Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
Breast Cancer. 2023 Nov;30(6):952-964. doi: 10.1007/s12282-023-01486-x. Epub 2023 Jul 25.
The participation rate for breast cancer screening remains to be suboptimal in Japan. Therefore, it is important to identify factors associated with non-participation and identify people at high risk for non-participation.
We carried out a cross-sectional study using the data of women aged 40-74 years from the 2016 and 2019 Comprehensive Survey of Living Conditions. We selected candidate predictor variables from the survey sheets and conducted a multivariable logistic regression for non-participation in breast cancer screening for the past 2 years. In addition, using data from 2016, we created an integer risk score for non-participation and tested its predictive performance in 2019.
The proportion of participants in breast cancer screening in 2016 and 2019 were 46.7% (50,177/107,513) and 48.7% (49,498/101,716), respectively. In multivariable logistic regression analysis, age over 50 years, single/divorced/widowed, lower education level, lower household expenditure, being insured for National Health Insurance, employed to small/middle scale company, non-regularly employed, current smoker, never/quit drinking or middle/high-risk drinking, lower self-rated health status, higher Kessler Psychological Distress Scale score, non-participation in the annual health checkups for diseases other than cancer, not constantly visiting hospitals/clinics showed a positive association with non-participation. The 9-item risk score (age, marital status, education, health insurance plan, employment, smoking, drinking, non-participation in the annual health checkups for diseases other than cancer, and not constantly visiting hospitals/clinics) and 3-item risk score (age, health insurance plan, non-participation in the annual health checkups for diseases other than cancer) showed the area under the receiver operating characteristic curve of 0.744 and 0.720, respectively.
We identified factors associated with non-participation in breast cancer screening. The simple risk score would be useful for public health sectors to identify people at risk for non-participation.
在日本，乳腺癌筛查的参与率仍然不理想。因此，确定与不参与相关的因素并确定高风险人群非常重要。
我们使用 2016 年和 2019 年生活条件综合调查中 40-74 岁女性的数据进行了横断面研究。我们从调查表格中选择候选预测变量，并对过去 2 年未参加乳腺癌筛查的情况进行多变量逻辑回归分析。此外，我们使用 2016 年的数据创建了不参与的整数风险评分，并在 2019 年测试了其预测性能。
2016 年和 2019 年乳腺癌筛查的参与者比例分别为 46.7%（50177/107513）和 48.7%（49498/101716）。在多变量逻辑回归分析中，年龄在 50 岁以上、单身/离婚/丧偶、教育程度较低、家庭支出较低、参加国民健康保险、在中小企业工作、非正规就业、当前吸烟者、从不/已戒烟或中度/高度饮酒、自评健康状况较差、Kessler 心理困扰量表评分较高、不参加除癌症以外的疾病年度健康检查、不经常去医院/诊所与不参加乳腺癌筛查呈正相关。9 项风险评分（年龄、婚姻状况、教育程度、健康保险计划、就业、吸烟、饮酒、不参加除癌症以外的疾病年度健康检查、不经常去医院/诊所）和 3 项风险评分（年龄、健康保险计划、不参加除癌症以外的疾病年度健康检查）的受试者工作特征曲线下面积分别为 0.744 和 0.720。
我们确定了与不参加乳腺癌筛查相关的因素。简单的风险评分将有助于公共卫生部门识别不参与的高风险人群。
