Esteva Magdalena, Ripoll Joana, Leiva Alfonso, Sánchez-Contador Carmen, Collado Francisca
Research Unit, Majorca District Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain.
BMC Public Health. 2008 Nov 13;8:387. doi: 10.1186/1471-2458-8-387.
High participation rates are needed to ensure that breast cancer screening programs effectively reduce mortality. We identified the determinants of non-participation in a public breast cancer screening program.
In this case-control study, 274 women aged 50 to 64 years included in a population-based mammography screening program were personally interviewed. Socio-demographic characteristics, health beliefs, health service utilization, insurance coverage, prior mammography and other preventive activities were examined.
Of the 192 cases and 194 controls contacted, 101 and 173, respectively, were subsequently interviewed. Factors related to non-participation in the breast cancer screening program included higher education (odds ratio [OR] = 5.28; 95% confidence interval [CI95%] = 1.57-17.68), annual dental checks-ups (OR = 1.81; CI95%1.08-3.03), prior mammography at a private health center (OR = 7.27; CI95% 3.97-13.32), gynecologist recommendation of mammography (OR = 2.2; CI95%1.3-3.8), number of visits to a gynecologist (median visits by cases = 1.2, versus controls = 0.92, P = 0.001), and supplemental private insurance (OR = 5.62; CI95% = 3.28-9.6). Among women who had not received a prior mammogram or who had done so at a public center, perceived barriers were the main factors related to non-participation. Among women who had previously received mammograms at a private center, supplemental private health insurance also influenced non-participation. Benign breast symptoms increased the likelihood of participation.
Our data indicate that factors related to the type of insurance coverage (such as prior mammography at a private health center and supplemental private insurance) influenced non-participation in the screening program.
需要高参与率以确保乳腺癌筛查项目有效降低死亡率。我们确定了公众乳腺癌筛查项目中不参与筛查的决定因素。
在这项病例对照研究中，对纳入基于人群的乳房X线筛查项目的274名50至64岁女性进行了个人访谈。调查了社会人口学特征、健康观念、医疗服务利用情况、保险覆盖范围、既往乳房X线检查及其他预防活动。
在联系的192例病例和194例对照中，分别有101例和173例随后接受了访谈。与不参与乳腺癌筛查项目相关的因素包括高等教育（优势比[OR]=5.28；95%置信区间[CI95%]=1.57 - 17.68）、每年进行牙科检查（OR = 1.81；CI95% 1.08 - 3.03）、曾在私立健康中心进行乳房X线检查（OR = 7.27；CI95% 3.97 - 13.32）、妇科医生推荐进行乳房X线检查（OR = 2.2；CI95% 1.3 - 3.8）、看妇科医生的次数（病例组的中位数就诊次数 = 1.2，对照组为0.92，P = 0.001）以及补充私人保险（OR = 5.62；CI95% = 3.28 - 9.6）。在未进行过乳房X线检查或在公共中心进行过检查的女性中，感知到的障碍是与不参与相关的主要因素。在之前在私立中心进行过乳房X线检查的女性中，补充私人健康保险也影响不参与情况。良性乳房症状增加了参与的可能性。
我们的数据表明，与保险覆盖类型相关的因素（如在私立健康中心进行过乳房X线检查和补充私人保险）影响了对筛查项目的不参与情况。
