NONATTENDANCE IN THE STOCKHOLM MAMMOGRAPHY SCREENING TRIAL - RELATIVEMORTALITY AND REASONS FOR NONATTENDANCE

The first objective of this study was to analyze the survival rate in a group of 69 breast cancers detected among nonattenders in a randomiz ed mammographic screening trial in relation to 142 clinically detected cancers in a nonscreened control population. By analyzing the cancers of the nonattenders we identified two subgroups, one (A) had actively avoided mammography, had cancers in more advanced stages on diagnosis , and had significantly higher mortality from breast cancer than the c ontrol group (p = 0.003). The second subgroup (B) had mammography done outside the screening program. This subgroup had a nonsignificant, sl ightly better survival (p = 0.19) compared to the control group. Conce rning stage the cancers in group B were similar to the cancers by the screening program. The second objective was to analyze women's reasons for nonattendance in the screening program. We interviewed 200 random ly selected nonattenders; 33% stated that they never could imagine hav ing mammography (definite nonattenders), 29.5% that they for various r easons had missed the mammography but could imagine having it next tim e (possible future attenders), and 32% had been examined outside the p rogram. Reasons for nonattendance included disinterest, medical proble ms, and fear of X-rays. From this interview investigation we believe t hat the subgroup of definite nonattenders (33 %) is difficult to influ ence. The second subgroup classified as possible future attenders (29. 5%) we believe can be influenced by more information and a new opportu nity to receive mammography, i.e., a reminder letter. The third subgro up, those examined outside the screening program (32%) were aware of t he benefit of mammography, taking action on their own. Concerning thes e women's health this seems acceptable; screening outside the program seemed equivalent to that inside the program concerning stage and mort ality in breast cancer as shown in the first part of the study.