Age differences in mammography screening reconsidered: life course trajectories in 13 European countries

摘要

Background: Breast cancer is the most common cause of cancer mortality among European women. To reduce mortality risk, early detection through mammography screening is recommended from the age of 50 years onwards. Although timely initiation is crucial for cancer prognosis, the temporal dimension has largely been ignored in research. In cross-sectional research designs, it is not clear whether reported age differences reflect 'true' age effects and/or presumed period effects resulting from evolving knowledge and screening programmes. Methods: We use longitudinal data from the survey of Health, Ageing and Retirement (SHARELIFE, 2008), which enables to cast light on age differences by providing retrospective information on the age at which women commenced regular mammography screening. Moreover, the cross-national dimension of the SHARE permits framing the results within the context of nationally implemented screening programmes. By means of the Kaplan-Meier procedure, we examine age trajectories for five 10-year birth cohorts in 13 European countries (n = 13 324). Results: Birth cohorts show very similar age trajectories for each country. Along with the observation that large country differences and country-specific deviations coincide with screening programme characteristics, this suggests strong period effects related to implemented national screening programmes. Conclusion: Age differences in mammography screening generally reflect the period effects of national screening policies. This leaves little room for economic theories about human health capital that leave out the institutional context of preventive health care provision.