25 Determinants of (non)attendance at the Dutch CSPs Introduction The Netherlands invests considerable time and effort hosting three population-based cancer screening programmes (CSPs) aimed at cervical, breast, and colorectal cancer (CRC). CSPs aim to detect cancer in an early or precursor stage, thus improving survival via early intervention. On average, this approach is thought to lead to a better prognosis, as well as fewer and less severe side effects of the treatment.1-4 CSPs in the Netherlands are offered free of charge by the Dutch government to all citizens of a specific age and gender. The National Institute for Public Health and the Environment (RIVM) and five regional screening organisations are charged with organizing and coordinating the programmes.5 Attendance is voluntary and monitored yearly by the RIVM.6-8 Although the three CSPs show many similarities, each CSP has its unique procedures and organization, mainly due to the differences in screening methods (Table 1). In Appendix A we describe the individual designs of the three CSPs. High participation rates are essential for a national CSP to be effective. According to the World Health Organization (WHO) at least 70% of the target population should be screened.9 Most recent national available attendance rates from the Netherlands (2016) were 60%, 77% and 73% for respectively the CSPs for cervical, breast and CRC. Despite these national numbers might be reassuring, an alarming sign is the downward trend in uptake which can be observed for both the long-lasting CSPs at cervical and breast cancer.7,8,10 Furthermore, there is a wide regional variation in attendance rates; with the lowest attendance rates among the four largest cities of the Netherlands, which all fall below the 70%, the minimal effective rate, for all three CSPs.11-13 In order to influence and optimize attendance rates, it is essential to identify and understand determinants of (non-)attendance and follow-up adherence. This study aims to give a systematic overview of the current known determinants of (non-)attendance at the Dutch oncological screening programmes. 2
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