Determinants of non attendance to mammography program in a region with high voluntary health insurance coverage

Esteva, Magdalena; Ripoll, Joana; Leiva, Alfonso; Sánchez-Contador, Carmen; Collado, Francisca
January 2008
BMC Public Health;2008, Vol. 8, p387
Academic Journal
Background: High participation rates are needed to ensure that breast cancer screening programs effectively reduce mortality. We identified the determinants of non-participation in a public breast cancer screening program. Methods: In this case-control study, 274 women aged 50 to 64 years included in a population-based mammography screening program were personally interviewed. Socio-demographic characteristics, health beliefs, health service utilization, insurance coverage, prior mammography and other preventive activities were examined. Results: Of the 192 cases and 194 controls contacted, 101 and 173, respectively, were subsequently interviewed. Factors related to non-participation in the breast cancer screening program included higher education (odds ratio [OR] = 5.28; 95% confidence interval [CI95%] = 1.57-17.68), annual dental checks-ups (OR = 1.81; CI95%1.08-3.03), prior mammography at a private health center (OR = 7.27; CI95% 3.97-13.32), gynecologist recommendation of mammography (OR = 2.2; CI95%1.3-3.8), number of visits to a gynecologist (median visits by cases = 1.2, versus controls = 0.92, P = 0.001), and supplemental private insurance (OR = 5.62; CI95% = 3.28-9.6). Among women who had not received a prior mammogram or who had done so at a public center, perceived barriers were the main factors related to non-participation. Among women who had previously received mammograms at a private center, supplemental private health insurance also influenced non-participation. Benign breast symptoms increased the likelihood of participation. Conclusion: Our data indicate that factors related to the type of insurance coverage (such as prior mammography at a private health center and supplemental private insurance) influenced nonparticipation in the screening program.


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