Factors determining non-attendance in breast cancer screening among women in the Netherlands: a national study

Breast cancer is one of the most common types of cancer among women. National mammography screening programs can detect breast cancer early, but attendance rates have been decreasing in the Netherlands over the past decade. Non-attendees reported that overdiagnosis, the risk of false-negative results, x-ray exposure and mammography pain could be barriers to attendance, but it is not clear whether these disadvantages explain non-attendance and in which situations they are considered barriers. We conducted a national survey among 1227 Dutch women who did not attend mammography screening appointments in 2016. Logistic regression models were used to identify factors that influenced the likelihood of the abovementioned disadvantages leading to non-attendance. The results showed that the doctor's opinion increased the likelihood of the risk of false-negative being perceived as a reason for non-attendance. Moreover, opportunistic screening increased the likelihood that the risk of false-negative, overdiagnosis and x-ray exposure would lead to non-attendance. Women with lower education levels were less likely to consider overdiagnosis and x-ray exposure as reasons for non-attendance, while women who had not undergone mammography screening before were more likely to reject the screening invitation because of concerns about x-ray exposure and mammography pain. These findings indicate how we can address the specific concerns of different groups of women in the Netherlands to encourage them to attend potentially life-saving breast-screening appointments. Screening organizations could provide accurate and unbiased information on the effectiveness of mammography screening to GPs, putting them in a better position to advise their patients.