Intermittent attendance at breast cancer screening

Abstract

<em>Background</em>. To determine why women skip rounds and factors influencing return of previous non attenders (PNAs) to breast screening. <em></em><br /><em>Design and methods</em>. Retrospective, quantitative, structured questionnaire posted to 2500 women. First PNAs did not attend their first screening appointment in 2007/2008 but then attended in 2010; First Controls first attended in 2010 without missed previous appointments. Women who attended screening in 2006 or earlier then skipped a round but returned in 2010 were Subsequent PNAs; Subsequent Controls attended all appointments.<br /><em>Results</em>. More First Controls than First PNAs had family history of cancer (72.7% <em>vs</em> 63.2%; P=0.003); breast cancer (31.3% <em>vs</em> 24.8%; P=0.04). More PNAs lived rurally; more First PNAs had 3rd level education (33.2% <em>vs</em> 23.6%; P=0.002) and fewer had private insurance than First Controls (57.7% <em>vs</em> 64.8%; P=0.04). Excellent/good health was reported in First PNAs and First Controls (82.9% <em>vs</em> 83.2%), but fewer Subsequent PNAs than Subsequent Controls (72.7% <em>vs</em> 84.9%; P=0.000). Common considerations at time of missed appointment were<em> had mammogram elsewhere</em> (33% First PNA) and <em>postponed to next round</em> (16% First PNA, 18.8% Subsequent PNA). Considerations when returning to screening were similar for First PNAs and Subsequent PNAs: <em>I am older </em>(35.4%, 29.6%), <em>I made sure I remembered</em> (29%, 23.6%), <em>could reschedule</em> (17.6%, 20.6%), <em>illness of more concern</em> (16.5%, 19%). More First PNAs stated <em>my family/friends advised</em> (22.3% <em>vs</em> 15.2%) or<em> my GP</em> (12.6% <em>vs</em> 4.6%) <em>advised me to attend</em>, h<em>eard good things about BreastCheck</em> (28.8% <em>vs</em> 13.6%).<br /><em>Conclusions</em>. Intermittent attenders do not fit socio-demographic patterns of non-attenders; GP recommendation and word of mouth were important in women’s return to screening. Fear and anxiety seem to act as a screening facilitator rather than an inhibitor.<br />