Non-Participation in Breast Cancer Screening in Spain and Potential Application in the Present and Future: A Cross Sectional Study.

Background: Currently, we are beginning to observe a stabilisation and even a decrease in breast cancer mortality in the world, which may be related, among other reasons, to breast cancer screening.

Methods: The objective of this study was to analyse the different reasons why women do not participate in the Breast Cancer Early Detection Programme in Extremadura (Spain) and to discuss the results, offering possible tools to improve the screening programs. This is an observational, descriptive, cross-sectional and retrospective study. A questionnaire with 14 questions was carried out by telephone or mail.

Results: A total of 3970 questionnaires were collected. However, only 2507 were valid. A total of 70.36% of young and educated women underwent mammographic controls. The type of women who did not attend the screening programme appointment corresponded to a woman of approximately 60 years of age, with no formal studies, married, with children, who does not work outside their home and who lived in the health area of Badajoz. Among the main reasons for not going to the appointment, 53.9% of the women surveyed indicated that they had check-ups with their gynaecologist, and this specialist referred them for a mammograph. These women were younger and have a higher level of education. Women with a lower educational level and older women did not have any mammography done and did not undergo screening. They indicated that they did not go to the appointment because they were afraid of having a mammography (44%) or because they did not receive the appointment in time (31.6%). A total of 26.9% of the women who did not attend the appointment for other reasons stated that they had problems in attending because they had a physical limitation (dependency).

Conclusions: Women who did not participate in the breast cancer screening programme in Extremadura had low educational levels and were older women. Specifically, fear of having a mammogram was the main argument raised by these women. In addition, a small group stated that they did not consider mammography to be useful. At present and in the future, good quality screening programs must be carried out to contribute to the reduction in breast cancer mortality. Furthermore, enhancing the participation of women is essential to increase the attendance rate and, therefore, the success of the screening programmes.