Uptake in breast cancer screening. A sociogeographical analysis

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Abstract
During the period 1992 to 1994, the female population aged 40 to 69 years old and living in Gent, Belgium, was invited through a personal letter to participate in a breast cancer screening programme. The women were asked to consult a physician before referral to a local radiologist. After six months, a reminder letter was sent. The eligible population amounted to 40,713 women. Of these, 22.5% were recorded to have attended for a screening mammography. The uptake levels were analysed per statistical sector, which is a more or less homogeneous quarter in social respect. The age-standardized participation ranged from 6 to 42% among the 150 sectors taken into account. The participation was definitely highest in well-to-do neighbourhoods and lowest in the poorer inner-city quarters. In a multivariate analysis, social exclusion indicators such as percentage of persons on welfare and percentage of unoccupied dwellings ranked first. On condition that this social gradient is confirmed on an individual basis, sociogeographical analysis may well be a powerful tool in area-based health promotion campaigns.

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