Non‐attendance in breast cancer screening is associated with unfavourable socio‐economic circumstances and advanced carcinoma

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Abstract
Our first objective was to assess changes in non‐attendance, proportion of advanced breast cancer and survival in Malmö Mammographic Service Screening Program, MMSSP, compared to a former trial, Malmö Mammographic Screening Trial, MMST. Our second objective was to describe non‐attenders in MMSSP in socio‐economic terms and risk for advanced breast cancer compared to attenders. Information from hospital and national registers was used to identify 33,800 women invited to service screening in MMSSP 1990–93. Attendance rates at first screening, the proportion of advanced breast cancers (Stage II–IV) and survival among non‐attenders in MMSSP were compared to the non‐attenders and with the control group of the former trial, MMST. Various socio‐economic factors were assessed as potential predictors of non‐attendance in MMSSP. Odds ratios (OR) and 95% confidence interval (CI) were computed. Incidence of breast cancer during a 10‐year‐period, relative risks and 95% CI among non‐attenders compared to attenders in MMSSP were computed. Attendance rates were significantly lower in MMSSP but a lower proportion of advanced breast cancers and a somewhat better survival among breast cancer cases (not significant) was seen in non‐attenders in MMSSP compared to MMST. In MMSSP non‐attendance was associated with being unmarried, being born abroad, being not currently employed, crowded housing conditions and low income. Incidence of advanced breast cancer was significantly higher among non‐attenders than among attenders. Attendance has decreased over time and potential reasons are discussed. Stage distribution and survival among non‐attenders seem to have improved. Several socio‐economic factors predict non‐attendance and non‐attenders are at higher risk for advanced breast cancer.