Abstract P6-08-07: Decline in compliance to breast cancer screening in France: Results of the 5th EDIFICE survey
Authors: Morère JF , Eisinger F , Blay J-Y , Greillier L , Brignoli-Guibaudet L , Lhomel C , Cortot AB , Couraud S , Viguier J 
Published: February 2018

Abstract
Background
The EDIFICE surveys have been conducted since 2005 to provide a better understanding of the participation of the French population in cancer screening programs. The breast cancer (BC) screening program is nowadays widely implemented throughout the target female population: women aged 50-74 years are invited for a mammogram once every two years. We analyzed the behavior of women over time (between 2005 and 2016) regarding BC screening according to age-group, socioprofessional categories (SPC) and social vulnerability.
Methods
The fifth nationwide observational survey, EDIFICE 5, was conducted by phone interviews using the quota method. A representative sample of 1299 subjects aged 50-74 years with no history of cancer was interviewed between November 22 and December 7, 2016. Interviewees (women aged 50-74 yrs; N=657) were asked about their uptake of BC screening, and the date of the last examination to determine the follow-up rate. Demographic data on social characteristics and SPC were also collected to determine the level of social vulnerability (validated EPICES score).
Results
Compliance with BC screening (a mammogram within the past 2 years) decreased significantly from 81% in 2014 to 75% in 2016 (P=0.02). From 2014, a significant impact of age was observed (P=0.02 in 2014 and 2016). In 2016, and for the first time, a significant and disturbing decrease in follow-up rate was recorded among younger women (age 50-54 yrs: 88% in 2014 vs 74% in 2016, P=0.01). SPC had no effect on compliance with screening. However, since 2008, fluctuations have been observed among unemployed individuals (U), with a significant decline in compliance in 2016 (U: 81% in 2014 vs 73% in 2016, P=0.03). In 2016, social vulnerability was seen as a factor that negatively impacts on compliance with BC screening (P≤0.01), but not in 2011 or 2014. We also observed a significant overall decrease in 2016 among both vulnerable (76% in 2014 vs 65% in 2016; P=0.04) and non-vulnerable populations (85% in 2014 vs 79% in 2016, P=0.04), highlighting a general loss of confidence.
Conclusion
For the first time since 2005, compliance with BC screening dropped significantly in France in 2016. A significant overall decline was observed regardless of social vulnerability status. Disturbing significant decreases were observed among the younger age-group (women aged 50-54 yrs) of the target population of the organized program, and among unemployed women. Although organized programs have been shown to ensure equitable access to cancer screening, this achievement remains precarious and requires regular monitoring.
Citation Format: Morère JF, Eisinger F, Blay J-Y, Greillier L, Brignoli-Guibaudet L, Lhomel C, Cortot AB, Couraud S, Viguier J. Decline in compliance to breast cancer screening in France: Results of the 5th EDIFICE survey [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-07.