Determinants of non-attendance in the Finnish breast cancer screening program: a population study

Abstract Background Breast cancer screenings decrease mortality from the disease. In Finland, women aged 50-69 receive biennial invitations to the screening. Attendance varies between population groups, but factors related to non-attendance are insufficiently understood. More comprehensive information is needed to improve participation across population groups. This study aimed to determine lifestyle and wellbeing-related factors associated with non-attendance in the screening. Methods Data from the national Healthy Finland 2022-2023 survey were linked to breast cancer screening data from the Finnish Cancer Registry. A total of 5220 women aged 50-72 who participated in the survey and received a screening invitation within five years were included. Non-attendance was defined as not attending the latest screening. Results were presented as population-weighted prevalences (%) and 95% confidence intervals (CI) of non-attendance. Results Of the study sample, 8.8% did not attend the latest screening. Non-attendance was more common in women with low consumption of vegetables and fruit (15.2% (95% CI 8.8-21.5)) vs. high consumption (7.3 (6.0-8.7)), low physical activity (PA) (14.1 (9.7-18.4)) vs. high PA (7.8 (6.2-9.3)), current smokers (15.8 (12.2-19.4)) vs. non-smokers (7.6 (6.6-8.6)), very low social inclusion (Experiences of Social Inclusion Scale (ESIS)<50) (14.4 (10.2-18.6)) vs. ESIS≥50 (8.3 (7.2-9.3)). Conclusions Breast cancer screening attendance is generally high in Finland. As a novelty, this study linked national registry-based screening data to population-based survey data enabling the study of diverse determinants of non-attendance. Unhealthy lifestyle habits and low social inclusion are associated with non-attendance. Understanding the factors associated with it may help to identify and target non-attenders, ultimately improving attendance and early detection, and thus decrease breast cancer mortality. Key messages • Poor lifestyle habits and low social inclusion are associated with lower breast cancer screening attendance. Screening participation should be addressed as part of broader public health strategies. • Identifying factors that are associated with poor breast cancer screening attendance aids in tailoring strategies to promote attendance and decrease cancer mortality.