Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
BMC Public Health. 2023 Aug 31;23(1):1678. doi: 10.1186/s12889-023-16589-5.
In Germany, all women aged 50-69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups.
Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1-2, 3-4, 5-6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy.
Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1-2 times, 31.7% participated 3-4 times and 25.6% participated regularly (5-6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50-59 were 25%, 18%, and 15%, respectively.
Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50-59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.
自 2009 年以来，德国所有 50-69 岁的女性都被邀请参加每两年一次的乳房 X 光筛查。我们旨在评估 2009 年 50 岁女性 10 年的纵向依从性，并对不同的依从性组进行特征描述。
使用德国药物流行病学研究数据库（GePaRD，约占德国人口的 20%），我们纳入了 2009 年（基线时）年龄为 50 岁的女性，她们具有连续的健康保险覆盖范围，并且没有乳腺癌或原位癌。我们对她们进行随访，直到 59 岁，并根据乳房 X 光筛查参与情况将她们分为以下组别：从未参加、1-2 次、3-4 次、5-6 次。我们特别描述了这些组别的特征，包括使用其他预防措施、非筛查性乳房 X 光检查（即在有组织的筛查计划之外进行的乳房 X 光检查）和激素替代疗法。
共有 82666 名女性被纳入研究。其中，27.6%的女性从未参加过筛查计划，15.1%参加过 1-2 次，31.7%参加过 3-4 次，25.6%定期参加（5-6 次）。在定期参与者中，91%在基线前使用了其他预防措施（例如，宫颈癌筛查、一般健康检查），而非参与者中这一比例为 66%。非参与者中激素替代疗法的使用最少（11%，而定期参与者中为 18%）。在非参与者中，50-59 岁之间使用≥1、≥2 和≥3 次非筛查性乳房 X 光检查的比例分别为 25%、18%和 15%。
本研究使用大型基于索赔数据的队列，提供了德国乳房 X 光筛查计划的纵向依从性以及该计划之外的乳房 X 光检查使用情况的新见解。在 50-59 岁之间，57%符合条件的女性至少参加了三次德国乳房 X 光筛查计划，而 28%（约 10 名女性中的 3 名）从未参加过。在非参与者中，15%的人在此期间至少进行了三次非筛查性乳房 X 光检查，这表明可能存在灰色筛查。与非参与者相比，参与者更经常使用其他预防措施。
