Breast cancer screening attendance in China from 2014 to 2022: results from nationwide surveys

Background: Breast cancer screening has been initiated to identify breast cancer at an early stage and reduce breast cancer mortality, while the attendance rate of screening varies among different countries. This study aimed to describe China’s changing attendance rate for breast cancer screening in 2014 and 2022, and identify socioeconomic factors associated with the attendance of breast cancer screening. Methods: We used data from China Health and Retirement Longitudinal Study (CHARLS) including 6935 females aged over 45 covering 28 provinces of China in 2014, and the China Residents Cancer Screening Service Survey including 3388 females aged over 45 from 26 provinces of China in 2022. Multilevel logistic regression models were used to identify the factors associated with attendance of breast cancer screening, accounting for the intraclass correlation within the provinces, with adjustment of age, BMI, and ethnicity. Findings: The attendance rate for breast cancer screening in China increased from 20.43% in 2014 to 51.36% in 2022. However, the attendance rate varied greatly in different provinces with the highest attendance rate of 76.9% in Shanghai in 2014 and 81.3% in Beijing in 2022, while in the provinces in central and western China, the rates were below 20% in 2014 and still below 40% in 2022. The screening attendance rates were lower in the rural areas than urban areas in both years (14.8% vs. 25.7% in 2014, and 44.9% vs. 63.0% in 2022, respectively). In 2014, women with junior high school educational level (OR=0.54 [95% CI=0.43-0.68]), and primary school or lower educational levels (OR=0.37 [95% CI=0.29-0.46]) were less likely to attend the breast cancer screening program as compared to those with higher education levels, and low-end and no job were associated with a lower screening rate (OR=0.69 [95% CI=0.59-0.81]). In 2022, lower education level and no job were still associated with lower screening attendance (OR for primary school=0.53, 95% CI=0.42-0.66; while OR for no job=0.83, 95% CI=0.69-1.00). Income level was associated with screening attendance, even after adjusting for education and job status (OR=1.91 [95% CI=1.48 -2.48]). Interpretation: Breast cancer screening attendance rate in China increased from 2014 to 2022, while there is still a gap between the rural and urban areas. Educational level, income level and job status are consistently associated with breast cancer screening attendance from 2014 to 2022. Some measures could target these obstacles to increase the attendance rate and narrow the gap between people with different social status.