80 Chapter 3 Introduction Many European countries offer population based cancer screening programmes (CSPs) to its inhabitants.1 The most common screening programmes (SPs) in Europe focus at the early detection of cervical, breast and colorectal cancer.1 CSPs aim to detect cancers in an early or precursor stage, and thereby improving chances of survival due to early intervention. Early intervention is thought to lead to a better prognosis, and to less extensive treatment options.2-4 Also in the Netherlands there are currently three CSPs implemented. The SPs concerning breast cancer (BC) and colorectal cancer (CRC) are most comparable, both target the same age-groups (starting at 50 and 55 years of age, respectively), and biennially invite potential participants.5 While the BC-SP was phased in as early as 1990 and reached national coverage in 1996,6 the CRC-SP was only phased in from 2014, and has only been fully operational since 2019.7 For a screening programme to be (cost-)effective, it is important that as many of the potential participants that are targeted, indeed participate.8, 9 The World Health Organization (WHO) suggests that at least 70% of a target population should actually be screened, for the SP in order to be beneficial to population health.10-12 Throughout Europe attendance at CSPs varies substantially, yet the Netherlands is known for its high attendance rates.1 Latest Dutch attendance rates – from before the Covid-19 pandemic – were 76% and 72%, for the BC-SP and CRC-SP, respectively.13, 14 Although these numbers might seem reassuring on a national level, the attendance rates were already declining gradually over the past years, and regional differences in screening attendance increased.15 Current screening uptake is lowest in the highly urbanised areas and big cities of the Netherlands, and in neighbourhoods with low socioeconomic status (SES).16 The city of The Hague is the third largest city of the country and represents a densely populated area, with a rich mixture of different cultures and ethnicities, and with major differences in health outcomes between various neighbourhoods. In 2019 The Hague’s average attendance rates were 64% and 57%, for the BC-SP and CR-CSP, respectively.17 Hence, both are below the minimal intended rate of 70%. To be able to promote participation in CSPs, it is important that the programmes are designed and operate as well as possible and are in accordance with the targeted populations. Further insight into the characteristics of attenders and non-attenders, especially in highly urbanised regions, is thus needed. The aim of this study was to gain insight in the background of differing attendance rates of a screening-eligible population aged 50 years and over, living in a highly urbanised region, over a longer period of time.
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