Breast cancer (BC) screening has been part of a nationally organized program in France since 2004. Women aged 50-74 years are invited for a mammography every two years. After an initial rise in participation, the uptake rate remained stable over 2008-2014 and since has shown a slight decrease. In this context, it is important to have clear insight into the characteristics of individuals who are reluctant to undergo BC screening.
The French nationwide observational survey EDIFICE 6 was conducted online from 26 June to 28 July 2017 on 12 046 individuals (age, 18-69 years). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to explain non-uptake of BC screening. The present analysis included 1954 individuals (50-69 years) with no history of cancer.
Of those who were in the target age range for BC screening, 6% (N=108) had never had a mammogram. Compared to individuals who had at least one test in their life time, the population of never-screened women was characterized by a lower mean age (56±6 yrs vs 59±6 yrs, P<0.05), and higher proportions of unmarried women (23% vs 13%, P<0.05), low socioprofessional categories (38% vs 27%, P<0.05), socially vulnerable individuals (67% vs 42%, P<0.05), and smokers (35% vs 23%, P<0.05). In multivariate analysis, items associated with not undergoing screening included: considering that progress made possible thanks to clinical research is not important (OR=2.14, 95% CI [1.16 – 3.82]), social vulnerability (OR=2.09 [CI=1.36 – 3.25]), and considering that protection provided by a prevention program is ineffective (OR=1.60 [1.01 - 2.51]). The most frequently cited reasons for not undergoing screening were "I don't feel concerned" (42%), fear of the examination/results (36%), “individual negligence/not a priority” (27%), and self-examination (22%).
Social vulnerability and medical skepticism are indicators of non-participation in BC screening. Not feeling concerned and individual negligence are the main reasons for this reluctance. These findings highlight the need for targeted communication for this population.
Clinical trial identification
Medical writing assistance was provided by Potentiel d’Action (France)