Individual and contextual factors associated with breast cancer screening in Brazil

Breast cancer screening aims to reduce mortality in women, as it is the most common and deadliest cancer among them. Various individual and contextual factors may impact screening coverage. We analysed the association of breast cancer screening in Brazil with individual and contextual variables. This is a cross-sectional analysis from the first wave of the Brazilian National Health Survey (Pesquisa Nacional de Saude - PNS). The sample comprised of 8,682 women aged 50 to 69 living in all five geopolitical Brazilian regions. Multilevel logistic regression was used to estimate the Odds Ratio (OR, 95% CIs). Random effects were estimated using the intraclass correlation coefficient (ICC) values and the per cent variance reduction. The individual variables associated with breast cancer screening were: high level of education, living with a partner, being overweight, practising physical activity, no tobacco use, and having health insurance. Regarding contextual variables, higher numbers of mammography examinations were performed in those states with higher levels of Human Development Index (HDI), Social Development Index (SDI) and number of mammography devices. Clear state inequalities underscore the importance of public health policies covering the entire target population and promoting breast cancer screening.