The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program

Adherence to screening may indirectly help assess whether a prior screening examination deters women from returning for a subsequent examination. We investigated whether compression force and pressure in mammography were associated with re-attendance among prevalently screened women in the organized breast cancer screening program in Norway. Data on compression force (kg) and pressure (kPa) from women's first screening examination in the program (prevalent screening) and subsequent re-attendance were available for 31,225 women aged 50-68, screened during 2007-2013. Crude re-attendance rates and log-binomial regression models estimating the prevalence ratio of re-attendance were used to identify the association between compression force or pressure and re-attendance two-years later. Age and year at prevalent screening, county of residence, screening result (negative or false positive), breast volume, and breast density were included in analyses. Overall, 27,197 (87.1%) women re-attended the program. Re-attendance was highest for women who received a compression force of 10.0-13.9 kg (87.5%) or pressure of 9.0-17.9 kPa (87.8%) and lowest for those who received a compression force of <10.0 kg (85.0%) or pressure of <9.0 kPa (84.7%). The adjusted prevalence of re-attendance was 3% lower for women who received low compression force (<10.0 kg) and 2% lower for women who received low compression pressure (<9.0 kPa) relative to the reference groups (10.0-13.9 kg and 9.0-17.9 kPa, respectively). Future research related to re-attendance should also include information about women's experience of pain, anxiety and stress, as well as image quality.