Journal article

Revisiting the Effects of Organized Mammography Programs on Inequalities in Breast Screening Uptake : A Multilevel Analysis of Nationwide Data From 1997 to 2017


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  • 2022
Published in:
  • Frontiers in Public Health. - 2022, vol. 10, no. 2022
English This study revisits the effects of mammography screening programs on inequalities
in breast screening uptake in Switzerland. The progressive introduction of regional
mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999
offers an opportunity to perform an ecological quasi-experimental study. We examine
absolute income and marital status inequalities in mammography uptake, and whether
the cantons’ implementation of mammography programs moderate these inequalities,
as previous research has devoted little attention to this. We use five waves of the
Swiss Health Interview Survey covering the 1997–2017 period and comprising data
on 14,267 women aged 50–70. Both up-to-date and ever-screening outcomes are
analyzed with multilevel models which assess the mammography programs’ withincanton
effect. Findings show that higher income women and married women (compared
to unmarried women) had significantly higher mammography uptake probabilities.
Mammography programs did not moderate absolute income differences in up-to-date
screening; however, they were associated with smaller absolute income differences in
ever-screening uptake. Mammography programs related to higher screening uptake
for married women, more than for unmarried women. In conclusion, we showed
absolute income inequalities in mammography uptake which were not revealed by
previous studies using relative inequality measures. Mammography programs may
have contributed to reducing income inequalities in ever-screening, yet this was not
observed for up-to-date screening. This study has implication for preventive health
interventions—e.g., cancer screening promotion should pay attention to women’s marital
status since screening programs may widen the screening gap between married and
unmarried women.
Faculté des sciences et de médecine
Master en médecine
  • English
Clinical medicine
Open access status
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