Nation-wide mammography screening participation in Denmark during the COVID-19 pandemic: an observational study
- The Danish Clinical Quality Program - National Clinical Registries, Denmark
- Randers Regional Hospital, Denmark
- Copenhagen University Hospital, Denmark
Abstract
Background: In most of the world, the mammography screening programmes were paused at the start of the pandemic, whilst mammography screening continued in Denmark. We examined the mammography screening participation during the COVID-19 pandemic in Denmark.
Methods: The study population comprised all women aged 50-69 years old invited to participate in mammography screening from 2016-2021 in Denmark based on data from the Danish Quality Database for Mammography Screening in combination with population-based registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of mammography screening participation within 90, 180 and 365 days since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation.
Results: The study comprised 1,828,791 invitations among 847,766 women. Before the pandemic, 80.2% of invitations resulted in participation in mammography screening within 90 days, 82.7% within 180 days and 83.1% within 365 days. At the start of the pandemic, the participation in screening within 90 days was reduced to 69.9% for those invited in pre-lockdown and to 76.5% for those invited in 1st lockdown. Extending the length of follow-up time to 365 days only a minor overall reduction was observed (PR=0.94; 95% CI: 0.93-0.95 in pre-lockdown and PR=0.97; 95% CI: 0.96-0.97 in 1st lockdown). A lower participation was; however, seen among immigrants and among women with a low income.
Conclusions: The short-term participation in mammography screening was reduced at the start of the pandemic, whilst only a minor reduction in the overall participation was observed with longer follow-up time indicating that women postponed screening. Some groups of women; nonetheless, had a lower participation indicating that the social inequity in screening participation was exacerbated during the pandemic.
Funding: The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.
Data availability
Data availability statementIn order to comply with the Danish regulations on data privacy, the datasets generated and analysed during this project are not publicly available as the data are stored and maintained electronically at Statistics Denmark, where it only can be accessed by pre-approved researchers using a secure VPN remote access. Furthermore, no data at a personal level nor data not exclusively necessary for publication are allowed to be extracted from the secure data environment at Statistics Denmark. Access to the data can; however, be granted by the authors of the present study upon a reasonable scientific proposal within the boundaries of the present project and for scientific purposes only. Scientific proposals should be forwarded to data analyst, PhD Henry Jensen at HERJEN@rkkp.dk. All analyses were conducted using STATA version 17.0.
Article and author information
Author details
Funding
The Danish Cancer Society Scientific Committee (R321-A17417)
- Tina Bech Olesen
The Danish regions
- Tina Bech Olesen
- Henry Jensen
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Reviewing Editor
- Nicolas Schlecht, Roswell Park Comprehensive Cancer Center, United States
Ethics
Human subjects: Ethical considerationsThe study is registered at the Central Denmark Region's register of research projects (journal number 1-16-02-381-20). According to Danish law, register-based studies should not be reported to the National Committee on Health Research Ethics. Furthermore, patient consent is not required by Danish law for register-based studies.
Version history
- Received: September 18, 2022
- Preprint posted: September 27, 2022 (view preprint)
- Accepted: July 27, 2023
- Accepted Manuscript published: August 17, 2023 (version 1)
- Version of Record published: September 21, 2023 (version 2)
Copyright
© 2023, Olesen et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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Nation-wide mammography screening participation in Denmark during the COVID-19 pandemic: an observational study
eLife 12:e83541.
https://doi.org/10.7554/eLife.83541
Further reading
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- Epidemiology and Global Health
Background:
In contrast to most of the world, the cervical cancer screening programme continued in Denmark throughout the COVID-19 pandemic. We examined the cervical cancer screening participation during the pandemic in Denmark.
Methods:
We included all women aged 23–64 y old invited to participate in cervical cancer screening from 2015 to 2021 as registered in the Cervical Cancer Screening Database combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PRs) and 95% CIs of cervical cancer screening participation within 90, 180, and 365 d since invitation during the pandemic in comparison with the previous years adjusting for age, year, and month of invitation.
Results:
Altogether, 2,220,000 invited women (in 1,466,353 individuals) were included in the study. Before the pandemic, 36% of invited women participated in screening within 90 d, 54% participated within 180 d, and 65% participated within 365 d. At the start of the pandemic, participation in cervical cancer screening within 90 d was lower (pre-lockdown PR = 0.58; 95% CI: 0.56–0.59 and first lockdown PR = 0.76; 95% CI: 0.75–0.77) compared with the previous years. A reduction in participation within 180 d was also seen during pre-lockdown (PR = 0.89; 95% CI: 0.88–0.90) and first lockdown (PR = 0.92; 95% CI: 0.91–0.93). Allowing for 365 d to participation, only a slight reduction (3%) in participation was seen with slightly lower participation in some groups (immigrants, low education, and low income).
Conclusions:
The overall participation in cervical cancer screening was reduced during the early phase of the pandemic. However, the decline almost diminished with longer follow-up time.
Funding:
The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.
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- Epidemiology and Global Health
- Medicine
- Cancer Biology
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