Breast cancer screening coverage and its association with hospitalisation and mortality: a nationwide ecological study from Poland (2019–2023)

INTRODUCTION: Breast cancer is the most frequently diagnosed malignancy among women in Poland and remains a major public health challenge. Population-based screening plays a central role in reducing mortality; however, its effectiveness depends on participation rates and equitable access to healthcare services. OBJECTIVE: To assess breast cancer screening coverage in Poland between 2019 and 2023 and to explore population-level associations between screening coverage, hospitalisations, and mortality. METHODS: Data were obtained from three national administrative sources: the Ministry of Health's Systemic and Implementation Analyses Database (BASiW), the national mortality registry maintained by Statistics Poland (GUS), and the National Health Fund (NFZ) database (API Statistics NFZ 1.1). Aggregated data from all 16 voivodeships were merged by year and region. Descriptive statistics, Pearson correlation coefficients, and multivariable linear regression models were applied. RESULTS: The mean screening coverage during the study period was 50.9%, with substantial regional variation (38.7%-68.2%). A marked decline in screening attendance was observed in 2020, coinciding with the COVID-19 pandemic, followed by gradual recovery in subsequent years. Strong positive correlations were identified between the number of screened women and hospitalisations (r = 0.96) as well as mortality (r = 0.99), largely reflecting population size effects. In multivariable regression analysis (Model 1), higher screening coverage (primary exposure) was statistically associated with lower breast cancer mortality in women aged ≥ 65 years (primary outcome) at the population level (B = - 1.93; p < 0.001). In Model 2, screening coverage was not significantly associated with hospitalisations in women aged 41-60 years (B = -0.81; p = 0.682). CONCLUSIONS: Breast cancer screening coverage in Poland remained below the level considered optimal and demonstrated substantial regional disparities. Higher participation was associated with lower mortality at the population level; however, this association should be interpreted descriptively due to the ecological study design. These findings suggest the need for further organisational optimisation and targeted strategies aimed at improving participation in breast cancer screening programmes.