The Role of Socio-Demographic Factors in the Coverage of Breast Cancer Screening: Insights From a Quantile Regression Analysis

Abstract

Background: In Flanders, breast cancer (BC) screening is performed in a population-based breast cancer screening program (BCSP), as well as in an opportunistic setting. Women with different socio-demographic characteristics are not equally covered by BC screening.Objective: To evaluate the role of socio-demographic characteristics on the lowest 10th and highest 90th quantile levels of BC screening coverage.Methods: The 2017 neighborhood-level coverage rates of 8,690 neighborhoods with women aged 50–69 and eligible for BCSP and opportunistic screening were linked to socio-demographic data. The association between socio-demographic characteristics and the coverage rates of BCSP and opportunistic screening was evaluated per quantile of coverage using multivariable quantile regression models, with specific attention to the lowest 10th and highest 90th quantiles.Results: The median coverage in the BCSP was 50%, 33.5% in the 10th quantile, and 64.5% in the 90th quantile. The median coverage of the opportunistic screening was 12, 4.2, and 24.8% in the 10th and 90th quantile, respectively. A lower coverage of BCSP was found in neighborhoods with more foreign residents and larger average household size, which were considered indicators for a lower socioeconomic status (SES). However, a higher average personal annual income, which was considered an indicator for a higher SES, was also found in neighborhoods with lower coverage of BCSP. For these neighborhoods, that have a relatively low and high SES, the negative association between the percentage of foreign residents, average household size, and average personal annual income and the coverage in the BCSP had the smallest regression coefficient and 95% confidence interval (CI) values were −0.75 (95% CI: −0.85, −0.65), −13.59 (95% CI: −15.81, −11.37), and −1.05 (95% CI: −1.18, −0.92), respectively, for the 10th quantile. The neighborhoods with higher coverage of opportunistic screening had a relatively higher average personal annual income, with the largest regression coefficient of 1.72 (95% CI: 1.59, 1.85) for the 90th quantile.Conclusions: Women from relatively low and high SES neighborhoods tend to participate less in the BCSP, whereas women with a relatively high SES tend to participate more in opportunistic screening. For women from low SES neighborhoods, tailored interventions are needed to improve the coverage of BCSP.

Differences and Similarities in Breast and Colorectal Cancer Screening Uptake among Municipalities in Flanders, Belgium

“…We found the percentage of foreigners to be associated with a lower probability of screening for CRC and BC. These findings are consistent with previous observations at both municipal and individual levels [17,24,25] and can be explained by the reported perceived language barriers and embarrassment when talking about screening [26]. Moreover, migrants are a high-risk group for limited health literacy.…”

Differences and Similarities in Breast and Colorectal Cancer Screening Uptake Among Municipalities in Flanders, Belgium

“…Second, with the exception of age, the other independent variables were measured for the complete municipality population and used as a proxy for the communal target population. Despite the limitations, our results substantiate previous findings at both municipal [17], [18], [24], [25], [29] and individual [26] level.…”

“…We found that percentages of people with non-Belgian/Dutch nationality and diabetes are associated with a lower probability of screening for CRC (more chances of being in Group 2 vs. Group 1) and BC (more chances of being in Group 3 vs. Group 1). With regards to foreign nationality, these findings are consistent with previous observations at both municipal and individual level [17], [24], [25] and can be explained by the reported perceived language barriers and embarrassment when talking about screening [26]. Moreover, migrants are a high-risk group for limited health literacy and may experience higher difficulties, compared to non-immigrant individuals, in processing health information and translating them it into healthy behaviors [27].…”

“…We found a marked association between average income and uptake of both BC and CRC screening (less chances of being in Group 2 vs. Group 1). It is interesting to compare our findings with results of previous studies which have found that, with regards to both BC and CRC screening, a higher average income is related to lower screening coverages for the organized screening, but to higher screening coverages for the non-organized (opportunistic) screening [17], [25]. Nevertheless, it should be kept in mind that, compared to this one, these studies investigated a different outcome (screening uptake vs. screening coverage).…”

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

“…Socioeconomic inequalities in breast cancer screening uptake have been shown to be higher in countries which do not have a nationwide population-based screening program (1,2). However, country-specific studies have brought mixed evidence on screening programs' potential to reduce inequalities in mammography uptake (3)(4)(5)(6)(7)(8). This is the case of Switzerland where regional mammography programs were not found to importantly moderate socioeconomic inequalities in screening uptake (9).…”