Socioeconomic variation in adherence to follow-up after an abnormal screening mammogram in the Danish breast cancer screening program.

OBJECTIVES

Timely and guideline-consistent follow-up after abnormal mammography findings is essential for early diagnosis and improved breast cancer outcomes. While socioeconomic position (SEP) is known to affect participation in screening, less is known about whether SEP also shapes women's adherence to follow-up once an abnormal result is identified. We aimed to investigate socioeconomic and regional differences in the timeliness and adequacy of follow-up after abnormal screening mammograms in Denmark.

METHODS

We included women aged 50-69 years with an abnormal screening result in Denmark, 2016-2021. Follow-up was classified as timely if initiated within 30 days and as adequate if aligned with national guidelines. SEP indicators were income, wealth, education, employment, cohabitation, country of origin, and comorbidity. Risk ratios (RR) were estimated using binomial generalized linear models.

RESULTS

Among 35,087 women, 99.3% received follow-up within six months, and 96.2% had guideline-consistent follow-up. Delays varied regionally, with higher risks in the Capital, Northern, and Zealand Regions. Delayed follow-up was more common among non-Western immigrants (RR = 1.445, 95% CI: 1.298-1.609), unemployed women (RR = 1.084, 95% CI: 1.009-1.165), and those living alone (RR = 1.073, 95% CI: 1.014-1.135). Low SEP increased the risk of no follow-up within six months, particularly among women with low wealth, low education, or immigrant background.

CONCLUSIONS

Although adherence was high, regional and socioeconomic disparities persist. Women with low SEP, immigrants, unemployed, and those living alone face higher risks of delayed or inadequate follow-up, highlighting a need to reduce inequalities in the diagnostic pathway.