Mammography and Cervical Cancer Screening - A Systematic Review about Women's Knowledge, Attitudes and Participation in Germany

Introduction: In the German statutory health insurance system, women can take part in free mammography and cervical cancer screening. The aim of this study is to 'investigate women's knowledge of, attitudes to and participation in these screening measures as well as the determinants of eligible women living in Germany. Methods: We conducted a systematic literature search, supplemented by an Internet search, of Medline and other German and English databases for the period 2000-2010. Data extraction and quality assessment were carried out by 2 independent reviewers. Data synthesis was qualitative. Results: We identified 12 studies on mammography and cervical cancer screening. Most women were found to be aware of the option of free screening. The majority of women were able to name risk factors for breast cancer correctly. This was not the case in cervical cancer, where women said they were insufficiently informed. To a significant extent, they were also uninformed about the benefits of screening and incidence of false-positive and false-negative test results in mammography. In 2007, 54% of the invited women took part in the organised mammography screening program with large variations in participation rate among the Federal states. It appears that better educated women or those with a private health insurance participate in the programme less frequently. However, one third of the non-participants attend a mammography outside the screening program. Data for participation in cervical cancer screening are inconsistent. There is some evidence that younger women, married women and those with higher education are more likely to participate in the screening. Conclusions: The interviewees' substantial lack of knowledge underscores the need for optimising communication on the aims, benefits and risks of screening tests to enable women to make an informed decision. It is desirable to continuously monitor women's knowledge about and participation in screening and determinants thereof with a view to laying the foundations for target group-specific information strategies.