Abstract P1-02-05: Who drops out of breast cancer screening? Results from the EDIFICE 6 survey
Authors: Morère J-F , Eisinger F , Couraud S , Greillier L , Touboul C , Lhomel C , Rouprêt M , Viguier J , De la Motte Rouge T 
Published: May 2019

Abstract
Background Breast cancer (BC) screening has been part of a nationally organized program in France since 2004. Women aged 50-74 years are invited for a mammography every two years. After stabilization of up-take figures over the period 2008-2014, the latest data from the French health authorities confirm a declining trend which began in 2015-2016. This fall has been observed in all age groups, with the exception of women aged 70-74 years. It therefore appeared important to gain clearer insight into the characteristics of women who have had at least one screening examination but have not returned after the recommended two-year interval for a repeat mammography.
Methodology The French nationwide observational survey EDIFICE 6 was conducted online from 26 June to 28 July 2017 on 12 046 individuals (age, 18-69 years). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to explain the non-uptake of subsequent BC screening. The present analysis included 1954 women (50-69 years) with no history of cancer.
Results Of those who were in the target age range for BC screening, 26% (N=380) did not return for the repeat examination within the recommended 2 years. Compared to those who were compliant with the recommendations, the population of non-compliant women was characterized by higher proportions of unmarried women (23% vs 19%, P&lt;0.05), socially vulnerable individuals (53% vs 38%, P&lt;0.05), and smokers (33% vs 20%, P&lt;0.05). No differences were observed between compliant and non-compliant women in terms of mean age (59.3 SD 5.8, years) or socioprofessional categories. In multivariate analysis, the items associated with non-compliance included: current smoking (OR=1.81 [CI=1.40 – 2.34]), individuals who would not encourage someone close to enroll in a clinical trial (OR=1.55 [1.17-2.04]), considering that protection provided by a prevention program is ineffective (OR=1.48 [1.11-1.97]), and social vulnerability (OR=1.38 [1.09-1.74]). The most frequently cited reasons for non-uptake of subsequent screening were "I don't feel concerned" (45%), “individual negligence/not a priority” (29%), fear of the examination/results (25%), "I have not received a screening invitation" (18%), and self-examination (15%).
Conclusion Indicators of non-uptake of repeat BC screening show various patterns: behavioral (currently smoking), social (vulnerability), and those related to information/education. In our analysis, this latter appeared concurrently with medical skepticism. The two main underlying reasons for not pursuing with breast cancer screening were "not feeling concerned" and "individual negligence". Our findings highlight the need for novel awareness campaigns that specifically target this population.
Citation Format: Morère J-F, Eisinger F, Couraud S, Greillier L, Touboul C, Lhomel C, Rouprêt M, Viguier J, De la Motte Rouge T. Who drops out of breast cancer screening? Results from the EDIFICE 6 survey [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-05.