Determinants of Non-Participation in Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

Lilu Ding; J Wang; M J W Greuter; M Goossens; Guido Van Hal; Geertruida H de Bock

doi:10.3389/fonc.2022.817222

Determinants of Non-Participation in Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

Front Oncol. 2022 Mar 2:12:817222. doi: 10.3389/fonc.2022.817222. eCollection 2022.

Authors

Lilu Ding¹, J Wang¹, M J W Greuter^{2

3}, M Goossens⁴, Guido Van Hal^{4

5}, Geertruida H de Bock¹

Affiliations

¹ Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
² Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
³ Department of Robotics and Mechatronics, University of Twente, Enschede, Netherlands.
⁴ Center for Cancer Detection, Flanders, Belgium.
⁵ Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium.

Abstract

Background: Breast cancer (BC) screening can be performed in a screening program (BCSP) or in opportunistic screening. The existing reviews on the determinants of non-participation depend on self-reported data which may be biased. Furthermore, no distinction was made between the probably different determinants of both screening strategies.

Objective: To find the determinants of non-participation in BCSP by means of a meta-analysis.

Methods: PubMed, Embase, and Web of Science were searched for observational studies which quantified factors associated with non-participation in BCSP in a general population. Studies on opportunistic screening and studies using self-reported data were excluded. A random-effect model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Potential sources of heterogeneity were explored by stratification of the results.

Results: Twenty-nine studies with in a total of 20,361,756 women were included. Low income (OR: 1.20, 95% CI: 1.10-1.30), low education (OR: 1.18, 95% CI: 1.05-1.32), living far from an assigned screening unit (OR: 1.15, 95% CI: 1.07-1.24), being immigrant (OR: 2.64, 95% CI: 2.48-2.82), and having a male family doctor (OR: 1.43, 95% CI: 1.20-1.61) was associated with higher non-participation in screening. Reminders sent to non-attenders and estimations of ORs (adjusted or not) partly explained substantial heterogeneity.

Conclusion: In this meta-analysis excluding studies on the non-participation in opportunistic screening, or with self-reported data on non-participation, the well-known determinants for non-participation are still significant, but less strong. This analysis only supports the relevance of meta-analysis of studies with registered non-participation in a BCSP.

Systematic review registration: PROSPERO, CRD42020154016.

Keywords: breast cancer; determinant; mammography; mass screening; participation.

Publication types

Systematic Review