91 Attendance characteristics of the breast and colorectal CSPs unfavourable forms of cancer, but in literature factors related to health illiteracy are often mentioned.23 Just recently, Kregting et al. compared the screening attendance of women at the screening ages of 55/65 years, and concluded that women living in areas with higher population density and lower SES-score were less likely to participated in more CSPs.24 Three studies conducted in the United Kingdom compared barriers for the CSPs and concluded that women who lived in a more deprived region, participated less in the CSPs.25-27 Age as a variable, was earlier described in two studies. One did not find any influence,25 the other reported a lower age to be associated with lesser screening attendance.26 Within our study we saw a mixed influence of age, depending on the CSP. With respect to screening adherence, we found rather high overall screening attendance rates for both CSPs. The yearly monitoring reports of RIVM show the same high screening adherence on a national level.13, 14 In terms of cancer risk, we found that men were more likely to be diagnosed with CRC than women, which is consistent with national trends.14 By conducting this study, we were able to compare a long-lasting programme with a relatively new programme. We focused on the city of The Hague since we believe, The Hague can be seen as a true ‘living lab’ to test for differences in screening attendance between different subgroups, due to strong differences between the different neighbourhoods, all well represented by the SES-scores.28 This also allows our study findings to be directly translated and applied into daily practice. While the segregation between neighbourhoods in The Hague is probably the most evident, we expect our findings to be also applicable for other large cities, as for example Amsterdam and Rotterdam, given their generally similar demographic characteristics.29-31 Our study has some limitations that need to be reflected on. Since the CRC-SP is a relative new CPS, we only had access to data of the implementation phase of the CSP, over a period of 4 years. This resulted in relatively little data on the CRC-SP, compared with the data on the BC-SP, and in particular resulted in small CRC numbers. Thereby, one might question the relevance of comparing the data of a CSP in the implementation phase, with a ‘steady state’ CSP. However, we felt it was relevant to compare the two CSPs at this early stage, as any shortcomings could then be addressed as early as possible. Another limitation has to do with the degree of crudeness of our variables. In the initial study design, we planned to look into several specific characteristics of potential participants and their association with screening attendance. Despite the large number of invited people by the CPSs, adding more patient specific characteristics would possibly lead to identification of individual participants. To avoid this risk, we decided to only look at relatively undetailed patient characteristics, such as: year of birth, age of diagnosis, sex, and neighbourhood SES-scores. 3
RkJQdWJsaXNoZXIy MTk4NDMw