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Uptake and associated factors of breast cancer screening using mammography and ultrasound in China: A multicenter
Yadi Zheng1, Xuesi Dong1, Wei Cao1
1Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Background:
Optimal uptake rates of mammography or ultrasound are essential for breast cancer screening. This study aimed to identify the individual and structural factors affecting breast cancer screening in China, with quantitative adjustment of structural factors to increase individual uptake rates.
Methods:
A multicenter prospective cohort study was conducted in 19 provinces across China, recruiting women aged 40-74 years. Logistic regression models identified individual factors affecting screening uptake, whereas linear regression models explored structural factors across 332 randomly selected communities. Adjusted structural approaches were used to improve individual uptake rates.
Results:
During 2013-2018, uptake rates among 343,244 high-risk women were 40.9% for ultrasound, 36.8% for mammography, and 34.9% for combined screening. Eleven individual-level factors affected ultrasound uptake, with ten for mammography and nine for combined screening. Taking mammography as an example, higher education level (OR [95% CI]: high vs. low: 1.25 [1.21, 1.28]), smoking (OR [95% CI]: yes vs. no: 1.07 [1.05, 1.1]), passive smoking (OR [95% CI]: ≥40 years vs. 0 years: 1.39 [1.35, 1.44]), occupational exposure to hazardous substances (OR [95% CI]: yes vs. no: 1.19 [1.17, 1.22]), metabolic syndrome components (OR [95% CI]: 3 vs. 0: 1.08 [1.05, 1.12]), benign breast disease (OR [95% CI]: yes vs. no: 1.71 [1.66, 1.75]), delivery history (OR [95% CI]: yes vs. no: 1.60 [1.55, 1.66]), and family breast cancer history (OR [95% CI]: yes vs. no: 1.31 [1.29, 1.33]) might increase the likelihood of screening. Two structural-level factors consistently impacted all three screening modalities. Taking mammography as an example, shorter risk assessment-to-screening intervals (β [95% CI]: ≥60 days vs. <7 days: -24.37 [-33.48, -15.25]) and 30- to 60-day reminders for nonattenders (β [95% CI]: 30-60 days vs. 0-14 days: 8.71 [3.18, 14.24]) increased community mammography uptake. Individual-level uptake rates were 1.95 times higher with <7-day vs. ≥60-day assessment-screening intervals, peaking at 50.14% with 30- to 60-day reminder intervals for nonattenders.
Conclusions:
This study identified factors associated with breast cancer screening uptake and proposed quantitative adjustments to structural approaches to maximize uptake rates with minimal resources.