Overview of breast cancer screening in Spain and its impact on mortality: An ecological study examining temporal trends (2000–2023)

BACKGROUND: Breast cancer mortality remains a public health problem. Screening programmes in Spain are well-established, but present regional differences in organisation and participation. OBJECTIVE: To describe the relationship between screening characteristics, participation levels, and breast cancer mortality by autonomous community. METHODOLOGY: An ecological and time-trend study (2000-2023). Unit of analysis: seventeen autonomous communities, and Ceuta and Melilla analysed jointly (n=18). The following features were considered: socioeconomic context, healthcare system, programme organisation, and mammogram uptake (population-based surveys). OUTCOME VARIABLE: age-standardised mortality rates in women aged 50-69 and ≥70 years. Non-parametric tests for simple associations and joinpoint regression for time trends were applied. RESULTS: Mortality showed a generalised decreasing trend (2000-2023), which slowed down from 2007, with regional differences and a higher rate in women aged ≥70 years. Mammogram uptake exceeded 70% in most regions, although it followed a sharp decreasing trend from 2017. Bivariate analysis linked lower mortality with higher mammogram uptake and a more favourable socioeconomic context. The organisational characteristics of the programmes showed minor differences in mortality. CONCLUSIONS: Despite the reduction in breast cancer mortality, an unfavourable socioeconomic context and the decline in mammogram uptake may have slowed down the decrease. The shift of mortality towards older age groups will pose a challenge for the healthcare system in the coming years. Structural determinants should be addressed, reinforcing preventive services and screening programmes to reduce regional disparities.