Lower attendance rates in BreastScreen Norway among immigrants
across all levels of socio-demographic factors: a population-based study
Received: 31 March 2018 /Accepted: 23 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Several studies have shown that immigrants attend mammographic screening less frequently than non-immigrants.
Studies have also shown that attendance is influenced by socio-demographic factors. We aimed to describe the relationship between
socio-demographic factors and first attendance among immigrant and non-immigrant women invited to BreastScreen Norway.
Methods Our cohort consisted of 885,979 women invited to BreastScreen Norway for their first time between 1996 and 2015.
We merged individual-level socio-demographic data to attendance data corresponding to women’s first invitation to the program.
Using Poisson regression, we calculated rate ratios with 95% confidence intervals (95% CI) for attendance, stratified by region of
origin. Covariates of interest included age, income, education level, employment status, marital status, citizenship and years since
immigration, among others.
Results Fifty-three percent of immigrants and 76% of non-immigrants attended mammographic screening after their first invitation;
immigrants as a whole had lower attendance rates across all socio-demographic factors. However, the association between socio-
demographic factors and attendance varied between immigrant groups. For all immigrants, no recorded education demonstrated the
strongest association with non-attendance compared with ≤ 10 years recorded education (RR
: 0.69, 95% CI: 0.67–0.71). Other
factors associated with non-attendance were low income, living in Oslo, not being employed and being a recent immigrant.
Conclusion The association between socio-demographic factors and mammographic screening attendance differed between
immigrant groups. Further studies and preventive health measures should take into account that considering immigrants as a
homogeneous group may lead to less effective interventions.
Keywords Breast Cancer
Breast cancer is the most common cancer and the leading cause
of cancer death among women worldwide (Ferlay et al. 2015).
However, breast cancer incidence and mortality rates vary
greatly across the world (Ferlay et al. 2015). While incidence
rates are lowest in Africa and Asia, mortality rates are highest in
Africa (Ferlay et al. 2015). Disparities in breast cancer mortality
may be related to the availability of diagnostics and treatment
and of access to screening (World Health Organization 2018).
Over the past decades, many high-income countries have
implemented mammographic screening as a strategy to reduce
breast cancer mortality (Youlden et al. 2012). The rationale
behind mammographic screening is to detect breast cancer at
an early stage requiring less advanced treatment and thereby
reducing morbitidy and mortality from the disease (Lauby-
Secretan et al. 2015;Marmotetal.2013). A high attendance
rate is necessary to reduce breast cancer mortality through
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s10389-018-0937-1) contains supplementary
material, which is available to authorized users.
* Sameer Bhargava
Faculty of Health Sciences, UiT The Arctic University of Norway,
9037 Tromsø, Norway
The Cancer Registry of Norway, P.O. Box 5313, Majorstuen,
N-0304 Oslo, Norway
Department of Life Sciences and Health, Faculty of Health Sciences,
Oslo and Akershus University College of Applied Sciences,
Department of Community Medicine, Faculty of Health Sciences,
UiT, The Arctic University of Norway, 9037 Tromsø, Norway
Institute of Health and Society, Faculty of Medicine, University of
Oslo, Oslo, Norway
Journal of Public Health: From Theory to Practice