Cancer Causes & Control

, Volume 13, Issue 1, pp 73–82 | Cite as

Sociodemographic predictors of non-attendance at invitational mammography screening – a population-based register study (Sweden)

  • Magdalena Lagerlund
  • Annette E. Maxwell
  • Roshan Bastani
  • Erik Thurfjell
  • Anders Ekbom
  • Mats Lambe


Objective: To investigate the role of sociodemographic factors in predicting mammography uptake in an outreach screening program. Methods: Linkage of data from a regional population-based mammography program with four Swedish nationwide registers: the Population and Housing Census of 1990, the Fertility Register, the Cancer Register, and the Cause of Death Register. We computed odds ratios (OR) and 95% confidence intervals (CI) for non-attendance by sociodemographic factors. Non-attendance was defined as failure to attend in response to the two most recent invitations. Results: Multivariate analyses among 4198 non-attenders and 38,972 attenders revealed that both childless and high-parity women were more likely to be non-attenders (OR = 1.8, 95% CI: 1.6–2.0 and OR = 2.2, 95% CI: 1.8–2.7, respectively). Women living without a partner were less likely to attend (OR = 1.7, 95% CI: 1.5–1.9), as were non-employed women (OR = 2.1, 95% CI: 1.9–2.3). Those renting an apartment were more likely to be non-attenders compared with home-owners (OR = 1.8, 95% CI: 1.6–2.0), and immigrants from non-Nordic countries were more than twice as likely to be non-attenders compared with Swedish-born women (OR = 2.4, 95% CI: 2.0–2.8). Conclusions: There are identifiable subgroups in which mammography utilization can be increased. Special attention should be paid to women who have never attended, childless women, and non-Nordic immigrants.

breast cancer demography mammography mass screening utilization 


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  1. 1.
    European Commission (1996) European Guidelines for Quality Assurance in Mammography Screening, 2nd edn. Luxembourg: European Commission.Google Scholar
  2. 2.
    Olsson S, Andersson I, Bjurstam N, et al. (1995) 600, 000 kvinnor per aår underso¨ ks med mammografi. Var femte inbjuden avstaår fraå n screening. [600 000 women are examined by mammography per year. Every fifth of them refuses screening.]. Lakartidningen 92: 552-556.Google Scholar
  3. 3.
    Blackman DK, Bennett EM, Miller DS (1999) Trends in selfreported use of mammograms (1989-1997) and Papanicolaou tests (1991-1997)-Behavioral Risk Factor Surveillance System. Mor Mortal Wkly Rep CDC Surveill Summ 48: 1-22.Google Scholar
  4. 4.
    Katz SJ, Zemencuk JK, Hofer TP (2000) Breast cancer screening in the United States and Canada, 1994: socioeconomic gradients persist. Am J Public Health 90: 799-803.Google Scholar
  5. 5.
    Smith RA, Haynes S (1992) Barriers to screening for breast cancer. Cancer 69: 1968-1978.Google Scholar
  6. 6.
    Bostick RM, Sprafka JM, Virnig BA, Potter JD (1994) Predictors of cancer prevention attitudes and participation in cancer screening examinations. Prev Med 23: 816-826. Mammography screening in Sweden 81Google Scholar
  7. 7.
    Calle EE, Flanders WD, Thun MJ, Martin LM (1993) Demographic predictors of mammography and Pap smear screening in US women. Am J Public Health 83: 53-60.Google Scholar
  8. 8.
    Martin LM, Calle EE, Wingo PA, Heath Jr CW (1996) Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med 12: 82-90.Google Scholar
  9. 9.
    Lagerlund M, Hedin A, Sparen P, Thurfjell E, Lambe M (2000) Attitudes, beliefs, and knowledge as predictors of nonattendance in a Swedish population-based mammography screening program. Prev Med 31: 417-428.Google Scholar
  10. 10.
    .Lagerlund M, Sparen P, Thurfjell E, Ekbom A, Lambe M (2000) Predictors of non-attendance in a population-based mammography screening program; sociodemographic factors and aspects of health behaviour. Eur J Cancer Prev 9: 25-33.Google Scholar
  11. 11.
    Lagerlund M, Widmark C, Lambe M, Tishelman C (2001) Rationales for attending or not attending mammography screening-a focus group study among women in Sweden. Eur J Cancer Prev 10: 429-442.Google Scholar
  12. 12.
    Johansson L, Finna¨ s F (1983) Fertility of Swedish Women Born 1927-1960. Stockholm: Statistics Sweden.Google Scholar
  13. 13.
    National Board of Health and Welfare. Center for Epidemiology (1998) Cancer Incidence in Sweden 1958-1995. Stockholm.Google Scholar
  14. 14.
    SAS Users Guide: Statistics (1993) Gary, NC: SAS Institute.Google Scholar
  15. 15.
    Hobbs P, Smith A, George WD, Sellwood RA (1980) Acceptors and rejectors of an invitation to undergo breast screening compared with those who referred themselves. J Epidemiol Commun Health 34: 19-22.Google Scholar
  16. 16.
    Kee F, Telford AM, Donaghy P, O'Doherty A (1992) Attitude or access: reasons for not attending mammography in Northern Ireland. Eur J Cancer Prev 1: 311-315.Google Scholar
  17. 17.
    Schofield PE, Cockburn J, Hill DJ, Reading D (1994) Encouraging attendance at a screening mammography program: determinants of response to different recruitment strategies. J Med Screen 1: 144-149.Google Scholar
  18. 18.
    Scaf-Klomp W, van Sonderen FL, Stewart R, van Dijck JA, van den Heuvel WJ (1995) Compliance after 17 years of breast cancer screening. J Med Screen 2: 195-199.Google Scholar
  19. 19.
    Calnan M (1984) The health belief model and participation in programs for the early detection of breast cancer: a comparative analysis. Soc Sci Med 19: 823-830.Google Scholar
  20. 20.
    Maclean U, Sinfield D, Klein S, Harnden B (1984) Women who decline breast screening. J Epidemiol Commun Health 38: 278-283.Google Scholar
  21. 21.
    McNoe B, Richardson AK, Elwood JM (1996) Factors affecting participation in mammography screening. NZ Med J 109: 359-361.Google Scholar
  22. 22.
    Seow A, Straughan PT, Ng EH, Emmanuel SC, Tan CH, Lee HP (1997) Factors determining acceptability of mammography in an Asian population: a study among women in Singapore. Cancer Causes Control 8: 771-779.Google Scholar
  23. 23.
    Sutton S, Bickler G, Sancho-Aldridge J, Saidi G (1994) Prospective study of predictors of attendance for breast screening in inner London. J Epidemiol Commun Health 48: 65-73.Google Scholar
  24. 24.
    French K, Porter AM, Robinson SE, McCallum FM, Howie JG, Roberts MM (1982) Attendance at a breast screening clinic: a problem of administration or attitudes. BMJ (Clin Res Ed) 285: 617-620.Google Scholar
  25. 25.
    Ore L, Hagoel L, Shifroni G, Rennert G (1997) Compliance with mammography screening in Israeli women: the impact of a prescheduled appointment and of the letter-style. Isr J Med Sci 33: 103-111.Google Scholar
  26. 26.
    Luengo S, Lazaro P, Azcona B, Madero R, Fitch K (1999) Use of mammography among women residing in Spanish provinces with breast cancer screening programs. Eur J Cancer Prev 8: 517-524.Google Scholar
  27. 27.
    Hagoel L, Ore L, Neter E, Shifroni G, Rennert G (1999) The gradient in mammography screening behavior: a lifestyle marker. Soc Sci Med 48: 1281-1290.Google Scholar
  28. 28.
    Donato F, Bollani A, Spiazzi R, et al. (1991) Factors associated with non-participation of women in a breast cancer screening program in a town in northern Italy. J Epidemiol Commun Health 45: 59-64.Google Scholar
  29. 29.
    Aro AR, de Koning HJ, Absetz P, Schreck M (1999) Psychosocial predictors of first attendance for organised mammography screening. J Med Screen 6: 82-88.Google Scholar
  30. 30.
    Gram IT, Slenker SE (1992) Cancer anxiety and attitudes toward mammography among screening attenders, nonattenders, and women never invited. Am J Public Health 82: 249-251.Google Scholar
  31. 31.
    Maxwell AE, Bastani R, Warda US (1998) Mammography utilization and related attitudes among Korean-American women. Women Health 27: 89-107.Google Scholar
  32. 32.
    Maxwell AE, Bastani R, Warda US (2000) Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. Am J Prev Med 18: 62-68.Google Scholar
  33. 33.
    Peragallo NP, Fox PG, Alba ML (1998) Breast care among Latino immigrant women in the U.S. Health Care Women Int 19: 165-172.Google Scholar
  34. 34.
    Remennick LI (1999) Breast screening practices among Russian immigrant women in Israel. Women Health 28: 29-51.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Magdalena Lagerlund
    • 1
  • Annette E. Maxwell
    • 2
  • Roshan Bastani
    • 2
  • Erik Thurfjell
    • 3
  • Anders Ekbom
    • 1
  • Mats Lambe
    • 1
  1. 1.Department of Medical EpidemiologyKarolinska InstitutetStockholmSweden
  2. 2.UCLA School of Public Health and Jonsson Comprehensive Cancer CenterDivision of Cancer Prevention and Control ResearchLos AngelesUSA
  3. 3.Department of Oncology, Radiology and Clinical Immunology, Section of RadiologyUppsala University HospitalUppsalaSweden

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