Only 18% of 95,603 Israeli women showed full adherence (≥80%) to national no-cost mammography screening, with lower rates in smokers and diabetics.
What are the adherence rates and associated sociodemographic and clinical factors for national mammography screening guidelines among Israeli women?
Despite a national, no-cost mammography screening program in Israel, overall adherence remains low at 18%, with sociodemographic factors and engagement in other preventive behaviors significantly influencing adherence.
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Abstract Background: Breast cancer is the most common malignancy among women in Israel and globally. Although early detection significantly improves prognosis, 30% of women in Israel are diagnosed at a locally advanced or metastatic stage. In the early 1990s, Israel implemented a national breast cancer screening program, offering biennial mammograms at no cost to women aged 50 and older at average risk. Such organized programs, which provide free and accessible mammography, have been shown to improve adherence rates. Despite this, a substantial proportion of women do not participate in regular screening. Objective: To evaluate adherence to national mammography screening guidelines among Israeli women and identify sociodemographic and clinical factors associated with adherence. Methods: This population-based retrospective study included 100,000 women aged 35-75, using data collected between 2006 and 2020 from the centralized healthcare registry of Clalit, the largest health maintenance organization (HMO) in Israel. Women with a personal history of breast cancer, prior breast surgery, or known genetic predisposition were excluded. Adherence was defined as the proportion of recommended mammograms completed, categorized as: 0.2, 0.5, 0.8, and ≥0.8. The ≥0.8 group was considered fully adherent. Results: A total of 95,603 women met inclusion criteria. Only 17,533 (18%) demonstrated full adherence (≥80%). Among the adherent group, 4% were Ultra-Orthodox Jewish and 13% were Arab. Smoking status was associated with lower adherence; 80% of adherent women were non-smokers. In diabetic women (n=39513), only 5,929 women (15%) demonstrated full adherence. Hormone replacement therapy (HRT) users were more likely to adhere, with 8,943 (51%) meeting the adherence threshold. Women engaged in other preventive health measures were significantly more likely to adhere to mammography screening. Among the adherent group, the median index for Pap smears was 0.18 (IQR: 0.07-0.30), for occult blood testing 0.33 (IQR: 0.17-0.56), and for colonoscopy 0.35 (IQR: 0.00-0.59). Adherence to pneumococcal vaccination showed high adherence to screening mammography with a median index of 1.0 (IQR: 0.60-1.0). In contrast, receipt of influenza vaccination was not associated with mammogram adherence. Conclusion: Despite the availability of a national, no-cost mammography screening program, overall adherence remains low. Sociodemographic characteristics and engagement in other preventive health behaviours significantly influence adherence. Targeted interventions are needed to improve screening rates, particularly among underserved populations. Citation Format: H. Kadar Sfarad, R. Magnezi, O. Eldar Friedman, O. Weinstein. Disparities in Mammography Screening in a Welfare-State Healthcare System: Data from 100,000 Women in Israel abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-22.
Sfarad et al. (Tue,) reported a other. Only 18% of 95,603 Israeli women showed full adherence (≥80%) to national no-cost mammography screening, with lower rates in smokers and diabetics.