Determinants of non-participation in population-based breast cancer screening: a systematic review and meta-analysis

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Published: 8 Oct 2020
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Lilu Ding - University of Groningen, Groningen, Netherlands

Lilu Ding speaks to ecancer about the outcomes of the systematic review and meta-analysis he presented at EBCC-12.

He first talks about the main objectives of this systematic review which were to pin-point the determinants of non-participation in population-based breast cancer screening.

Ding then further explains the inclusion/exclusion criteria that was used in this paper alongside the databases that were utilised to.

He observes that women from low-income backgrounds were screened less for breast cancer in comparison to women with a higher socio-economic status.

Other determinants were also analysed in this paper.

In the end, Ding says that the current screening policy is based on age but this study can impact this policy in a positive way and target women who are still left out in a more robust way.

For our study the aim is to assess the determinants of non-participation in the population-based breast cancer screening programmes with a meta-analysis.

What were the inclusion/exclusion criteria and databases used in this systematic review?

We searched the main three databases, the PubMed, the Embase and also the Web of Science. So we included studies that reported data on the relationship between the determinants and the non-participation in breast cancer screening programmes with mammography which means the screening modality has to be mammography; also, the studies are published in English.

We excluded studies based on four criteria: first is if the studies were only reporting data on opportunistic breast cancer screening or if the studies only reported self-reporting screening compliance data. The third is if the studies focussed on the determinants of the re-attendance to the screening. Lastly is the non-original studies such as the case reports, letters, comments, editorials, reviews and conference abstracts were excluded.

What were the key outcomes observed in this review?

The main outcome of our study was that we included 33 studies in our systematic review and 24 studies were eligible for our meta-analysis. So in these studies we found nine determinants of screening non-participation. Amongst them, five determinants were significant. They included the income level of women, education level of women and the living distance to the screening unit, also, the marital status and the immigration status. So, for example for the income level, women with a low income level had higher non-participation compared to women with high income.

The effective size of these five determinants ranged between 1.10 and 1.44, that’s basically the main results.

How can the results from this study impact population-based breast cancer screening in the future?

The implications of our results are twofold. First we provided the quantitative evidence of the determinants of non-participation in the population-based breast cancer screening programmes in a wide range of countries. The women that are characterised by these significant determinants have less likelihood to attend the breast cancer screening programme which means that women that are characterised by these determinants can be identified in the larger population. So our results can inform the policymakers in the making of health policies to be more engaging for this group of women.

Secondly, our result is also an indication that the current criteria in a lot of countries that select women for invitation to the screening programme only based on their age might need some modification. For example, a more personalised invitation strategy maybe can help.