RT Journal Article
SR Electronic
T1 Geographic access to mammography screening centre and participation of women in the Quebec Breast Cancer Screening Programme
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP jech-2013-202614
DO 10.1136/jech-2013-202614
A1 Sylvie St-Jacques
A1 Mathieu D Philibert
A1 André Langlois
A1 Jean-Marc Daigle
A1 Éric Pelletier
A1 Diane Major
A1 Jacques Brisson
YR 2013
UL http://jech.bmj.com/content/early/2013/07/12/jech-2013-202614.abstract
AB Background This study evaluated the impact of distance between women's residences and designated screening centres (DSC) on participation in the Quebec Breast Cancer Screening Programme, whether this impact varied according to the rural–urban classification and the proportion of participants who used the DSC nearest to their home. Methods Travel distance between the residence of 833 856 women and the nearest DSC (n=85) was estimated. Data were obtained from administrative and screening programme databases. The analysis made use of a log-binomial regression model adjusting for age and material and social deprivation. The proportions of participants who used the DSC nearest to their residence were measured. Results Compared to women living <2.5 km from a DSC, absolute decreases of 6.3% and 9.8% in participation rate were observed for distances of 50.0 to <75.0 km (rate ratios (RR)=0.88, 95% CI 0.86 to 0.89) and ≥75.0 km (RR=0.81, 95% CI 0.79 to 0.83), respectively. The lowest participation (42%) was observed in Montreal Island. The distance at which participation started to decrease materially varied according to rural–urban classification. Participation rates decreased at distances of ≥25.0 km in the Montreal suburbs and midsize cities, at ≥12.5 km in small cities and at ≥50.0 km in rural areas (interaction p<0.0001). The proportion of participants who had their mammography at the nearest DSC decreased with increasing distance. Conclusions Distance affects participation and this effect varies according to rural–urban classification. The lower participation in Montreal Island, where all women lived <12.5 km from a DSC, argues for a major impact of other characteristics or other dimensions of accessibility.