New study: Low screening participation in Oslo, especially among immigrant women

Female immigrants had a lower turnout than the Norwegian-born in the whole country, and this difference was particularly large in Oslo. This despite the fact that Norwegian-born Oslo women already had the lowest turnout in the country, according to a new study.

On a national basis, 76 per cent of all invitations in the Mammography Programme led to an attendance.

At the same time, women in Oslo with backgrounds from so-called "non-Western countries" (Asia, Africa, Latin America and Eastern Europe) had an attendance rate of 39 per cent in the Mammography Programme.

By comparison, the turnout among Norwegian-born women in Oslo was 67 per cent, while the corresponding figures outside Oslo were 50 per cent for immigrant women and 79 per cent for Norwegian-born women respectively.

The new findings were published by researchers at the Cancer Registry of Norway and Bærum Hospital in the Journal of the Norwegian Medical Association on 2 February 2021. The study is based on information from the period 1996 to 2015, about a total of 885 979 women in the target group for the Mammography Programme.

See also the case for the study in forskning.no

Oslo women less often attend mammography screening

The research group is concerned about the major differences.

"In previous studies, we have shown that women in these immigrant groups generally have a lower incidence of breast cancer than the Norwegian-born, but also often more advanced disease if they are first diagnosed with breast cancer," says oncologist and first author of the study, Sameer Bhargava at the Cancer Registry.

More advanced breast cancer at the time of diagnosis generally means a poorer prognosis. The purpose of mammography screening is to detect breast cancer at an early stage of disease development, so that the treatment will have a greater chance of success.

The researchers are therefore concerned that low participation among immigrant women will lead to a higher proportion with a poor prognosis for diagnosed breast cancer in these groups.

What is it about Oslo?

According to the researchers, Oslo stood out in the attendance statistics

"There may be several reasons why attendance in Oslo is lower than in the other counties, such as inequalities in socioeconomic conditions, opportunities to prioritise the survey and how accessible the services are perceived," says Bhargava.

For immigrant women, communication challenges, including language, may also play a role, in addition to familiarity with and trust in public services, and whether the women feel that the offer of screening is relevant to them.

Bhargava also notes that attendance among Norwegian-born women is lower in Oslo than in the rest of the country.

The researchers had no information on the use of private mammography screening services among the women, but point out that there are more private providers in Oslo compared with the rest of the country.

Women who have attended mammography screening privately will appear to the researchers as having failed to attend screening, and the screening figures for Oslo may therefore be higher than they appear in this study.

Bhargava points out that the Norwegian-born Oslo women had a lower turnout than immigrants from so-called "western countries" (Western Europe, North America, Australia and New Zealand) in most counties outside Oslo.

Furthermore, he says that based on this study, they cannot say for sure what is the cause of the observed differences, although some may be due to differences at the group level in age, education and marital status.

He and his colleagues wonder whether the differences in the use of the health services that they have found in this mammography study, which shows that immigrant women living in Oslo may be particularly vulnerable, also exist within other preventive health measures. If so, these may be lessons that are relevant in relation to the ongoing rollout of COVID-19 vaccination.

Measures underway in the Mammography Programme

"This study builds on research results from studies conducted at the Cancer Registry of Norway over the past five years, and provides more knowledge about attendance in the Mammography Programme among both Norwegian-born women and immigrant women," says Solveig Hofvind at the Cancer Registry, researcher and head of the Mammography Programme.

Hofvind is concerned that challenges with language and information may have contributed to the immigrant women not meeting to the same extent as the Norwegian-born. The Cancer Registry of Norway is now working on several projects to offer adapted information to immigrants.

Among other things, the information in the Mammography Programme has recently been translated into Arabic, English, Polish, Urdu and Somali.

These translations will now be used by the Cancer Registry of Norway in the study ImmigrantScreen, which is funded by the Norwegian Cancer Society. The aim of the study is to investigate whether sending an invitation to the Mammography Programme in the woman's native language in addition to Norwegian will affect attendance. The final preparations for the study are now ongoing, and the study is scheduled to start in spring 2021.

The Cancer Registry of Norway has also planned several studies in the near future to explore results from the screening survey among immigrants and Norwegian-born women, including studies investigating the severity of breast cancer and survival after breast cancer detected in and outside the Mammography Programme.