Social Capital in Breast Cancer Screening

Abstract

Many European nations have instituted publicly reimbursed breast cancer screeningprograms. Internationally, private opportunistic screening is also available in numerous countries. Opportunistic screening is screening "offered outside an organized screening program" (Canadian Cancer Society 2009). Previous and ongoing studies have evaluated participation and re-uptake rates in screening and the variables that influence these rates. Worldwide, many studies have also focused on socioeconomic predictors of breast cancer screening and their effect on the stage at diagnosis (Rosenberg et al. 2005). Fewer studies, however, have explored the concept of social capital in relation to screening. If social capital has a significant effect on screening rates and participation, this can prove useful for policy and programming decisions. Norges Forskningsråd (2005) has identified social capital as a potentially important factor for policymaking and problem solving efforts. The intent of this paper is to examine social capital in screening programs in general and in breast cancer screening programs in Norway in particular. A questionnaire distributed in coordination with the Norwegian Foreningen for Brystkreftopererte was used to identify variables that affect mammography uptake, screening, and participation as well as the variables that influence the use of opportunistic screening and rehabilitation. The questionnaire was distributed to 3000 Foreningen for Brystkreftopererte members aged 40 to 69 who have been diagnosed with breast cancer. To define relevant variables, the questionnaire requested information about several topics, including demographic information, public and private screening, treatment, rehabilitation, breast reconstruction, use of follow-up services, social capital, health status, education, employment, and knowledge and opinions about genetic testing for breast cancer. In Section 2 “Screening,” the paper begins by discussing screening in general and then explores breast cancer screening in particular in Section 3. Breast cancer epidemiology, staging and types, treatment, and rehabilitation issues are then discussed in Section 4. Afterwards, Section 5 of the paper addresses the concept of social capital in general terms and then in regard to screening and breast cancer screening. In Section 6 social inequality is briefly discussed. Section 7 “Data” provides an overview of the questionnaire responses while Section 8 addresses the methods used in this study. Section 9 addresses the results and analysis, and conclusions are discussed in Section 10.