Adherence to mammographic screening in a centralized breast health program in South Brazil: preliminary results.
Authors: Caleffi M , Ribeiro RA , Bedin A , Butzke JV , Duarte D , Skonieski G , Kivitz P , Weber B 
Published: December 2010

Abstract
Abstract #5092
Background: There are scarce data on adherence to population-based screening mammography (MMG) in Brazil. A survey conducted with a large nationwide sample (Lima-Costa et al, Cad Saude Publica, 2007) showed a high rate of women that never had a MMG (49%) and a considerable fraction that performed their last exam &gt;= 3 yrs before (8%). Although this study provided valuable information, its cross-sectional design prevented an evaluation of adherence through time. Since 2004, our institution is conducting an innovative screening project in our city, the Nucleo Mama Porto Alegre (NMPOA), in which circa 4,500 women between 40-69 yrs have been enrolled so far. Visits are scheduled every year, and the project staff works closely together with the Public Health System (PHS) professionals in order to assure that participants return in the appropriate time. The major feature of NMPOA is its centralized control of participants, with active search of all enrolled women when their 1-yr interval for next exam is approaching. Although our project aims at 1-yr interval between MMGs, we consider a 2-yr interval as acceptable, since it is the one recommended by Brazil's PHS. Methods: We conducted an analysis of adherence to both desired and acceptable intervals between MMGs in the beginning of 2007 and 2008. In each analysis, we included women who entered the project 2 or more yrs before. Factors that could influence adherence rate were evaluated in univariate analysis. Variables with a p&lt;0.05 were explored in logistic regression. Results: In 2007 (N=1552), 58% of women had performed their MMG in the previous year and 72% in the last 2 years. In 2008 (N=3259), these numbers increased to 62% and 77.5%, respectively (p&lt;0.01 for both comparisons between 2007 and 2008). In univariatate analysis, lower level of education, history of smoking and higher number of pregnancies were associated with lower adherence to the program, while strong family history for breast cancer, regular breast self-exam (BSE) and previous use of oral contraceptives were related to higher adherence. In multivariate analysis, higher number of pregnancies (OR=1.05 for each pregnancy, p&lt;0.01), history of smoking (OR=1.28, p&lt;0.01) and lack of regular BSE performance (OR=1.18, p=0.05) were independent predictors of lower adherence. Conclusions: Our program is pioneer in Brazil's scenario, where longitudinal data regarding adherence to MMG screening are lacking. The NMPOA project shows excellent results, with adherence higher than the proposed goal for the United States (U.S. Department of Health and Human Services, Healthy People 2010). Factors related to better self-care and higher socio-economic level were independent predictors of higher commitment to the program. The significant increase in attendance rate in the course of time emphasizes the need of a very committed professional team and continuous community education regarding early breast cancer detection, in order to maintain women adherence through time.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5092.