EQUITY IN THE ACCESS TO MAMMOGRAPHY IN SPAIN

The purpose of this study is to measure the access to mammography of w omen aged 40-70 in Spain and to analyze the factors related to access to the test. Women were considered to have access to mammography if th ey had received at least one mammogram in the preceding 2 years. Numer ous studies have shown that breast cancer mortality is reduced in wome n receiving periodic mammography, although experts disagree about the most appropriate age range for screening. An equitable health care sys tem should provide access to effective procedures to all persons who n eed them. A number of factors influencing the access to mammography ha ve been described. We conducted a cross-sectional population-based sur vey of 3218 women residing in Spain who were between 40 and 70 years o f age. The sample was selected using a multi-stage stratified cluster technique, with proportional assignment to each stratum. Data collecti on took place between March and May 1994 by means of individual oral i nterviews using a standardized questionnaire. The questionnaire includ ed information on the dependent variable (mammography use) and the ind ependent variables (those potentially associated with access to the te st). Information on other independent variables was collected in offic ial institutions or from existing publications. Data analysis consiste d of univariate and multivariate analyses. Only about 28% of all women had received a mammogram in the last 2 years. According to the univar iate analysis, access to mammography is most strongly associated with number of gynaecologist visits, residence in the autonomous community of Navarre, and physician referral for mammography. In the multivariat e analysis, the factors most strongly associated with access to mammog raphy are gynaecologist visits at least once in the last 2 years (OR = 8.71; CI = 6.84-11.10), existence of a breast cancer screening progra mme (OR = 7.64; CI = 5.24-11.10), and physician referral for testing ( OR = 4.78; CI = 3.83-5.96). The multivariate analysis also showed a si gnificant association with place of residence and with women's attitud es about testing. A small proportion of Spanish women who could potent ially benefit from mammography have received the test in the last 2 ye ars. Establishing breast cancer screening programs equitably throughou t the nation, and carrying out educational interventions aimed at wome n and especially at physicians, will help to reduce inequalities and i ncrease the access to mammography in Spain. Copyright (C) 1996 Elsevie r Science Ltd