Analizan las actitudes de las mujeres frente al cribado de cáncer de mama

Title: Effect of false-positives and women's characteristics on long-term adherence to breast cancer screening.

Abstract: False-positive results may influence adherence to mammography screening. The effectiveness of breast cancer screening is closely related to adequate adherence among the target population. The objective of this study was to evaluate how false-positives and women's characteristics affect the likelihood of reattendance at routine breast cancer screening in a sequence of routine screening invitations. We performed a retrospective cohort study of 1,371,218 women aged 45-69 years, eligible for the next routine screening, who underwent 4,545,346 screening mammograms from 1990 to 2006. We estimated the likelihood of attendance at seven sequential screening mammograms. Multilevel discrete time hazard models were used to estimate the effect of false-positive results on reattendance, and the odds ratios (OR) of non-attendance for the women's personal characteristics studied. The overall reattendance rate at the second screening was 81.7% while at the seventh screening was 95.6%. At the second screening invitation reattendance among women with and without a false-positive mammogram was 79.3 vs. 85.3%, respectively. At the fourth and seventh screenings, these percentages were 86.3 vs. 89.9% and 94.6 vs. 96.0%, respectively. The study variables associated with a higher risk of failing to participate in subsequent screenings were oldest age (OR = 8.48; 95% CI: 8.31-8.65), not attending their first screening invitation (OR = 1.12; 95% CI: 1.11-1.14), and previous invasive procedures (OR = 1.09; 95% CI: 1.07-1.10). The risk of non-attendance was lower in women with a familial history of breast cancer (OR = 0.97; 95% CI: 0.96-0.99), and those using hormone replacement therapy (OR = 0.96; 95% CI: 0.94-0.97). In conclusion, reattendance was lower in women with false-positive mammograms than in those with negative results, although this difference decreased with the number of completed screening participations, suggesting that abnormal results in earlier screenings more strongly influence behavior. These findings may be useful in providing women with accurate information and in improving the effectiveness of screening programs.

Author(s): Roman, R (Roman, R.)1,2,6; Sala, M (Sala, M.)1,2; De La Vega, M (De La Vega, M.)3; Natal, C (Natal, C.)4; Galceran, J (Galceran, J.)5; Gonzalez-Roman, I (Gonzalez-Roman, I.); Baroja, A (Baroja, A.)7; Zubizarreta, R (Zubizarreta, R.)8; Ascunce, N (Ascunce, N.)2,9; Salas, D (Salas, D.)10,11; Castells, X (Castells, X.)1,12,2

Addresses:

1. Mar Teaching Hosp, Inst Municipal Invest Med Parc Salut Mar, Dept Epidemiol & Evaluat, Barcelona 08003, Spain

2. Consortium Biomed Res Epidemiol & Publ Hlth CIBER, Barcelona, Spain

3. Consejeria Sanidad, Direcc Gen Programas Asistenciales, Servicio Canario Salud, Canary Isl, Spain

4. Hlth Off, Program Anal Unit, Asturias, Spain

5. Fdn Soc Canc Res & Prevent, Pere Virgili Hlth Res Inst, Tarragona, Spain

6. SACYL, Castilla Leon Breast Canc Screening Programme, Direcc Gen Salud Publ ID & I, Castilla Y Leon, Spain

7. Fdn Rioja Salud, La Rioja Breast Canc Screening Programme, Logrono, Spain

8. Hlth Off, Galician Breast Canc Screening Programme, Publ Hlth & Planning Directorate, Santiago De Compostela, Spain

9. Inst Publ Hlth, Navarra Breast Canc Screening Programme, Navarra, Spain

10. Gen Directorate Publ Hlth, Valencia, Spain

11. CSISP, Ctr Publ Hlth Res, Valencia, Spain

12. Univ Autonoma Barcelona, E-08193 Barcelona, Spain