[Factors related to non-participation in a breast cancer early detection program]

Mammography use for breast cancer screening in Portugal: results from the 2005/2006 National Health Survey

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.

Strategies for increasing mammography screening in primary care in Chile: results of a randomized clinical trial

BACKGROUND

Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.

METHODS

We compared the effects on mammography screening rates of standard care, of a low-intensity intervention based on mail contact, and of a high-intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women with the age of 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past 2 years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self-report and by electronic clinical records. An intention to treat model was used to analyze the results.

RESULTS

Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low-intensity group and 70.1% in the high-intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low- and high-intensity groups received the mail contact, and 50% in the high-intensity group received a telephone or personal contact.

CONCLUSION

A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates.

IMPACT

A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.

'If I feel something wrong, then I will get a mammogram': understanding barriers and facilitators for mammography screening among Chilean women

BACKGROUND

Breast cancer is the leading cause of cancer among women in Chile and in many Latin American countries. Breast cancer screening is an effective strategy to reduce mortality, but it has a very low compliance among Chilean women.

OBJECTIVE

To understand barriers and facilitators for breast cancer screening in a group of Chilean women aged 50-70.

METHODS

Following the Predisposing, Enabling and Reinforcing (PRECEDE) framework, seven focus groups (N = 48 women) were conducted with women that have had diverse experiences with breast cancer and screening practices. Information was collected using field notes and audio and video recording. Following the grounded theory model, a sequential process of open, axial and selective coding was used for the information analysis. Atlas ti 5.5 software was used for coding and segmenting the data obtained from the interviews.

RESULTS

The presence of symptoms and/or the finding of lumps through breast self-examination (BSE) were the main predisposing factors for getting a mammogram. Secrecy, embarrassment and fatalism about breast cancer were significant cultural factors that influenced the decision to seek mammogram screening. Confidence in medical staff and dignity in the treatment at the clinic were important enabling factors. The main reinforcing factors for getting the test were a sense of fulfilment by doing something good for themselves and getting timely information about the results.

CONCLUSIONS

Primary health care providers should use culturally appropriate strategies to better inform women about the importance of mammography screening and the limitations of BSE for preventing advanced breast cancer.