German mammography screening program: adherence, characteristics of (non-)participants and utilization of non-screening mammography-a longitudinal analysis.
Adherence
Breast cancer screening
Claims data
Comorbidity
Gray screening
Longitudinal study
Mammography
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
31 08 2023
31 08 2023
Historique:
received:
08
05
2023
accepted:
22
08
2023
medline:
4
9
2023
pubmed:
1
9
2023
entrez:
31
8
2023
Statut:
epublish
Résumé
In Germany, all women aged 50-69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups. Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1-2, 3-4, 5-6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy. Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1-2 times, 31.7% participated 3-4 times and 25.6% participated regularly (5-6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50-59 were 25%, 18%, and 15%, respectively. Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50-59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.
Sections du résumé
BACKGROUND
In Germany, all women aged 50-69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups.
METHODS
Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1-2, 3-4, 5-6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy.
RESULTS
Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1-2 times, 31.7% participated 3-4 times and 25.6% participated regularly (5-6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50-59 were 25%, 18%, and 15%, respectively.
CONCLUSIONS
Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50-59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.
Identifiants
pubmed: 37653487
doi: 10.1186/s12889-023-16589-5
pii: 10.1186/s12889-023-16589-5
pmc: PMC10469853
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1678Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M, et al. The benefits and harms of breast cancer screening: an independent review. Lancet. 2012;380(9855):1778–86.
doi: 10.1016/S0140-6736(12)61611-0
Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M, et al. The benefits and harms of breast cancer screening: an independent review: a report jointly commissioned by Cancer Research UK and the Department of Health (England) October 2012. Br J Cancer. 2013;108(11):2205–40.
doi: 10.1038/bjc.2013.177
pubmed: 23744281
pmcid: 3693450
Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013(1):Cd001877.
International Agency for Research on Cancer (IARC). Breast Cancer Screening. Lyon: IARC; 2016.
Kriaucioniene V, Petkeviciene J. Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006–2014. Int J Environ Res Public Health. 2019;16(22):4535.
Eichholzer M, Richard A, Rohrmann S, Schmid SM, Leo C, Huang DJ, et al. Breast cancer screening attendance in two Swiss regions dominated by opportunistic or organized screening. BMC Health Serv Res. 2016;16(1):519.
doi: 10.1186/s12913-016-1760-4
pubmed: 27663642
pmcid: 5035496
Petrelli A, Giorgi Rossi P, Francovich L, Giordani B, Di Napoli A, Zappa M, et al. Geographical and socioeconomic differences in uptake of Pap test and mammography in Italy: results from the National Health Interview Survey. BMJ Open. 2018;8(9):e021653.
doi: 10.1136/bmjopen-2018-021653
pubmed: 30232106
pmcid: 6150150
Pokora RM, Büttner M, Schulz A, Schuster AK, Merzenich H, Teifke A, et al. Determinants of mammography screening participation-a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS). PLoS One. 2022;17(10):e0275525.
doi: 10.1371/journal.pone.0275525
pubmed: 36197888
pmcid: 9534433
Pett L, Hollenberg B, Mahoney J, Paz J, Siu N, Sun A, et al. Participation and adherence to mammography screening in the Capital Region of Denmark: the importance of age over time. PLoS ONE. 2023;18(1):e0280790.
doi: 10.1371/journal.pone.0280790
pubmed: 36689434
pmcid: 9870097
Törnberg S, Kemetli L, Svane G, Rosen M, Stenbeck M, Nystrom L. Pattern of participation in a cohort aged 50–60 years at first invitation to the service-screening programme with mammography in Stockholm county. Sweden Prev Med. 2005;41(3–4):728–33.
doi: 10.1016/j.ypmed.2005.07.004
pubmed: 16137757
Larsen M, Moshina N, Sagstad S, Hofvind S. Factors associated with attendance and attendance patterns in a population-based mammographic screening program. J Med Screen. 2021;28(2):169–76.
doi: 10.1177/0969141320932945
pubmed: 34053363
Cox B, Sneyd MJ. Bias in breast cancer research in the screening era. Breast (Edinburgh, Scotland). 2013;22(6):1041–5.
doi: 10.1016/j.breast.2013.07.046
pubmed: 23988397
Malek D, Kääb-Sanyal V. Implementation of the German Mammography Screening Program (German MSP) and first results for initial examinations, 2005–2009. Breast Care. 2016;11(3):183–7.
doi: 10.1159/000446359
pubmed: 27493618
pmcid: 4960364
Kooperationsgemeinschaft Mammographie (KoopG). Jahresbericht Evaluation 2020. Deutsches Mammographie-Screening-Programm. Berlin: Kooperationsgemeinschaft Mammographie; 2020. p. 2022.
Haug U, Schink T. German Pharmacoepidemiological Research Database (GePaRD). In: Sturkenboom M, Schink T, editors. Databases for Pharmacoepidemiological Research. Springer Series on Epidemiology and Public Health. 1st ed. Cham: Springer; 2021. p. 119–24.
Asendorf M, Reinold J, Schink T, Kollhorst B, Haug U. Assessing the socioeconomic status in the German Pharmacoepidemiological Research Database (GePaRD): Description and exemplary application using the association with obesity. GMS Med Inform Biom Epidemiol. 2022;18(1):Doc02.
Wild C, Weiderpass E, Stewart B, editors. World Cancer Report: Cancer Research for Cancer Prevention. Lyon, France: International Agency for Research on Cancer; 2020. Available from: http://publications.iarc.fr/586 .
García-Albéniz X, Hernán MA, Logan RW, Price M, Armstrong K, Hsu J. Continuation of annual screening mammography and breast cancer mortality in women older than 70 years. Ann Intern Med. 2020;172(6):381–89.
Starker A, Kraywinkel K, Kuhnert R. Früherkennung von Brustkrebs: Inanspruchnahme der Mammografie in Deutschland. J Health Monit. 2017;2(4):74–80.
Starker A, Saß AC. Inanspruchnahme von Krebsfrüherkennungsuntersuchungen. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2013;56(5):858–67.
doi: 10.1007/s00103-012-1655-4
pubmed: 23703507
Albert US, Kalder M, Schulte H, Klusendick M, Diener J, Schulz-Zehden B, et al. Das populationsbezogene Mammografie-Screening-Programm in Deutschland: Inanspruchnahme und erste Erfahrungen von Frauen in 10 Bundesländern. Gesundheitswesen. 2012;74(02):61–70.
doi: 10.1055/s-0030-1268441
pubmed: 21229475
Czwikla J, Urbschat I, Kieschke J, Schussler F, Langner I, Hoffmann F. Assessing and explaining geographic variations in mammography screening participation and breast cancer incidence. Front Oncol. 2019;9:909.
doi: 10.3389/fonc.2019.00909
pubmed: 31620366
pmcid: 6759661
Mitchell AJ, Pereira IE, Yadegarfar M, Pepereke S, Mugadza V, Stubbs B. Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake. Br J Psychiatry. 2014;205(6):428–35.
doi: 10.1192/bjp.bp.114.147629
pubmed: 25452600
Heinig M, Schwarz S, Haug U. Self-selection for mammography screening according to use of hormone replacement therapy: A systematic literature review. Cancer Epidemiol. 2021;71: 101812.
doi: 10.1016/j.canep.2020.101812
pubmed: 33608235
Poehls UG, Hack CC, Wunderle M, Renner SP, Lux MP, Beckmann MW, et al. Awareness of breast cancer incidence and risk factors among healthy women in Germany: an update after 10 years. Eur J Cancer Prev. 2019;28:515.
doi: 10.1097/CEJ.0000000000000500
pubmed: 30681416
Günster C, Klauber J, Robra BP, Schmacke N, Schmucker C. Versorgungs-Report Früherkennung. Berlin: Wissenschaftliches Institut der AOK (WIdO); 2019.
Heinig M, Heinze F, Schwarz S, Haug U. Initial and ten-year treatment patterns among 11,000 breast cancer patients undergoing breast surgery—an analysis of German claims data. BMC Cancer. 2022;22(1):130.
doi: 10.1186/s12885-022-09240-w
pubmed: 35109813
pmcid: 8812022
Kooperationsgemeinschaft Mammographie (KoopG). Jahresbericht Evaluation 2015. Deutsches Mammographie-Screening-Programm. Berlin: Kooperationsgemeinschaft Mammographie; 2015. p. 2017.