment status), socio-demographic factors, self-perceived health and smoking behaviour, by using multinomial logistic models, and inequality measurement based on the Slope index of inequality (SII) and Relative index of inequality (RII). The results show that the utilization of mammography (Odds Ratio (OR) = 0.55, 95% confidence interval (95%CI):0.50–0.61), cervical smear tests (OR = 0.60, 95%CI:0.56–0.65) and colorectal testing (OR = 0.82, 95%CI:0.78–0.86) was overall less likely among individuals within a low household income compared to a high household income. Also, individuals with a non-EU country of birth, low educational level and being unemployed (or retired) were overall less likely to be tested. The income-based inequality in breast (SII = 0.191;RII = 1.260) and colorectal testing utilization (SII = 0.161;RII = 1.487) was the greatest in Southern Europe. For cervical smears, this inequality was greatest in Eastern Europe (SII = 0.122;RII = 1.195). We concluded that there is considerable inequality in the use of cancer tests in Europe, with inequalities associated with household income, educational level, employment status, and country of birth.
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Mottram R, Knerr WL, Gallacher D, Fraser H, Al-Khudairy L, Ayorinde A, Williamson S, Nduka C, Uthman OA, Johnson S, Tsertsvadze A, Stinton C, Taylor-Phillips S, Clarke A. Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis. BMJ Open 2021; 11:e046660. [PMID: 34848507 PMCID: PMC8634222 DOI: 10.1136/bmjopen-2020-046660] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Attendance 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. DESIGN CINAHL, 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 SYNTHESIS Independent 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. RESULTS Of 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. CONCLUSIONS Attendance 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 NUMBER CRD42016051597.
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Affiliation(s)
- Rebecca Mottram
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Wendy Lynn Knerr
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Daniel Gallacher
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hannah Fraser
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Williamson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chidozie Nduka
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samantha Johnson
- University of Warwick Library, University of Warwick, Coventry, West Midlands, UK
| | - Alexander Tsertsvadze
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Christopher Stinton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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8
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Thabane K, Mashologu Y, Thabane L. Exploring factors associated with breast cancer screening among women aged 15-49 years in Lesotho. Pan Afr Med J 2021; 38:108. [PMID: 33912278 PMCID: PMC8051214 DOI: 10.11604/pamj.2021.38.108.21110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/14/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction breast cancer is associated with serious morbidity, low quality of life and mortality. Prevention through early screening remains one of the most optimal strategies against breast cancer. The primary objective of this analysis was to determine the prevalence of breast cancer screening using the clinical breast examination (CBE) and breast self-examination (BSE) methods among women aged 15-49 years, and the secondary objective was to explore demographic and socio-economic factors associated with clinical breast examination (CBE) and breast self-examination (BSE) breast cancer screening methods. Methods the study used Demographic Health Survey data collected in 2014. The study participants were Basotho women aged 15-49 years. STATA 17 was employed for developing logistic regressions and weighting for sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance. Results variables that were associated with significantly increased odds of having you had a breast cancer either self-examination or clinical test in last 12 months were: i) visiting a health centre in the past 12 months [odd ratio (OR): 1.21 (95% confidence interval [CI]: 1.02, p = 1.43); p = 0.025]; ii) completion of primary level education [1.27 ((1.10; 1.49); 0.001]; iii) being aware of breast cancer [2.18 (1.78;2.65); 0.001]; and iv) age [35-39 years: 1.40 (1.10;1.78);0.007]; while district of origin [Butha - Buthe: 0.63 (0.46; 0.85); 0.003] was significantly associated with decreased odds of the outcome. Conclusion our findings suggest that raising awareness about breast cancer is the most effective method of improving breast cancer screening among women in Lesotho.
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Affiliation(s)
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON, Canada.,Departments of Pediatrics and Anesthesia, McMaster University, Hamilton ON, Canada.,Biostatistics Unit, St Joseph´s Healthcare, Hamilton, Hamilton ON, Canada
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9
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Ding L, Jidkova S, Greuter MJW, Van Herck K, Goossens M, Martens P, de Bock GH, Van Hal G. Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade. Int J Equity Health 2020; 19:212. [PMID: 33246477 PMCID: PMC7694412 DOI: 10.1186/s12939-020-01323-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- L Ding
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - S Jidkova
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - M J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - K Van Herck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - M Goossens
- Center for Cancer Detection, Flanders, Belgium
| | - P Martens
- Center for Cancer Detection, Flanders, Belgium
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - G Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium.,Center for Cancer Detection, Flanders, Belgium
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10
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Deprivation and mass screening: Survival of women diagnosed with breast cancer in France from 2008 to 2010. Cancer Epidemiol 2019; 60:149-155. [DOI: 10.1016/j.canep.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/22/2019] [Accepted: 03/29/2019] [Indexed: 02/06/2023]
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11
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Lux MP, Emons J, Bani MR, Wunderle M, Sell C, Preuss C, Rauh C, Jud SM, Heindl F, Langemann H, Geyer T, Brandl AL, Hack CC, Adler W, Schulz-Wendtland R, Beckmann MW, Fasching PA, Gass P. Diagnostic Accuracy of Breast Medical Tactile Examiners (MTEs): A Prospective Pilot Study. Breast Care (Basel) 2019; 14:41-47. [PMID: 31019442 DOI: 10.1159/000495883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The usefulness of clinical breast examination (CBE) in general and in breast cancer screening programs has been a matter of debate. This study investigated whether adding vision-impaired medical tactile examiners (MTEs) improves the predictiveness of CBE for suspicious lesions and analyzed the feasibility and acceptability of this approach. Methods The prospective study included 104 patients. Physicians and MTEs performed CBEs, and mammography and ultrasound results were used as the gold standard. Sensitivity and specificity were calculated and logistic regression models were used to compare the predictive value of CBE by physicians alone, MTEs alone, and physicians and MTEs combined. Results For CBEs by physicians alone, MTEs alone, and both combined, sensitivity was 71, 82, and 89% and specificity was 55, 45, and 35%, respectively. Using adjusted logistic regression models, the validated areas under the curve were 0.685, 0.692, and 0.710 (median bootstrapped p value (DeLong) = 0.381). Conclusion The predictive value for a suspicious breast lesion in CBEs performed by MTEs in patients without prior surgery was similar to that of physician-conducted CBEs. Including MTEs in the CBE procedure in breast units thus appears feasible and could be a way of utilizing their skills.
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Affiliation(s)
- Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Mayada R Bani
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Charlotte Sell
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Caroline Preuss
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Hanna Langemann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Thomas Geyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Anna-Lisa Brandl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Werner Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | | | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
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12
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He W, Eriksson L, Törnberg S, Strand F, Hall P, Czene K. Discontinuation of adjuvant hormone therapy among breast cancer patients not previously attending mammography screening. BMC Med 2019; 17:24. [PMID: 30700300 PMCID: PMC6354407 DOI: 10.1186/s12916-019-1252-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer patients who have not previously attended mammography screening may be more likely to discontinue adjuvant hormone therapy and therefore have a worse disease prognosis. METHODS We conducted a population-based cohort study using data from Stockholm Mammography Screening Program, Stockholm-Gotland Breast Cancer Register, Swedish Prescribed Drug Register, and Swedish Cause of Death Register. Women in Stockholm who were diagnosed with breast cancer between 2001 and 2008 were followed until December 31, 2015. Non-participants of mammography screening were defined as women who, prior to their breast cancer diagnosis, were invited for mammography screening but did not attend. RESULTS Of the 5098 eligible breast cancer patients, 4156 were defined as screening participants and 942 as non-participants. Compared with mammography screening participants, non-participants were more likely to discontinue adjuvant hormone therapy, with an adjusted hazard ratio (HR) of 1.30 (95% CIs, 1.11 to 1.53). Breast cancer patients not participating in mammography screening were also more likely to have worse disease-free survival, even after adjusting for tumor characteristics and other covariates (adjusted HR 1.22 (95% CIs, 1.05 to 1.42 for a breast cancer event). CONCLUSIONS Targeted interventions to prevent discontinuation of adjuvant hormone therapy are needed to improve breast cancer outcomes among women not attending mammography screening.
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Affiliation(s)
- Wei He
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, 171 77, Stockholm, Sweden.
| | - Louise Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, 171 77, Stockholm, Sweden.,Department of Oncology-Pathology, Cancer Center Karolinska, Department of Oncology, Radiumhemmet, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm-Gotland Regional Cancer Centre, Stockholm, Sweden
| | - Fredrik Strand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, 171 77, Stockholm, Sweden.,Department of Thoracic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, 171 77, Stockholm, Sweden.,Department of Oncology, South General Hospital, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12 A, 171 77, Stockholm, Sweden
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13
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Bhargava S, Moen K, Qureshi SA, Hofvind S. Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis. Acta Radiol 2018; 59:1285-1291. [PMID: 29451023 DOI: 10.1177/0284185118758132] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Groups of immigrant and minority women are more often diagnosed with advanced stage breast cancer than other women. Mammographic screening aims to reduce mortality from breast cancer through early detection in asymptomatic women. Purpose To compare mammographic screening attendance among immigrant and minority women to that of other women. Material and Methods A literature search of PubMed, Embase, Google Scholar, and Cochrane identified 1369 papers published between January 1995 and March 2016. In the review, we included 33 studies investigating mammographic screening attendance among immigrant and/or minority women. In a meta-analysis, we included 19 of the studies that compared attendance among immigrant and/or minority women with that among other women, using a random effects model. Results The review included studies from Europe, North America, and Oceania, with 42,666,093 observations of opportunities for mammographic screening. Attendance was generally lower among immigrant and minority women compared to other women (46.2% vs. 55.0%; odds ratio = 0.64, 95% confidence interval = 0.56-0.73; P < 0.05, I2 = 99.9%). Non-Western immigrants had lower attendance rates than other immigrants. Conclusion Immigrant and minority women had lower mammographic screening attendance than other women, which could potentially put them at increased risk for more advanced breast cancer. This review emphasizes the importance of continued efforts to engage with the preventative health needs of diverse populations in attempts to achieve equality in access to, and use of, care.
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Affiliation(s)
- Sameer Bhargava
- Cancer Registry of Norway, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Samera Azeem Qureshi
- Norwegian Centre for Minority and Migrant Health Research, Oslo University Hospital, Oslo, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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14
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Deborde T, Chatignoux E, Quintin C, Beltzer N, Hamers FF, Rogel A. Breast cancer screening programme participation and socioeconomic deprivation in France. Prev Med 2018; 115:53-60. [PMID: 30099047 DOI: 10.1016/j.ypmed.2018.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/18/2018] [Accepted: 08/04/2018] [Indexed: 11/17/2022]
Abstract
The objective was to quantify the relationship between deprivation and national breast cancer screening programme (NBCSP) participation at an ecological level in mainland France. Data from 4,805,390 women-living in 36,209 municipalities within 95 departments-participating in the 2013-2014 NBCSP were analysed using the French Deprivation Index (FDep). FDep population quintiles by municipality were computed to describe NBCSP participation according to deprivation. To better examine the relationship between continuous value of deprivation index and participation rates at the municipality level, we built a generalized linear mixed model. Geographical variations in participation rates were marked. The national standardized participation rate was higher in the intermediate quintiles (55%), 45% for the least deprived one and 52% for the most deprived one. Using our model, we also obtained an inverted U-curve for the relationship between NBCSP participation and municipality deprivation: participation was lower for both the least and most deprived municipalities. This relationship was also observed for each of the two subpopulations-urban municipalities and rural ones-considered separately. Introducing the FDep in the model reduced slightly the unexplained variations in participation rates between departments and between municipalities (with a proportional change in variance of 14% and 12% respectively). We highlight major disparities in departmental participation rates and FDep/participation profiles. However, deprivation appears to have only little influence on geographical variation in participation rates. There is a need to further understand the factors affecting geographical variation in participation rates, in particular the use of opportunistic screening.
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Affiliation(s)
- Thérèse Deborde
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Edouard Chatignoux
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Cécile Quintin
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Nathalie Beltzer
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France.
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15
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Virgilsen LF, Pedersen AF, Andersen B, Vedsted P. Non-participation in breast cancer screening among previous cancer patients. J Cancer Res Clin Oncol 2018; 144:1959-1966. [PMID: 30097713 PMCID: PMC6153592 DOI: 10.1007/s00432-018-2734-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/04/2018] [Indexed: 12/14/2022]
Abstract
Purpose Breast cancer can be detected at early stages through organised screening. This study explored reasons for non-participation in breast cancer screening among previous cancer patients, who have high risk of developing a new primary cancer. Method We conducted a population-based historical cohort study, including all women invited to the first organised screening round in 2008–2009 in the Central Denmark Region (n = 149,234). All data were based on national registers. Results Among women with previous cancer (n = 6638), 25.3% did not participate in breast cancer screening compared to 20.9% of women with no registrations of previous cancer, thus previous cancer patients were 21% less likely not to participate in breast cancer screening (PRR 1.21, 95% CI 1.16–1.27). Further analysis showed that this association was due to women receiving current cancer treatment or being in palliative care in the time leading up to screening. Women with previous malignant melanoma or colorectal cancer were more likely to participate in breast cancer screening, whereas women with previous gynaecological or “other” cancer types were less likely to participate. Conclusion Screening for breast cancer may help diagnose breast cancer at an early stage. Women with previous cancer who are not undergoing current treatment or in palliative care have the same propensity to participate as other women invited to breast cancer screening. Women with previous gynaecological cancer were less likely to participate in breast cancer screening than women with other cancer types. These results may only be generalised to similar health care systems.
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Affiliation(s)
- Line Flytkjær Virgilsen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark. .,Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark.
| | - Anette Fischer Pedersen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark.,Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark
| | - Berit Andersen
- Department for Public Health Programmes, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8000, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark.,Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark
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16
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Roswall N, Andersen ZJ, von Euler-Chelpin M, Vejborg I, Lynge E, Jensen SS, Raaschou-Nielsen O, Tjønneland A, Sørensen M. Residential traffic noise and mammographic breast density in the Diet, Cancer, and Health cohort. Cancer Causes Control 2018. [PMID: 29520472 DOI: 10.1007/s10552-018-1021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Traffic is the most important source of community noise, and it has been proposed to be associated with a range of disease outcomes, including breast cancer. As mammographic breast density (MD) is one of the strongest risk factors for developing breast cancer, the present study investigated whether there is an association between residential exposure to traffic noise and MD in a Danish cohort. METHODS We included women with reproductive and lifestyle information available from the Diet, Cancer, and Health cohort, who also participated in the Copenhagen Mammography Screening Programme (n = 5,260). Present and historical addresses from 1987 to 2011 were found in national registries, and traffic noise was modeled 5 years before mammogram. Analyses between residential traffic noise and MD were performed using logistic regression. RESULTS We found no association between residential road and railway noise exposure 5 years before mammogram, and having a mixed/dense versus a fatty mammogram, and no interaction with menopausal status, BMI, HRT use, and railway noise exposure, for analyses on road traffic noise. CONCLUSION The present study does not suggest an association between residential traffic noise exposure and subsequent MD in a cohort of middle-aged Danish women.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Zorana Jovanovic Andersen
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - My von Euler-Chelpin
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, Diagnostic Imaging Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elsebeth Lynge
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | | | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of natural Science and Environment, Roskilde University, Roskilde, Denmark
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17
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Lim LY, Ho PJ, Liu J, Chay WY, Tan MH, Hartman M, Li J. Determinants of breast size in Asian women. Sci Rep 2018; 8:1201. [PMID: 29352164 PMCID: PMC5775321 DOI: 10.1038/s41598-018-19437-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/02/2018] [Indexed: 12/26/2022] Open
Abstract
Breast size as a risk factor of breast cancer has been studied extensively with inconclusive results. Here we examined the associations between breast size and breast cancer risk factors in 24,353 Asian women aged 50 to 64 years old enrolled in a nationwide mammography screening project conducted between October 1994 and February 1997. Information on demographic and reproductive factors was obtained via a questionnaire. Breast size was ascertained as bust line measured at study recruitment and total breast area measured from a mammogram. The average bust line and total breast area was 91.2 cm and 102.3 cm2, respectively. The two breast measurements were moderately correlated (Spearman correlation coefficient = 0.65). Age, BMI, marital and working status were independently associated with bust line and total breast area. In the multivariable analyses, the most pronounced effects were observed for BMI (24.2 cm difference in bust line and 39.4 cm2 in breast area comparing women with BMI ≥30 kg/m2 to BMI <20 kg/m2). Ethnicity was a positive predictor for total breast area, but not bust line.
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Affiliation(s)
- Li Yan Lim
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peh Joo Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jenny Liu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Min-Han Tan
- National Cancer Centre, Singapore, Singapore.,Institute of Bioengineering and Nanotechnology, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jingmei Li
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Human Genetics, Genome Institute of Singapore, Singapore, Singapore.
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18
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Pletscher M. The effects of organized screening programs on the demand for mammography in Switzerland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:649-665. [PMID: 27826716 DOI: 10.1007/s10198-016-0845-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 10/19/2016] [Indexed: 06/06/2023]
Abstract
The objective of this study is to estimate the causal effect of organized mammography screening programs on the proportion of women between 50 and 69 years of age who have ever used mammography. We exploit the gradual implementation of organized screening programs in nine Swiss cantons using a difference-in-difference approach. An analysis of four waves of the Swiss Health Survey shows that 3.5-5.4% points of the 87.9% utilization rate in cantons with screening programs in 2012 can be attributed to these organized programs. This effect indicates that organized programs can motivate women who have never done mammography to initiate screening.
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Affiliation(s)
- Mark Pletscher
- Institute of Economic Research, University of Neuchâtel, Rue A.-L. Breguet 2, 2000, Neuchâtel, Switzerland.
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8400, Winterthur, Switzerland.
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19
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Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey. Prev Med 2016; 91:250-263. [PMID: 27527575 DOI: 10.1016/j.ypmed.2016.08.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged.
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20
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Eichholzer M, Richard A, Rohrmann S, Schmid SM, Leo C, Huang DJ, Güth U. Breast cancer screening attendance in two Swiss regions dominated by opportunistic or organized screening. BMC Health Serv Res 2016; 16:519. [PMID: 27663642 PMCID: PMC5035496 DOI: 10.1186/s12913-016-1760-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/15/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. We evaluated factors associated with attendance to breast cancer screening in these two regions. METHODS We analyzed the data of 50-69 year-old women (n = 2769) from the Swiss Health Survey 2012. Factors of interest included education level, place of residence, nationality, marital status, smoking history, alcohol consumption, physical activity, diet, self-perceived health, history of chronic diseases and mental distress, visits to medical doctors and cervical and colorectal cancer screening. Outcome measures were dichotomized into ≤2 years since most recent mammography versus >2 years or never. RESULTS In the German- and French-speaking regions, mammography attendance within the last two years was 34.9 % and 77.8 %, respectively. In the French region, moderate alcohol consumption (adjusted OR 2.01, 95 % CI 1.28-3.15) increased screening attendance. Compared to those with no visit to a physician during the recent year, women in both regions with such visits attended statistically significantly more often BC screening (1-5 times vs. no visit: German (adjusted OR 3.96, 95 % CI 2.58-6.09); French: OR 7.25, 95 % CI 4.04-13.01). Non-attendance to cervical screening had a negative effect in both the German (adjusted OR 0.44, 95 % CI 0.25-0.79) and the French region (adjusted OR 0.57, 95 % CI 0.35-0.91). The same was true for colorectal cancer screening (German (adjusted OR 0.66, 95 % CI 0.52-0.84); French: OR 0.52, 95 % CI 0.33-0.83). No other factor was associated with BC screening and none of the tests of interaction comparing the two regions revealed statistically significant results. CONCLUSION The effect of socio-demographic characteristics, lifestyle, health factors and screening behavior other than mammography on non-attendance to BC screening did not differ between the two regions with mainly opportunistic and organized screening, respectively, and did not explain the large differences in attendance between regions. Other potential explanations such as public promotion of attendance for BC screening, physicians' recommendations regarding mammography participation or women's beliefs should be further investigated.
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Affiliation(s)
- Monika Eichholzer
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.
| | - Aline Richard
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Seraina M Schmid
- Department of Gynecology & Obstetrics, Spital Grabs, Spitalstrasse 44, CH-9472, Grabs, Switzerland.,Breast Center St. Gallen, Rorschacher Strasse 150, CH-9006, St.Gallen, Switzerland
| | - Cornelia Leo
- Department of Gynecology and Obstetrics, Kantonsspital Baden AG, Interdisciplinary Breast Centre, CH-5404, Baden, Switzerland
| | - Dorothy J Huang
- Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse 21, CH-4031, Basel, Switzerland
| | - Uwe Güth
- Breast Center Zurich, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
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Jacobsen KK, von Euler Chelpin M, Vejborg I, Lynge E. Impact of invitation schemes on breast cancer screening coverage: A cohort study from Copenhagen, Denmark. J Med Screen 2016; 24:20-26. [PMID: 27206815 PMCID: PMC5414897 DOI: 10.1177/0969141316641982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The purpose of mammography screening is to decrease breast cancer mortality. To achieve this a high coverage by examination is needed. Within an organized screening programme, we examined the impact of changes in the invitation schedule on the interplay between coverage and participation. Method We studied nine cohorts aged 50-51 when first targeted by mammography screening in Copenhagen, Denmark. Population data were retrieved from the Danish Civil Registration System; invitation and attendance data from the screening programme database. Data were linked using unique personal identification numbers. Coverage by invitation was defined as (number of invited women/number of targeted women), coverage by examination as (number of screened women/number of targeted women), and participation rate as (number of screened women/number of invited women). Results Coverage by invitation was close to or above 95% for all newly recruited cohorts. In subsequent invitation rounds, both technical errors and changes in the invitation scheme affected the coverage by invitation. Coverage by examination at first invitation was 72.5% for the first cohort, but dropped to 64.2% for the latest cohort. Furthermore, coverage by examination dropped by increasing invitation number and with omission of re-invitation of previous non-attenders. Participation rate closely reflected changes in the invitation scheme. Conclusion Changes in the invitation schemes influenced coverage by invitation, coverage by examination, and participation rate. We observed a considerable gap between coverage by examination and participation rate, strongly indicating that the latter cannot without reservations, be taken as an indicator of the first.
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Affiliation(s)
- Katja Kemp Jacobsen
- 1 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ilse Vejborg
- 2 Department of Radiology, Center of Diagnostic Imaging, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elsebeth Lynge
- 1 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Jensen LF, Pedersen AF, Andersen B, Vedsted P. Self-assessed health, perceived stress and non-participation in breast cancer screening: A Danish cohort study. Prev Med 2015; 81:392-8. [PMID: 26494608 DOI: 10.1016/j.ypmed.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Population-based cancer screening is offered in many countries to detect early stages of cancer and reduce mortality. Screening efficiency and equality is susceptible due to a group of non-participants. We investigated associations between self-assessed health, perceived stress and subsequent non-participation in breast cancer screening. METHODS This population-based cohort study included 4512 women who had participated in a Health Survey in 2006 and who were also the target group (aged 50-69 years) for the first organised breast cancer screening programme -3 years later in the Central Denmark Region in 2008-2009. RESULTS A U-shaped association was observed for physical health assessment as women with the highest (PR=1.28, 95% CI: 1.06-1.55), and the lowest (PR=1.41, 95% CI: 1.18-1.68) physical health scores were less likely to participate in the programme than women with physical health scores in the middle range. Women with low mental health assessment were more likely not to participate than women with mental health scores in the middle range (PR=1.44, 95% CI: 1.22-1.69). Higher non-participation propensity was also observed for women with the highest perceived stress scores (PR=1.27, 95% CI: 1.07-1.51) compared with women scoring in the middle range. CONCLUSIONS Women with highest and lowest self-assessed physical health, with lowest mental health or highest perceived stress were significantly more likely not to participate in breast cancer screening 2-3 years later than women who reported average health. Interventions targeting these groups may promote equal participation in future breast cancer screening programmes.
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Affiliation(s)
- Line Flytkjær Jensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Department for Public Health Programs, Randers Regional Hospital, Central Denmark Region, Skovlyvej 1, Randers, NE 8930, Denmark.
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark
| | - Berit Andersen
- Department for Public Health Programs, Randers Regional Hospital, Central Denmark Region, Skovlyvej 1, Randers, NE 8930, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark; Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark
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Labeit A, Peinemann F. Breast and cervical cancer screening in Great Britain: Dynamic interrelated processes. HEALTH ECONOMICS REVIEW 2015; 5:32. [PMID: 26487452 PMCID: PMC4615931 DOI: 10.1186/s13561-015-0065-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
No previous analysis has investigated the determinants of screening uptake for breast and cervical cancer screening for possible spillover effects from one type of screening examination to the other type of screening examination with a dynamic bivariate panel probit model. For our analysis, we used a dynamic random effects bivariate panel probit model with initial conditions (Wooldridge-type estimator) and dependent variables were the participation of breast and cervical cancer screening in the recent year. The balanced panel sample consisted of 844 women from the British Household Panel Survey (BHPS) from the time period 1992 to 2008. Our analysis showed the high relevance of past screening behaviour and the importance of state dependency for the same and the other type of cancer screening examinations even after controlling for covariates and unobserved heterogeneity. The uptake for breast and cervical cancer screening was higher when the same screening examination was done one or three years earlier. This result is in accordance with the medical screening programmes in Great Britain. With regard to breast and cervical cancer screening positive spillover effects existed between screening examinations in the third order lags. Women with a previous visit to a general practitioner and individuals in the recommended age groups had a higher uptake for breast and cervical cancer screening. Other socioeconomic and health related variables had non-uniform results in both screening examinations. Promoting the uptake of one female prevention activity could also enhance the uptake of the other prevention activity.
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Affiliation(s)
- Alexander Labeit
- School of Health and Related Sciences, Regent Court, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Frank Peinemann
- FOM University of Applied Science for Economics & Management, Leimkugelstr. 6, 45141, Essen, Germany.
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Lemke D, Berkemeyer S, Mattauch V, Heidinger O, Pebesma E, Hense HW. Small-area spatio-temporal analyses of participation rates in the mammography screening program in the city of Dortmund (NW Germany). BMC Public Health 2015; 15:1190. [PMID: 26615393 PMCID: PMC4663041 DOI: 10.1186/s12889-015-2520-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/18/2015] [Indexed: 11/16/2022] Open
Abstract
Background The population-based mammography screening program (MSP) was implemented by the end of 2005 in Germany, and all women between 50 and 69 years are actively invited to a free biennial screening examination. However, despite the expected benefits, the overall participation rates range only between 50 and 55 %. There is also increasing evidence that belonging to a vulnerable population, such as ethnic minorities or low income groups, is associated with a decreased likelihood of participating in screening programs. This study aimed to analyze in more detail the intra-urban variation of MSP uptake at the neighborhood level (i.e. statistical districts) for the city of Dortmund in northwest Germany and to identify demographic and socioeconomic risk factors that contribute to non-response to screening invitations. Methods The numbers of participants by statistical district were aggregated over the three periods 2007/2008, 2009/2010, and 2011/2012. Participation rates were calculated as numbers of participants per female resident population averaged over each 2-year period. Bayesian hierarchical spatial models extended with a temporal and spatio-temporal interaction effect were used to analyze the participation rates applying integrated nested Laplace approximations (INLA). The model included explanatory covariates taken from the atlas of social structure of Dortmund. Results Generally, participation rates rose for all districts over the time periods. However, participation was persistently lowest in the inner city of Dortmund. Multivariable regression analysis showed that migrant status and long-term unemployment were associated with significant increases of non-attendance in the MSP. Conclusion Low income groups and immigrant populations are clustered in the inner city of Dortmund and the observed spatial pattern of persistently low participation in the city center is likely linked to the underlying socioeconomic gradient. This corresponds with the findings of the ecological regression analysis manifesting socioeconomically deprived neighborhoods as risk factors for low attendance in the MSP. Spatio-temporal surveillance of participation in cancer screening programs may be used to identify spatial inequalities in screening uptake and plan spatially focused interventions.
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Affiliation(s)
- Dorothea Lemke
- Institute of Epidemiology and Social Medicine, Medical Faculty, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, D 48149, Münster, Germany. .,Institute for Geoinformatics, Geosciences Faculty, Westfälische Wilhelms-Universität Münster, Münster, Germany.
| | - Shoma Berkemeyer
- Reference Center for the Mammography Screening Program, University Hospital, Westfälische Wilhelms-Universität Münster, Münster, Germany.
| | - Volkmar Mattauch
- Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany.
| | - Oliver Heidinger
- Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany.
| | - Edzer Pebesma
- Institute for Geoinformatics, Geosciences Faculty, Westfälische Wilhelms-Universität Münster, Münster, Germany.
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, Medical Faculty, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1 D3, D 48149, Münster, Germany. .,Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany.
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Hellmann SS, Njor SH, Lynge E, von Euler-Chelpin M, Olsen A, Tjønneland A, Vejborg I, Andersen ZJ. Body mass index and participation in organized mammographic screening: a prospective cohort study. BMC Cancer 2015; 15:294. [PMID: 25880028 PMCID: PMC4404005 DOI: 10.1186/s12885-015-1296-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer is the leading cancer among women, and early diagnosis is essential for future prognosis. Evidence from mainly cross-sectional US studies with self-reported exposure and outcome found positive association of body mass index (BMI) with non-participation in mammographic screening, but hardly addressed the influence of potential effect-modifiers. We studied the association between objective measures of BMI and participation in mammographic screening in a Danish prospective cohort, and explored the influence of menopausal status, hormone therapy (HT), previous screening participation, and morbidities on this relationship. Methods A total of 5,134 women from the Diet, Cancer, and Health cohort who were invited to population based mammographic screening in Copenhagen were included in analysis. Women were 50–64 years old at inclusion (1993–97) when their height and weight were measured and covariates collected via questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) for the association between BMI and mammographic screening participation were estimated by logistic regression, adjusted for other breast cancer risk factors and morbidities. Effect modification was evaluated by an interaction term and tested by Wald test. Results Underweight (BMI < 18.5 kg/m2, OR: 95% CI; 2.24: 1.27-3.96) and obese women of class II (BMI 35–40 kg/m2, 1.54: 0.99-2.39) and III (BMI ≥ 40 kg/m2, 1.81: 0.95-3.44) had significantly higher odds of non-participation than women with normal weight. This association was limited to postmenopausal women (Wald test p = 0.08), with enhanced non-participation in underweight (2.83: 1.52-5.27) and obese women of class II and III (1.84: 1.15-2.95; 2.47: 1.20-5.06) as compared to normal weight postmenopausal women. There was no effect modification by HT, previous screening participation, or morbidities, besides suggestive evidence of enhanced non-participation in diabetic overweight and obese women. Conclusions Underweight and very obese postmenopausal women were significantly less likely to participate in mammographic screening than women with normal weight, while BMI was not related to screening in premenopausal women. Effect of BMI on mammographic screening participation was not significantly modified by HT, previous screening participation, or morbidities.
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Affiliation(s)
- Sophie Sell Hellmann
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Sisse Helle Njor
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - My von Euler-Chelpin
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Anja Olsen
- Danish Cancer Society, Institute of Cancer Epidemiology, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Anne Tjønneland
- Danish Cancer Society, Institute of Cancer Epidemiology, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Ilse Vejborg
- Diagnostic Imaging Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Zorana Jovanovic Andersen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
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Dialla PO, Arveux P, Ouedraogo S, Pornet C, Bertaut A, Roignot P, Janoray P, Poillot ML, Quipourt V, Dabakuyo-Yonli TS. Age-related socio-economic and geographic disparities in breast cancer stage at diagnosis: a population-based study. Eur J Public Health 2015; 25:966-72. [PMID: 25829506 DOI: 10.1093/eurpub/ckv049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to determine the impact of socio-economic and geographic disparities on disease stage at diagnosis according to age in breast cancer (BC) patients. Secondary purpose was to describe survival METHODS All women with primary invasive BC, diagnosed from 1998 to 2009 in the department of Côte d'Or were retrospectively selected using data from the Côte d'Or BC registry. European transnational ecological deprivation index (French European Deprivation Index) was used to measure the socio-economic environment. Relationships between socio-geographic deprivation and disease stage at diagnosis according to age were assessed by a multilevel ordered logistic regression model. Relative survival rates (RSRs) were given at 5 years according to tumour and patients characteristics. RESULTS In total, 4364 women were included. In multivariable analysis, socio-economic deprivation was associated with disease stage at diagnosis. Women aged between 50 and 74 years and living in deprived areas were more often diagnosed with advanced tumour stages (stages II/III vs. I or stages IV vs. II/III) with odds ratio = 1.27 (1.01-1.60). RSRs were lowest in women living in the most deprived area compared with those living in most affluent area with RSR = 88.4% (85.9-90.4) and 92.6% (90.5-94.2), respectively. CONCLUSIONS Socio-economic factors affected tumour stage at diagnosis and survival. Living in a deprived area was linked to advanced-stage BC at diagnosis only in women aged 50-74 years. This is probably due to the socio-economic disparities in participation in organized BC screening programmes. Furthermore, living in deprived area was associated with a poor survival rate.
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Affiliation(s)
- Pegdwende O Dialla
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Patrick Arveux
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Samiratou Ouedraogo
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Carole Pornet
- 3 Department of Epidemiological Research and Evaluation, CHU de Caen, France 4 EA3936, Medical School, Université de Caen Basse-Normandie, Caen, France 5 U1086 Inserm, Cancers and Preventions, Medical School, Université de Caen Basse-Normandie, Avenue de la Côte de Nacre, Caen, France
| | - Aurélie Bertaut
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | | | | | - Marie-Laure Poillot
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Valérie Quipourt
- 8 Coordination Unit in Geriatric oncology in Burgundy, Hôpital de jour Gériatrique, Hôpital de Champmaillot, Dijon, France
| | - Tienhan S Dabakuyo-Yonli
- 2 EA 4184, Medical School University of Burgundy, Dijon, France 9 Biostatistics and Quality of Life Unit, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France
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Ricardo-Rodrigues I, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, Jiménez-Trujillo I, López de Andrés A. Social disparities in access to breast and cervical cancer screening by women living in Spain. Public Health 2015; 129:881-8. [PMID: 25818014 DOI: 10.1016/j.puhe.2015.02.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/07/2014] [Accepted: 02/15/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. STUDY DESIGN Cross-sectional study using data from the 2011 Spanish national health survey. METHODS Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. RESULTS Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. CONCLUSION Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.
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Affiliation(s)
- I Ricardo-Rodrigues
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - R Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain.
| | - V Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - P Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - I Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - A López de Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
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European transnational ecological deprivation index and participation in population-based breast cancer screening programmes in France. Prev Med 2014; 63:103-8. [PMID: 24345603 DOI: 10.1016/j.ypmed.2013.12.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 12/05/2013] [Accepted: 12/07/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND We investigated factors explaining low breast cancer screening programme (BCSP) attendance taking into account a European transnational ecological Deprivation Index. PATIENTS AND METHODS Data of 13,565 women aged 51-74years old invited to attend an organised mammography screening session between 2010 and 2011 in thirteen French departments were randomly selected. Information on the women's participation in BCSP, their individual characteristics and the characteristics of their area of residence were recorded and analysed in a multilevel model. RESULTS Between 2010 and 2012, 7121 (52.5%) women of the studied population had their mammography examination after they received the invitation. Women living in the most deprived neighbourhood were less likely than those living in the most affluent neighbourhood to participate in BCSP (OR 95%CI=0.84[0.78-0.92]) as were those living in rural areas compared with those living in urban areas (OR 95%CI=0.87[0.80-0.95]). Being self-employed (p<0.0001) or living more than 15min away from an accredited screening centre (p=0.02) was also a barrier to participation in BCSP. CONCLUSION Despite the classless delivery of BCSP, inequalities in uptake remain. To take advantage of prevention and to avoid exacerbating disparities in cancer mortality, BCSP should be adapted to women's personal and contextual characteristics.
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To what extent is women's economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010. Cancer Causes Control 2014; 25:977-83. [PMID: 24842393 DOI: 10.1007/s10552-014-0397-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/08/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE In France, larger social inequalities are reported for cervical cancer screening, based on individual practice, than for breast cancer screening for which organized screening exists. Our aim was to investigate the association between women's economic situation and breast and cervical cancer screening. METHODS We used data from a large French national health survey conducted in 2010. The economic situation was assessed using the number of adverse economic conditions respondents were facing, based on three variables (low income, lacking food, and perceived financial difficulties). Logistic regressions were adjusted for socioeconomic and sociodemographic characteristics, healthcare use and insurance, and health behaviors. RESULTS Mammography was less frequent among women experiencing two or more adverse economic conditions, whereas Pap smear was less frequent among women experiencing at least one adverse economic condition. For both screenings, higher rates were observed among women who lived in the Paris region. Sociodemographic indicators and health behaviors were associated with Pap smear, whereas healthcare use and insurance characteristics were associated with mammography. CONCLUSIONS The women's economic situation is an important determinant of breast and cervical cancer screening in France in 2010. Alleviating economic barriers to female cancers screening should be a priority in future programs implementation.
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Kristensson JH, Sander BB, von Euler-Chelpin M, Lynge E. Predictors of non-participation in cervical screening in Denmark. Cancer Epidemiol 2014; 38:174-80. [DOI: 10.1016/j.canep.2013.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
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Andersen ZJ, Baker JL, Bihrmann K, Vejborg I, Sørensen TIA, Lynge E. Birth weight, childhood body mass index, and height in relation to mammographic density and breast cancer: a register-based cohort study. Breast Cancer Res 2014; 16:R4. [PMID: 24443815 PMCID: PMC3978910 DOI: 10.1186/bcr3596] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 01/06/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction High breast density, a strong predictor of breast cancer may be determined early in life. Childhood anthropometric factors have been related to breast cancer and breast density, but rarely simultaneously. We examined whether mammographic density (MD) mediates an association of birth weight, childhood body mass index (BMI), and height with the risk of breast cancer. Methods 13,572 women (50 to 69 years) in the Copenhagen mammography screening program (1991 through 2001) with childhood anthropometric measurements in the Copenhagen School Health Records Register were followed for breast cancer until 2010. With logistic and Cox regression models, we investigated associations among birth weight, height, and BMI at ages 7 to 13 years with MD (mixed/dense or fatty) and breast cancer, respectively. Results 8,194 (60.4%) women had mixed/dense breasts, and 716 (5.3%) developed breast cancer. Childhood BMI was significantly inversely related to having mixed/dense breasts at all ages, with odds ratios (95% confidence intervals) ranging from 0.69 (0.66 to 0.72) at age 7 to 0.56 (0.53 to 0.58) at age 13, per one-unit increase in z-score. No statistically significant associations were detected between birth weight and MD, height and MD, or birth weight and breast cancer risk. BMI was inversely associated with breast cancer, with hazard ratios of 0.91 (0.83 to 0.99) at age 7 and 0.92 (0.84 to 1.00) at age 13, whereas height was positively associated with breast cancer risk (age 7, 1.06 (0.98 to 1.14) and age 13, 1.08 (1.00 to 1.16)). After additional adjustment for MD, associations of BMI with breast cancer diminished (age 7, 0.97 (0.88 to 1.06) and age 13, 1.01 (0.93 to 1.11)), but remained with height (age 7, 1.06 (0.99 to 1.15) and age 13, 1.09 (1.01 to 1.17)). Conclusions Among women 50 years and older, childhood body fatness was inversely associated with the breast cancer risk, possibly via a mechanism mediated by MD, at least partially. Childhood tallness was positively associated with breast cancer risk, seemingly via a pathway independent of MD. Birth weight was not associated with MD or breast cancer in this age group.
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Lindberg LG, Svendsen M, Dømgaard M, Brodersen J. Better safe than sorry: a long-term perspective on experiences with a false-positive screening mammography in Denmark. HEALTH RISK & SOCIETY 2013. [DOI: 10.1080/13698575.2013.848845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Anderson WF, Rosenberg PS, Petito L, Katki HA, Ejlertsen B, Ewertz M, Rasmussen BB, Jensen MB, Kroman N. Divergent estrogen receptor-positive and -negative breast cancer trends and etiologic heterogeneity in Denmark. Int J Cancer 2013; 133:2201-6. [PMID: 23616071 PMCID: PMC3749265 DOI: 10.1002/ijc.28222] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/09/2013] [Indexed: 12/30/2022]
Abstract
Long-term breast cancer trends in incidence in the United States (US) show rising estrogen receptor (ER)-positive rates and falling ER-negative rates. We hypothesized that these divergent trends reflect etiologic heterogeneity and that comparable trends should be observed in other countries with similar risk factor profiles. Therefore, we analyzed invasive female breast cancers in Denmark, a country with similar risk factors as the US. We summarized the overall trend in age-standardized rates with the estimated annual percentage change (EAPC) statistic (1993-2010) and used age-period-cohort models to estimate age-specific EAPCs, cohort rate ratios and projections for future time periods (2011-2018). In Denmark, the overall rate of ER-positive cancers rose between 1993 and 2010 by 3.0% per year (95% CI: 2.8-3.3% per year), whereas the overall rate of ER-negative cancers fell by 2.1% per year (95% CI: -2.5 to -1.6% per year). The ER-positive rate increased fastest among postmenopausal women and the ER-negative rate decreased fastest among premenopausal women, reflecting that cohorts born after 1944 were at relatively higher risk of ER-positive tumors and lower risk of ER-negative tumors. If current trends continue, ER-positive cancers will increase at least 13% by 2018 in Denmark, ER-negative cancers will fall 15% by 2018, and breast cancer overall will increase at least 7% by 2018. Divergent ER-specific trends are consistent with distinct etiologic pathways. If trends in known risk factors are responsible, the Danish and US experience may foreshadow a common pattern worldwide.
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Affiliation(s)
- William F Anderson
- DHHS/NIH/National Cancer Institute/Division of Cancer Epidemiology and Genetics/Biostatistics Branch, Bethesda, MD, USA.
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Beckmann KR, Roder DM, Hiller JE, Farshid G, Lynch JW. Do breast cancer risk factors differ among those who do and do not undertake mammography screening? J Med Screen 2013; 20:208-19. [DOI: 10.1177/0969141313510293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives There is considerable interest in whether mammography screening leads to over-diagnosis of breast cancer. However self-selection into screening programmes may lead to risk differences that affect estimates of over-diagnosis. This study compares the breast cancer risk profiles of participants and non-participants of population-based mammography screening. Risk profiles are also compared between those who have and have not used private screening services. Setting This study involved 1162 women aged 40–84 who participated in the 2012 Health Omnibus, an annual face-to-face interview-based survey of a representative sample of the population in the state of South Australia. Methods Data were collected on participation in mammography screening, demographic characteristics and breast cancer risk factors (including reproductive, familial and lifestyle factors). Missing data were multiply imputed. Factors independently associated with ever having been screened were identified using multivariable logistic regression, for population-based and ad hoc, private mammography screening separately. Results Compared with non-participants, participants of population-based screening were more likely to have used hormone replacement therapy (odds ratio [OR] = 3.72), experienced breast biopsy or surgery (OR = 2.22), and be overweight or obese (OR = 1.57). They were less likely to be sufficiently active (OR = 0.57) or be born in a non-English speaking country (OR = 0.50) or aged under 50 (OR = 0.09). Women who were screened privately were more likely to have a family history of breast cancer (OR = 1.66) and have experienced breast biopsy or surgery (OR = 3.17) than those who had not. Conclusions South Australian women who participated in the population-based mammography screening have a slightly higher prevalence of breast cancer risk factors. This also applies to those who undertook private screening.
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Affiliation(s)
- Kerri R Beckmann
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - David M Roder
- Population Health, Health Sciences, University of South Australia, Adelaide, Australia
| | - Janet E Hiller
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
| | | | - John W Lynch
- School of Population Health, University of Adelaide, Adelaide, Australia
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Hellmann SS, Lynge E, Schwartz W, Vejborg I, Njor SH. Mammographic density in birth cohorts of Danish women: a longitudinal study. BMC Cancer 2013; 13:409. [PMID: 24106754 PMCID: PMC3766215 DOI: 10.1186/1471-2407-13-409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 08/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the leading malignant disease among western women with incidence increasing over time. High mammographic density is a well-established risk factor for breast cancer. We explored trends in mammographic density across birth cohorts to gain further insight into possible time trends in women's mammographic density that might explain the historical increase in breast cancer incidence. METHODS Data derived from two mammography screening programs in Denmark from 1991 to 2001, including on average 41,091 women from Copenhagen and 52,938 women from Funen aged 50-69. Mammographic density was assessed qualitatively (fatty or mixed/dense) by senior screening radiologists. The proportion of women with mixed/dense mammographic density was calculated by age at screening, screening period, and birth cohort. The Generalized Estimating Equations were used to calculate odds ratios and 95% confidence intervals. All statistical tests were two-sided. RESULTS The proportion of women with mixed/dense mammographic density increased from 45% among women born in the 1920s to 75-80% among women born in the 1940s. In Copenhagen, the age-adjusted odds ratio (95% CI) of mixed/dense mammographic density in women born in 1941-42 was 2.48 (2.22-2.76) compared with women born in 1921-22. In Funen, the age-adjusted odds ratio of mixed/dense mammographic density in women born in 1946-47 was 5.89 (5.32-6.51) compared with women born in 1924-25. Hormone use had a greater impact on mammographic density in birth cohorts of the 1920s compared with those of the 1940s. CONCLUSIONS We found suggestive evidence of a birth cohort pattern in mammographic density and an attenuated impact of hormone use in younger compared with older birth cohorts suggesting that postmenopausal mammographic density could be linked to changing exposures accumulated over time in women's lives.
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Kristiansen M, Lue-Kessing L, Mygind A, Razum O, Norredam M. Migration from low- to high-risk countries: a qualitative study of perceived risk of breast cancer and the influence on participation in mammography screening among migrant women in Denmark. Eur J Cancer Care (Engl) 2013; 23:206-13. [PMID: 23855488 DOI: 10.1111/ecc.12100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2013] [Indexed: 11/29/2022]
Abstract
Migrants are less likely to participate in mammography screening programmes compared with local-born populations in Europe. We explored perceptions of breast cancer risk and the influence on participation in mammography screening programmes among migrant women born in countries with low incidence rates of breast cancer. We conducted eight individual interviews and six group interviews including a total of 29 women aged 50-69 years living in Copenhagen, Denmark. Women were migrants born in Somalia, Turkey, Pakistan or Arab countries. Phenomenological analysis was used. Breast cancer was perceived to be caused by multiple factors, including genetics, health behaviour, stress, fertility and breastfeeding. Some women perceived breast cancer to be more prevalent in Denmark as compared with their country of birth, and perceived their risk of developing breast cancer to increase with length of stay in Denmark. Although most women agreed on the relevance of mammography screening, other cancers, chronic and infectious diseases and mental health problems were mentioned as equally or more important to target in public health programmes. A life course perspective comprising previous and current circumstances in country of birth as well as immigration country is important for understanding and influencing the screening behaviour of migrants.
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Affiliation(s)
- M Kristiansen
- Research Centre for Migration, Ethnicity, and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Jensen LF, Pedersen AF, Andersen B, Vedsted P. Identifying specific non-attending groups in breast cancer screening--population-based registry study of participation and socio-demography. BMC Cancer 2012; 12:518. [PMID: 23151053 PMCID: PMC3526420 DOI: 10.1186/1471-2407-12-518] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 11/10/2012] [Indexed: 11/29/2022] Open
Abstract
Background A population-based breast cancer screening programme was implemented in the Central Denmark Region in 2008–09. The objective of this registry-based study was to examine the association between socio-demographic characteristics and screening participation and to examine whether the group of non-participants can be regarded as a homogeneous group of women. Method Participation status was obtained from a regional database for all women invited to the first screening round in the Central Denmark Region in 2008–2009 (n=149,234). Participation data was linked to registries containing socio-demographic information. Distance to screening site was calculated using ArcGIS. Participation was divided into ‘participants’ and ‘non-participants’, and non-participants were further stratified into ‘active non-participants’ and ‘passive non-participants’ based on whether the woman called and cancelled her participation or was a ‘no-show’. Results The screening participation rate was 78.9%. In multivariate analyses, non-participation was associated with older age, immigrant status, low OECD-adjusted household income, high and low level education compared with middle level education, unemployment, being unmarried, distance to screening site >20 km, being a tenant and no access to a vehicle. Active and passive non-participants comprised two distinct groups with different socio-demographic characteristics, with passive non-participants being more socially deprived compared with active non-participants. Conclusion Non-participation was associated with low social status e.g. low income, unemployment, no access to vehicle and status as tenant. Non-participants were also more likely than participants to be older, single, and of non-Danish origin. Compared to active non-participants, passive non-participants were characterized by e.g. lower income and lower educational level. Different interventions might be warranted to increase participation in the two non-participant groups.
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Affiliation(s)
- Line Flytkjær Jensen
- The Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark.
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Diderichsen F, Andersen I, Manuel C, Andersen AMN, Bach E, Baadsgaard M, Brønnum-Hansen H, Hansen FK, Jeune B, Jørgensen T, Søgaard J. Health Inequality - determinants and policies. Scand J Public Health 2012; 40:12-105. [DOI: 10.1177/1403494812457734] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Celie Manuel
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Elsa Bach
- The National Research Centre for the Working Environment
| | | | | | | | | | | | - Jes Søgaard
- The Danish Institute for Health Services Research
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Pons-Vigués M, Puigpinós-Riera R, Rodríguez D, Fernández de Sanmamed MJ, Pasarín MI, Pérez G, Borrell C, Casamitjana M, Benet J. Country of origin and prevention of breast cancer: Beliefs, knowledge and barriers. Health Place 2012; 18:1270-81. [DOI: 10.1016/j.healthplace.2012.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
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Dourado F, Carreira H, Lunet N. Mammography use for breast cancer screening in Portugal: results from the 2005/2006 National Health Survey. Eur J Public Health 2012; 23:386-92. [PMID: 22874736 DOI: 10.1093/eurpub/cks103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Understanding the patterns of mammography use is essential to promote the participation in breast cancer screening. OBJECTIVES To describe the patterns of screening mammography use in Portugal. METHODS As part of the fourth National Health Survey (2005/2006), 3045 women were evaluated in face-to-face interviews. The previous use of mammography for screening was classified as never or ever, and the latter was further grouped according to the time elapsed since the latest mammography. Having undergone the latest mammography >2 years before was considered underuse. We assessed the determinants of never having been screened by mammography and, among those who had been tested, the determinants of mammography underuse, through age- and education-adjusted odds ratios (ORs), with 95% confidence intervals (95% CIs). RESULTS Among women aged 45-49 and 50-69 years, 86.3% and 88.0%, respectively, underwent a screening mammography before, and most of them were tested in the previous 2 years. The lowest risk of never having been screened was in Norte (OR = 0.41, 95% CI: 0.21-0.80) and the highest in Açores (OR = 4.04, 95% CI: 2.37-6.92), in comparison with Centro (the region with organized screening for a longer time). Participants with <4 years of formal education were more likely to have never been screened than the more educated (OR = 4.27, 95% CI: 1.67-10.89). Women with private health insurance (OR = 0.16, 95% CI: 0.04-0.65), as well as those who had undergone cervical cytology screening before (OR = 0.50, 95% CI: 0.30-0.85), had a lower risk of underuse. CONCLUSIONS This study provides useful information to improve the allocation of resources to breast cancer screening.
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Affiliation(s)
- Fernanda Dourado
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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Jacobsen KK, von Euler-Chelpin M. Performance indicators for participation in organized mammography screening. J Public Health (Oxf) 2012; 34:272-8. [DOI: 10.1093/pubmed/fdr106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kristiansen M, Thorsted BL, Krasnik A, von Euler-Chelpin M. Participation in mammography screening among migrants and non-migrants in Denmark. Acta Oncol 2012; 51:28-36. [PMID: 22035117 DOI: 10.3109/0284186x.2011.626447] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Inequality in use of mammography screening across population groups is a concern since migrants are more likely to become non-users compared to the general population. The aim of this study was to a) identify determinants of participation among migrant groups and Danish-born women with emphasis on the effect of household size, socioeconomic position and use of healthcare services, and b) test whether effects of determinants were consistent across migrant and non-migrant groups. MATERIAL AND METHODS We used data from the first eight invitation rounds of the mammography screening programme in Copenhagen, Denmark (1991-2008) in combination with register-based data. RESULTS The crude odds ratio (OR) for not participating in mammography screening was 1.38 (95% CI, 1.30-1.46) for women born in other-Western and 1.80 (95% CI, 1.71-1.90) for women born in non-Western countries compared to Danish-born women. The adjusted OR was 1.14 (95% CI, 1.06-1.21) for other-Western and 1.19 (95% CI, 1.11-1.27) for women born in non-Western countries. Lack of contact with a general practitioner or dental services, and not being employed had a significant negative effect on use of mammography screening. Higher-educated women were significantly less likely to use mammography screening in all groups whilst hospitalisation had a significant effect among Danish-born women. Living alone was consistently associated with non-use of mammography screening. The probability of becoming a non-user was significantly less among women living within households of two to four persons compared to women living alone. Except in the case of age and hospitalisation, trends were similar across country of birth, but the relative importance of specific determinants in explaining use of mammography screening differed. CONCLUSION Household size, socioeconomic position and use of healthcare services were determinants of participation in mammography screening. This study emphasises the need for conducting refined analyses distinguishing among subgroups within diverse populations when explaining differences in screening behaviour.
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Affiliation(s)
- Maria Kristiansen
- Danish Research Centre for Migration, Ethnicity, and Health, Health Services Research Unit, Department of Public Health, University of Copenhagen, Denmark.
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Von Euler-Chelpin M, Lynge E, Rebolj M. Register-based studies of cancer screening effects. Scand J Public Health 2011; 39:158-64. [PMID: 21775376 DOI: 10.1177/1403494811401479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There are two organised cancer screening programmes in Denmark, against cervical and breast cancers. The aim with this study was to give an overview of the available register-based research regarding these two programmes, to demonstrate the usefulness of data from the national registers. RESEARCH TOPICS The register-based studies on cancer screening in Denmark could be grouped into research concerning effectiveness, in terms of mortality and incidence reduction, short-term indicators, e.g. in relation to recommended quality assurance indicators, and side effects, e.g. as false-positive results and overdiagnosis. CONCLUSION The results indicate that registers have proven to be a valuable tool in evaluating the effects of ongoing screening activities. As they cannot be systematically used to test new screening technologies, register-based studies should not be seen as an alternative to randomised controlled trials, but as a supplement.
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Giordano L, Stefanini V, Senore C, Frigerio A, Castagno R, Marra V, Dalmasso M, del Turco MR, Paci E, Segnan N. The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years. Eur J Public Health 2011; 22:413-8. [PMID: 21746751 DOI: 10.1093/eurpub/ckr090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several factors can influence access to population breast cancer screening. The aim of the study was to evaluate the impact of different information approaches, women's socio-demographic characteristics and organizational factors on mammography screening uptake. METHODS We selected 5744 women aged 40-45 years who were randomly assigned to be given letters with: (i) a pre-fixed appointment plus standard leaflet (Group 1); (ii) a pre-fixed appointment plus a more comprehensive booklet (Group 2); (iii) point (ii) plus the offer of a counselling session (Group 3); and (iv) an invitation to contact the centre to get information and arrange participation (Group 4). RESULTS Ninety-five women were excluded before the invitation and 5649 were randomized. After excluding undelivered letters (n = 41) and women reporting an exclusion criterion following our invitation (n = 248), the final eligible population was 5360 women. Participation rates following the first contact were 36.5, 39.9, 35.8 and 16.5% for Groups 1-4, respectively. The rates increased to 40.9, 43.6, 40.1 and 35.1% after the reminder letters. Women receiving more complete information had a higher uptake (Group 2), although not statistically significant. Differences among the four groups were maintained by controlling the effect of socio-demographic and attendance determinants. Regardless of intervention, participation was higher among married, higher educated, white-collared women, those born in northern Italy, living closer to the screening unit and with a female-collaborative doctor. CONCLUSION Invitation letters with a fixed appointment correlate with a higher attendance rate. Providing women with more information on procedures, risks and benefits of mammography screening does not modify their participation.
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Affiliation(s)
- Livia Giordano
- Unit of Epidemiology - CPO Piemonte, Center for Cancer Prevention, Turin, Italy.
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Pons-Vigués M, Puigpinós-Riera R, Rodríguez-Sanz M, Serral G, Palència L, Borrell C. Preventive Control of Breast and Cervical Cancer in Immigrant and Native Women in Spain: The Role of Country of Origin and Social Class. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2011; 41:483-99. [DOI: 10.2190/hs.41.3.e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study describes the periodic use of cervical and breast cancer screening by women residing in Spain, according to their country of origin, and analyzes whether the observed associations are modified by social class. A cross-sectional design was used, with the study population consisting of women residing in Spain in 2006, ages 25–65 years (N = 10,093) and 40–69 years (N = 6,674) in the cervical and breast cancer screening groups, respectively. The information source was Spain's National Health Survey of 2006. The dependent variables were: undergoing periodic cervical cancer screening (every 5 years or less) and breast cancer screening (every 2 years or less). The independent variables were: country of origin, social class, health care coverage, cohabitation, and age. A descriptive analysis was carried out, and robust Poisson regression models were fitted. Women from low-income countries underwent fewer periodic screening exams for cervical cancer and breast cancer. Independent of country of origin, women from the manual classes underwent fewer screening exams than those from the non-manual classes. In the 50–69 years age group, it was mainly women from the manual classes from low-income countries who underwent fewer periodic mammograms. Having only public health care coverage and not cohabiting with a partner were also associated with lower prevalences of use.
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Halkett G, Aoun S, Hayne D, Lund JA, Gruen A, Villa J, Livi L, Arcangeli S, Velikova G, Spry N. EORTC radiation proctitis-specific quality of life module – Pretesting in four European countries. Radiother Oncol 2010; 97:294-300. [DOI: 10.1016/j.radonc.2010.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 03/11/2010] [Accepted: 04/05/2010] [Indexed: 11/12/2022]
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Frederiksen BL, Jørgensen T, Brasso K, Holten I, Osler M. Socioeconomic position and participation in colorectal cancer screening. Br J Cancer 2010; 103:1496-501. [PMID: 20959827 PMCID: PMC2990593 DOI: 10.1038/sj.bjc.6605962] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening with faecal occult blood test (FOBT) has the potential to reduce the incidence and mortality of CRC. Screening uptake is known to be inferior in people with low socioeconomic position (SEP) when compared with those with high position; however, the results of most previous studies have limited value because they are based on recall or area-based measures of socioeconomic position, and might thus be subject to selective participation and misclassification. In this study we investigated differences in CRC screening participation using register-based individual information on education, employment, and income to encompass different but related aspects of socioeconomic stratification. Also, the impact of ethnicity and cohabiting status was analysed. METHODS A feasibility study on CRC screening was conducted in two Danish counties in 2005 and 2006. Screening consisted of a self-administered FOBT kit mailed to 177 114 inhabitants aged 50-74 years. Information on individual socioeconomic status was obtained from Statistics Denmark. RESULTS A total of 85 374 (48%) of the invited returned the FOBT kits. Participation was significantly higher in women than in men (OR=1.58 (1.55-1.61)), when all socioeconomic and demographic variables were included in the statistical model. Participation also increased with increasing level of education, with OR=1.38 (1.33-1.43) in those with a higher education compared with short education. Also, participation increased with increasing income levels, with OR=1.94 (1.87-2.01) in the highest vs lowest quintile. Individuals with a disability pension, the unemployed and self-employed people were significantly less likely to participate (OR=0.77 (0.74-0.80), OR=0.83 (0.80-0.87), and OR=0.85 (0.81-0.89), respectively). Non-western immigrants were less likely to participate (OR=0.62 (0.59-0.66)) in a model controlling for age, sex, and county; however, this difference might be attributed to low SEP in these ethnic groups ((OR=0.93 (0.87-0.99), when adjusting for SEP indicators). CONCLUSION This study based on individual information on several socioeconomic dimensions in a large, unselected population allowed for identification of several specific subgroups within the population with low CRC screening participation. Improved understanding is needed on the effect of targeted information and other strategies in order to reduce socioeconomic inequalities in screening.
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Affiliation(s)
- B L Frederiksen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Building 84/85, DK-2600 Glostrup, Denmark.
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López-de-Andrés A, Martin-Lopez R, Hernández-Barrera V, Carrasco-Garrido P, Gil-de-Miguel Á, Esteban y Peña MM, Jiménez-García R. Predictors of Breast and Cervical Cancer Screening in a Spanish Metropolitan Area. J Womens Health (Larchmt) 2010; 19:1675-81. [DOI: 10.1089/jwh.2009.1828] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bastos J, Peleteiro B, Gouveia J, Coleman MP, Lunet N. The state of the art of cancer control in 30 European countries in 2008. Int J Cancer 2010; 126:2700-15. [PMID: 19830695 DOI: 10.1002/ijc.24963] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Inequalities in cancer incidence, mortality and survival represent a major challenge for public health. Addressing this challenge requires complex and multidisciplinary approaches. Sharing successful experiences from across Europe may therefore be of benefit. We describe the state of the art of cancer control structures in the 27 European Union countries, plus Iceland, Norway and Switzerland, at the beginning of 2008. Information on cancer plans, cancer registries, cancer screening, Human Papillomavirus (HPV) vaccination and smoking restrictions in each country was identified through PubMed, the official websites of national and international organizations and Google searches. Experts and/or health authorities from each country completed and validated the information. Sixteen countries had implemented national cancer plans in 2008. Twenty four countries had population-based cancer registries with 100% coverage. The exceptions were Greece and Luxembourg (no population-based registry yet), France, Italy and Spain (<50%), and Switzerland (62%). In 9 countries, population coverage of breast cancer screening was 100% with participation ranging from 26 to 87%; 8 countries did not have organized programmes. Seven countries had cervical cancer screening programmes with 100% coverage with participation ranging from 10 to 80%; 8 countries had no organized programme. Nine countries had announced national HPV vaccination policies by early 2008. Six countries had organized colorectal cancer screening programmes. Five countries had complete bans on smoking in public places. There is wide international heterogeneity in cancer control structures in Europe. This provides considerable scope and motivation for cooperation and sharing of experience.
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Affiliation(s)
- Joana Bastos
- Department of Hygiene and Epidemiology, University of Porto Medical School, Portugal
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