Determinants of Non-Participation in Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

Area of Science:

• Oncology
• Public Health
• Epidemiology

Background:

• Existing reviews on breast cancer screening (BCS) non-participation often rely on self-reported data, potentially introducing bias.
• A distinction between determinants for screening programs (BCSP) and opportunistic screening is often lacking.

Approach:

• A meta-analysis was conducted on observational studies quantifying factors associated with non-participation in BCSP.
• Studies utilizing self-reported data or focusing on opportunistic screening were excluded.
• A random-effect model was employed to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs).

Key Points:

• Low income (OR: 1.20), low education (OR: 1.18), living far from screening units (OR: 1.15), immigrant status (OR: 2.64), and having a male family doctor (OR: 1.43) were associated with higher non-participation.
• Reminders and adjusted OR estimations partially explained heterogeneity.
• Twenty-nine studies involving over 20 million women were included.

Conclusions:

• This meta-analysis, excluding opportunistic screening and self-reported data, confirms significant determinants of non-participation in BCSP.
• The identified determinants, while significant, were less pronounced than previously reported.
• The study supports the value of meta-analyses using registered non-participation data within BCSP.