Effect of invitation letter in language of origin on screening attendance: randomised controlled trial in BreastScreen Norway.

OBJECTIVE: To explore attendance at organised mammographic screening among immigrant groups that received an invitation letter and information leaflet (invitation) in their language of origin and Norwegian compared with Norwegian only. DESIGN: Randomised controlled trial. SETTING: Population based screening programme for breast cancer in Norway (BreastScreen Norway), which invites women aged 50-69 to two-view mammographic screening biennially. PARTICIPANTS: All women invited to BreastScreen Norway in the study period April 2021 to June 2022 whose language of origin was Arabic (women born in Algeria, Egypt, Lebanon, Iraq, Palestine, Sudan, Syria, Tunisia, or Morocco), English (women born in the Philippines), Polish (women born in Poland), Somali (women born in Somalia), or Urdu (women born in Pakistan) (n=11 347). INTERVENTION: The study group received an invitation to screening in their language of origin and in Norwegian, whereas the control group received an invitation in Norwegian only during the study period. MAIN OUTCOME MEASURE: Attendance at BreastScreen Norway during the study period. RESULTS: Overall attendance was 46.5% (2642/5683) in the study group and 47.4% (2682/5664) in the control group. No statistical differences in attendance were observed after stratification by language of invitation, age at invitation, or years since immigration. CONCLUSIONS: No difference in attendance was observed between immigrant women invited to BreastScreen Norway in their language of origin and in Norwegian compared with Norwegian only. Several barriers to cancer screening may exist among immigrants, and translating the invitation is probably only a part of a complex explanation. TRIAL REGISTRATION: NCT04672265. CLINICALTRIALS: gov NCT04672265.

Women's conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study.

OBJECTIVE: To investigate conceptual knowledge about mammographic screening among Norwegian women. DESIGN: We administered a cross-sectional, web-based survey. We used multiple-choice questions and a grading rubric published by a research group from Australia. SETTING: Our Norwegian-language survey was open from April to June 2020 and targeted women aged 45-74 years. PARTICIPANTS: 2033 women completed our questionnaire. We excluded 13 women outside the target age range and 128 women with incomplete data. Responses from 1892 women were included in the final study sample. PRIMARY AND SECONDARY OUTCOME MEASURES: The questionnaire focused on women's knowledge about the breast cancer mortality reduction, false positive results and overdiagnosis associated with mammographic screening. The primary outcome was the mean number of marks assigned in each of the three themes and overall. There were three potential marks for questions about breast cancer mortality, one for false positives and six for overdiagnosis. RESULTS: Most women (91.7%) correctly reported that screened women are less likely to die of breast cancer than non-screened women. 39.7% of women reported having heard of a 'false positive screening result' and 86.2% identified the term's definition; 51.3% of women had heard of 'overdiagnosis' and 14.8% identified the term's definition. The mean score was 2.59 of 3 for questions about breast cancer mortality benefit and 0.93 of 1 for the question about false positive screening results. It was 2.23 of 6 for questions about overdiagnosis. CONCLUSIONS: Most participants correctly answered questions about the breast cancer mortality benefit and false positive results associated with screening. The proportion of correct responses to questions about overdiagnosis was modest, indicating that conceptual knowledge about overdiagnosis was lower. Qualitative studies that can obtain in-depth information about women's understanding of overdiagnosis may help improve Norwegian-language information about this challenging topic.

Attendance in BreastScreen Norway among immigrant and Norwegian-born women. / Oppmøte i Mammografiprogrammet blant innvandrere og norskfødte kvinner.

BACKGROUND: Women residing in Oslo have had lower attendance in BreastScreen Norway than the national average. We explored attendance in BreastScreen Norway among immigrant versus Norwegian-born women in Oslo, compared to other counties in Norway. MATERIAL AND METHOD: We linked attendance data from BreastScreen Norway to sociodemographic data from Statistics Norway for 885 979 women offered mammographic screening in the period 1996-2015. We undertook descriptive analyses of attendance in the different counties for the group of invitees as a whole, and for Norwegian-born and immigrants by country of birth ('Western Europe, Northern America, Australia and New Zealand' and 'other countries'). Furthermore, we estimated the predicted likelihood of attendance with the aid of logistic regression, using attendance (yes/no) as the outcome variable. Independent variables in the model included place of residence (Oslo/other counties), country of birth and interaction between these variables. In addition, we adjusted for age at the time of the invitation, education and marital status. RESULTS: Among women residing in Oslo, attendance was 67 % among Norwegian-born women, 61 % among women born in Western Europe, Northern America, Australia and New Zealand, and 39 % among women born in 'other countries'. Among women residing outside Oslo, the corresponding attendance was 79 %, 71 % and 50 % respectively. INTERPRETATION: Oslo as place of residence was associated with lower attendance in BreastScreen Norway, especially among immigrant women from 'other countries', and independently of adjustment for possible confounding variables.

Monthly variation in mammographic screening attendance in Norway.

Breast Cancer Awareness Month (BCAM) increases screening attendance in the USA. However, this effect has not been investigated in Europe, where organized screening is widespread. We examined monthly attendance within the Norwegian Breast Cancer Screening Programme, 2005-15. Relative to October, the odds of attending screening in January, February, March, August, September or December were slightly decreased (ORadj 0.93-0.98, P ≤ 0.003 for all). BCAM may marginally increase attendance in October but seasonal factors such as weather may also explain this observed variation. Furthermore, it is possible that organized screening with predetermined appointments evens out the effect BCAM has on screening attendance.