Open Access Research article

Determinants of non attendance to mammography program in a region with high voluntary health insurance coverage

Magdalena Esteva1*, Joana Ripoll1, Alfonso Leiva1, Carmen Sánchez-Contador2 and Francisca Collado2

Author Affiliations

1 Research Unit, Majorca District Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain

2 Breast Cancer Screening Programme, Department of Public Health, Balearic Department of Health, Cecilio Metelo 18, 07003, Palma de Mallorca, Spain

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BMC Public Health 2008, 8:387  doi:10.1186/1471-2458-8-387

Published: 13 November 2008



High participation rates are needed to ensure that breast cancer screening programs effectively reduce mortality. We identified the determinants of non-participation in a public breast cancer screening program.


In this case-control study, 274 women aged 50 to 64 years included in a population-based mammography screening program were personally interviewed. Socio-demographic characteristics, health beliefs, health service utilization, insurance coverage, prior mammography and other preventive activities were examined.


Of the 192 cases and 194 controls contacted, 101 and 173, respectively, were subsequently interviewed. Factors related to non-participation in the breast cancer screening program included higher education (odds ratio [OR] = 5.28; 95% confidence interval [CI95%] = 1.57–17.68), annual dental checks-ups (OR = 1.81; CI95%1.08–3.03), prior mammography at a private health center (OR = 7.27; CI95% 3.97–13.32), gynecologist recommendation of mammography (OR = 2.2; CI95%1.3–3.8), number of visits to a gynecologist (median visits by cases = 1.2, versus controls = 0.92, P = 0.001), and supplemental private insurance (OR = 5.62; CI95% = 3.28–9.6). Among women who had not received a prior mammogram or who had done so at a public center, perceived barriers were the main factors related to non-participation. Among women who had previously received mammograms at a private center, supplemental private health insurance also influenced non-participation. Benign breast symptoms increased the likelihood of participation.


Our data indicate that factors related to the type of insurance coverage (such as prior mammography at a private health center and supplemental private insurance) influenced non-participation in the screening program.