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Factors Associated with Attendance at Breast Cancer Screening: A Systematic Review and Meta-Analysis

Leads: Prof Aileen Clarke, Dr Lena Al-Khudairy (Public Health), Dr Angela Noufaily, Dr Nick Parsons (Meths)

Rapid response research

Dates: 2019


Despite debates about the risks and benefits of population-based breast cancer screening, it is widely associated with reduced morbidity and mortality. Screening attendance varies, and most reviews assess individual factors associated with attendance.

Policy and Practice Partners:

Public Health England Screening.

Co-Funding Partners:

Public Health England.

Aims and Objectives:

This systematic review aims to assess all factors associated with attendance at population-based breast screening.


CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched up to 26 June 2019, for studies of any design, reporting attendance at routine screening programmes in relation to at least one patient factor.

Independent reviewers performed screening, data extraction and study quality appraisal. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated for screening attendance for each factor and, where possible, meta-analysed using a random-effects model.

Main Results:

Of 19,776 publications identified, 331 were assessed at full text and 66 were included. Risk of bias was generally low. Attendance was more likely among women with higher socioeconomic status (SES) (n = 10 studies; OR 1.46, 95% CI: 1.19–1.80); those with higher income (n = 5 studies; OR 1.96, 95% CI: 1.68–2.29); homeowners (n = 3 studies; OR 2.16, 95% CI: 2.08–2.23); and non-immigrants (n = 7 studies; OR 2.23, 95% CI: 2.00–2.48). Women were more likely to attend if they were married/cohabiting (n = 7 studies; 1.86, 95% CI: 1.58–2.19) or had a medium (rather than low) level of education (n = 6 studies; OR 1.24, 95% CI: 1.09–1.41). Women who previously received a false-positive result were less likely to re-attend (n = 6 studies; OR 0.77, 95% CI: 0.68–0.88). There were no differences by age group or by rural versus urban residence.


Geographical variations in health services delivery and screening programme organization may influence findings. Attendance is lower in women with lower income and SES, immigrants, non-homeowners and those with previous false-positive results. These are univariable associations; the underlying causes of lower uptake should be investigated.

Implications for Implementation:

Colleagues at PHE Screening have been given a copy of this work and discussions with them about issues for implementation are ongoing. To improve equity of access to breast screening, programmes should concentrate on women facing practical, physical and financial barriers.