90 Chapter 3 Table 5. Combination of the datasets; invited women and their attendance status. Total amount of invited women (n=38,071) Attendance CSP (+/-) BC+ CRC+ BC+ CRCBCCRC+ BCCRCStatistical test Proportion % (n) 69.8 (26,560) 12.4 (4,721) 13.3 (5,111) 4.4% (1,679) Year of birth Median (25-75%) 1953 (19471958) 1951 (19471954) 1954 (19471959) 1951 (19481954) KruskalWalllis p<.01 Neighbourhood SES-score n % n % n % n % Likelihood Ratio p<.01 1 7,289 27.5 1,757 37.3 1,597 31.4 682 40.7 2 5,704 21.5 922 19.6 1,050 20.6 327 19.5 3 2,129 8.0 351 7.4 408 8.0 115 6.9 4 11,373 42.9 1,684 35.7 2,036 40.0 552 32.9 Unknown 62 7 20 3 CSP= cancer screening programme, BC= breast cancer, CRC= colorectal cancer, SES= social economic status (SES 1: low; SES 4: high), (+)= attendance, (-)= non-attendance Discussion This retrospective observational study, among people eligible for attending the BC-SP and CRC-SP, conducted in a highly urbanised region between 2005 to 2019, delivered multiple insights concerning screening attendance, screening adherence and cancer risks within subgroups. Non-attendance for both CSPs was found in lower SES neighbourhoods and associated with a more unfavourable (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. Several studies conducted in the Netherlands did focus on SES as a determinant for screening attendance and/or adherence, and did report the same conclusion: living in a lower SES-area/region/neighbourhood is associated with lower screening uptake.2022 Our study thus confirms this ‘SES-effect’, and shows to remain valid, even within a highly urbanised region. Additionally, our study adds that non-attenders living in a lower SES-neighbourhood, are more often diagnosed with a more unfavourable form of BC, and the same tendency seems to exist for CRCs. In this study we did not look into mechanisms on why people living in lower SES-neighbourhoods developed these more
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