Núcleo Mama Porto Alegre, Associação Hospitalar Moinhos de Vento, Brazil.
Cancer Epidemiol Biomarkers Prev. 2010 Oct;19(10):2673-9. doi: 10.1158/1055-9965.EPI-10-0338. Epub 2010 Aug 17.
Adherence to breast cancer screening is a key element to ensure effectiveness of programs aiming at downstaging of breast cancer. In this study, we evaluated adherence to a screening program and its predictors in underserved women in southern Brazil.
Attendance to the program, which is based on yearly mammogram and clinical examination, was evaluated prospectively. Mean time frames between visits were calculated. Possible predictors of adherence (defined as mean intervals ≤18 mo), such as socioeconomic indicators and health/lifestyle behaviors, were investigated.
A total of 3,749 women (age 51 ± 8 y, illiteracy rate of 6.8%, 57.4% with parity ≥3) were analyzed. Median time between screening rounds was 16.5 months (interquartile range, 13.1-25.7), and median number of rounds attended was 3 (interquartile range, 2-4); 57.6% had mean intervals ≤18, and 71% ≤24 months. The most important independent predictors of adherence were high genetic risk [relative risk (RR), 1.25; 95% confidence interval (95% CI), 1.11-1.40], illiteracy (RR, 0.77; 95% CI, 0.67-0.90), parity ≥5 (RR, 0.89; 95% CI, 0.83-0.96), and smoking (RR, 0.82; 95% CI, 0.77-0.88).
Although the proposed screening interval was 1 year, compliance to biannual screening (accepted in several international programs) was high, especially when considering the low socioeconomic level of the sample.
This project aims to test a breast cancer screening model for underserved populations in limited-resource countries where adherence is an issue. The identification of worst adherence predictors can point to interventions to improve outcomes of similar public health screening strategies.
乳腺癌筛查的依从性是确保旨在降期乳腺癌的项目有效性的关键因素。本研究评估了在巴西南部资源匮乏的女性中筛查计划的依从性及其预测因素。
前瞻性评估参加该计划的情况，该计划基于每年进行乳房 X 光检查和临床检查。计算两次就诊之间的平均时间间隔。调查了依从性的可能预测因素（定义为平均间隔≤18 个月），例如社会经济指标以及健康/生活方式行为。
共分析了 3749 名女性（年龄 51±8 岁，文盲率为 6.8%，57.4%的人产次≥3）。筛查轮次之间的中位时间为 16.5 个月（四分位间距 13.1-25.7），中位筛查轮次数为 3 轮（四分位间距 2-4）；57.6%的人平均间隔≤18 个月，71%的人平均间隔≤24 个月。依从性的最重要独立预测因素是高遗传风险[相对风险（RR）1.25；95%置信区间（95%CI）1.11-1.40]、文盲（RR 0.77；95%CI 0.67-0.90）、产次≥5（RR 0.89；95%CI 0.83-0.96）和吸烟（RR 0.82；95%CI 0.77-0.88）。
尽管建议的筛查间隔为 1 年，但对每半年进行一次筛查（在多个国际项目中被接受）的依从性很高，特别是考虑到样本的社会经济水平较低。
本项目旨在为资源有限的国家中服务不足的人群测试一种乳腺癌筛查模式，这些国家的依从性是一个问题。确定最差的依从性预测因素可以指出改善类似公共卫生筛查策略结果的干预措施。
