Two distinct groups of non-attenders in an organized mammography screeningprogram

Objective. To find out reasons for non-attendance and to study subgroup dif ferences of the non-attenders in an organized mammography screening program . Design. Prospective for background and psychosocial factors, retrospective for reasons of non-attendance. Setting. Finnish screening based on personal first round invitations, with 89% attendance rate. Participants. Four hundred thirty six women with both pre-screening respons e to socioeconomic and psychosocial measures, and post-screening response r eporting reasons of non-attendance. Main results. Most common single reason for non-attendance was previous rec ent mammogram (53%), but also reasons related to practical obstacles, worry and fear, knowledge and attitudes, and organization of screening were ment ioned. Two distinct groups of non-attenders were found based on the reasons for non-attendance. Those who did not attend because a mammogram taken els ewhere (ELSE, n = 233) were urban, well-to-do women, who took care of their health by own initiation and felt more susceptible to breast cancer, and a lso expected mammogram to be painful. Other (real) non-attenders (REAL, n = 155) were less compliant with health recommendations and services, more so cially isolated, depressed and anxious than ELSE. Level of depression among REAL was clearly higher (10.80) than the mean value (7.91, SD = 7.28) of t he age group, and was also slightly above the cut-off score of 10 indicatin g mild or moderate depression. Trait anxiety was also markedly higher (40.1 8) than that of the same age group (37.76, SD = 8.95). Conclusions. Further research should clarify determinants and consequences of depression and anxiety among real non-attenders. Knowledge gaps and atti tudinal barriers among non-attenders require more targeted campaigns.