78 Chapter 3 Abstract Objectives Throughout Europe many countries offer population-based cancer screening programmes (CSPs). In the Netherlands two implemented CSPs are targeting people of 50 years and older, aiming at breast cancer (BC) and colorectal cancer (CRC). In order for a CSP to be (cost-)effective, high participation rates and outreach to the populations at risk are essential. People living in highly urbanised areas and big cities are known to participate less in CSPs. The aim of this study was to gain further insight in the participation rates of a screening-eligible population of 50 years and over, living in a highly urbanised region, over a longer time period. Design A retrospective observational study. Setting Participation data of the regional screening organization, linked to the cancer incidence data derived from the Netherlands Cancer Registry, concerning the city of The Hague, between 2005 to 2019. Attendance groups were defined as attenders (attending >50% of the invitations) and non-attenders (attending ≤50% of the invitations) and were mutually compared. Results The databases contained 106.377 unique individuals on the BC screening programme (SP), and 73.669 on the CRC-SP. Non-attendance at both CSPs was associated with living in a lower socioeconomic status (SES) neighbourhood and as a counter effect, also associated with a more unfavourable, relatively late-stage, tumour diagnosis. When combining the results of the two CSPs, our results imply high screening adherence over time. Women who did not participate in both CSPs were older, and more often lived in neighbourhoods with a lower SES-score. Conclusions Since low screening uptake is one of the factors that contribute to increasing inequalities in cancer survival, future outreach strategies should be focussed on engaging specific non-attending subgroups.
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