Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis

• Published in: BMJ open Vol. 11; no. 11; p. e046660
• Main Authors: Mottram, Rebecca, Knerr, Wendy Lynn, Gallacher, Daniel, Fraser, Hannah, Al-Khudairy, Lena, Ayorinde, Abimbola, Williamson, Sian, Nduka, Chidozie, Uthman, Olalekan A, Johnson, Samantha, Tsertsvadze, Alexander, Stinton, Christopher, Taylor-Phillips, Sian, Clarke, Aileen
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 30.11.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Breast cancer; breast imaging; breast tumours; diagnostic radiology; Diagnostics; Education; Immigration policy; Mammography; Medical diagnosis; Medical research; Meta-analysis; Population; Public health; Sensitivity analysis; Sociodemographics; Systematic review; Variables; Womens health; North America; Europe
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-046660

ObjectiveAttendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance.DesignCINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987–June 2019, and reporting attendance in relation to at least one patient-level factor.Data synthesisIndependent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible.ResultsOf 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence.ConclusionsAttendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated.Trial registration numberCRD42016051597.