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The breast cancer paradox: a systematic review of the association between area-level deprivation and breast cancer screening uptake in Europe

Lookup NU author(s): Dr Katie ThomsonORCiD, Professor Clare BambraORCiD, Professor Adam ToddORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Breast cancer rates are lower amongst women from more socio-economically deprived areas. However, their mortality rates are higher. One explanation of this breast cancer paradox is that women from more deprived areas are less likely to attend breast cancer screening programmes. This systematic review is the first to examine this issue in Europe. A systematic review of Embase, Medline and PsychINFO (from 2008 to 2019) was undertaken (PROSPERO registration number: CRD42018083703). Observational studies were included if they were based in Europe, measured breast cancer screening uptake, compared at least two areas, included an area-level measure of socio-economic deprivation and were published in the English language. The Joanna Briggs Institute critical appraisal checklist was used to assess study quality and risk of bias. Thirteen studies from seven different European countries met our inclusion criteria and were included in the review. In ten of the thirteen studies, there was a significant negative association between screening uptake and area-level socio-economic deprivation – with women living in more socio-economically deprived neighbourhoods less likely to attend breast cancer screening. Although universal screening programmes were provided in most studies, there were still strong negative associations between screening uptake and area-level socio-economic deprivation. Future breast cancer screening strategies should acknowledge these challenges, and consider developing targeted interventions in more deprived areas to increase screening participation.

Publication metadata

Author(s): Smith D, Thomson K, Bambra C, Todd A

Publication type: Article

Publication status: Published

Journal: Cancer Epidemiology

Year: 2019

Volume: 60

Pages: 77-85

Print publication date: 01/06/2019

Online publication date: 28/03/2019

Acceptance date: 11/03/2019

Date deposited: 14/03/2019

ISSN (print): 1877-7821

ISSN (electronic): 1877-783X

Publisher: Elsevier


DOI: 10.1016/j.canep.2019.03.008


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Funder referenceFunder name
MR/K02325X/1Medical Research Council (MRC)