Lower attendance rates in immigrant versus non-immigrant women in the Norwegian Breast Cancer Screening Programme

Abstract

Objective: The Norwegian Breast Cancer Screening Programme invites women aged 50-69 to biennial mammographic screening. Although 84% of invited women have attended at least once, attendance rates vary across the country. We investigated attendance rates among various immigrant groups compared with non-immigrants in the programme.Methods: There were 4,053,691 invitations sent to 885,979 women between 1996 and 2015. Using individual level population-based data from the Cancer Registry and Statistics Norway, we examined percent attendance and calculated incidence rate ratios, comparing immigrants with nonimmigrants, using Poisson regression, following women's first invitation to the programme and for ever having attended.Results: Immigrant women had lower attendance rates than the rest of the population, both following the first invitation (53.1% versus 76.1%) and for ever having attended (66.9% versus 2 86.4%). Differences in attendance rates between non-immigrant and immigrant women were less pronounced, but still present, when adjusted for sociodemographic factors. We also identified differences in attendance between immigrant groups. Attendance increased with duration of residency in Norway. A subgroup analysis of migrants' daughters showed that 70.0% attended following the first invitation, while 82.3% had ever attended. Conclusions:Immigrant women had lower breast cancer screening attendance rates. The rationale for immigrant women's non-attendance needs to be explored through further studies targeting women from various birth countries and regions.

Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population‐based study

“…Income level of the source country does not completely explain the patterns observed in our study as for example, South Korea showed a gradual increase in participation with duration of residence in Canada, similar to Indian or CMHT immigrants. Among studies that have reported screening rates for immigrants by region or country of birth, there are similarities to our findings of lower rates of screening among women from Eastern European/Central Asian, East Asian, and South Asian countries 26, 30…”

“…Acknowledging the challenges with comparing studies, findings have generally reported that screening rates among immigrant populations are lower than those among nonimmigrants. Among these studies, several have further assessed and reported a similar positive association between duration of residence in the adopted country and screening participation 26, 30, 31. A recent population‐based study from Norway reported that participation rates rose much more quickly with years of residence in Norway for women who immigrated from high‐income countries compared to those that immigrated from middle‐ or low‐income countries.…”

“…There have been numerous studies of breast cancer screening among immigrant populations undertaken in other countries 26, 27, 28, 29, 30, 31, 32. Comparing results between studies is challenging as the birth country composition of immigrant populations vary significantly across countries, barriers to screening for immigrants in their adopted country may be different, and the health and cancer screening systems may also differ in significant ways.…”

Differences in cancer survival between immigrants in Norway and the host population

“…4,29 At the individual level, behavioural explanations, like improved language skills or knowledge about the healthcare system, might be relevant. 7,8 Despite this, our analysis did not detect differences in breast cancer survival between non-Western immigrants and Norwegians, and when we condition on stage at diagnosis, breast cancer survival was potentially even better for non-Western immigrants. Social networks of immigrant populations might also develop over time and contribute to improved healthcare in the groups with long residence time.…”

“…6 A previous study, investigating cancer stage distribution in immigrants compared to the Norwegian host population, showed that non-Western women had higher risk of being diagnosed with a more advanced stage of breast cancer. 8,9 The low screening attendance and advanced breast cancer stage distribution reported for non-Western immigrants may contribute to poor cancer survival. 8,9 The low screening attendance and advanced breast cancer stage distribution reported for non-Western immigrants may contribute to poor cancer survival.…”