Why do colorectal and breast screening participation vary? A territorial mixed-method study, France
Abstract
Background: Participation in organized breast and colorectal cancer screening remains socially and territorially patterned. Understanding how contextual factors shape screening behaviors is critical to improving equity for proposing adapted prevention strategies.
Objectives: Using a pilot mixed methods approach, this study aims to understand the decision-making processes involved in screening considering modifiable contextual factors (territorial mobility, neighborhood social cohesion, and the role of general practitioner recommendations).
Methods: In the Lyon metropole area, France, in 2025, a quantitative analysis explore geographic participation rates disparities. A qualitative semi-structured interviews analysis to women conducted across different levels of urbanization and deprivation, allowed describing perception to screenings.
Results: Mammography screening is well known and appears to be part of women routine, in contrast colorectal screening remains less integrated, women need more support, particularly at the time of first participation and whilst awaiting the results. In favored and urban areas, distance from services has a limited influence on participation in screening, whereas trust in healthcare professionals appears to be the main determining factor. Conversely, in more deprived peri-urban areas, although mobility does not prevent access to screening, geographical proximity plays a central role in the use of health services, and the level of deprivation has an indirect but significant impact on decision-making, via social isolation, trust in institutions and professionals, and the circulation of information within the community.
Conclusions: This pilot research uses mixed methods with a small number of interviews proposed place-based measures to improve promotion and prevention policies tailored to the local environment.
Key messages: • Context—not distance—drives screening: trust in providers matters most in advantaged areas, while proximity and social context shape participation in deprived communities.
• Colorectal screening lags behind mammography: targeted, place-based strategies and stronger support at first uptake are needed to reduce inequalities.
Related
- Age and sex do not explain territorial disparities in colorectal cancer screening
- Disparities in screening participation and stage at diagnosis for breast and bowel cancers among individuals with pre-existing mental health disorders: A population-based study
- A nationwide ecological analysis of municipal factors affecting breast cancer screening participation during the COVID-19 pandemic in Japan
- Improving breast and colorectal cancer screening information through co-design with underserved groups in an urban area.
- Clustering of COVID-19 Testing and Incidence Time Series: A Method to Understand Epidemic Dynamics at the Territorial Scale
BibTeX
@article{padilla2026colorectal,
title = {{Why do colorectal and breast screening participation vary? A territorial mixed-method study, France}},
author = {CM Padilla and S Baudont and P Soler Michel and M Ottavy},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1793},
url = {https://doi.org/10.1093/eurpub/ckag169.1793},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Why do colorectal and breast screening participation vary? A territorial mixed-method study, France
AU - CM Padilla
AU - S Baudont
AU - P Soler Michel
AU - M Ottavy
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1793
UR - https://doi.org/10.1093/eurpub/ckag169.1793
AB - Background: Participation in organized breast and colorectal cancer screening remains socially and territorially patterned. Understanding how contextual factors shape screening behaviors is critical to improving equity for proposing adapted prevention strategies. Objectives: Using a pilot mixed methods approach, this study aims to understand the decision-making processes involved in screening considering modifiable contextual factors (territorial mobility, neighborhood social cohesion, and the role of general practitioner recommendations). Methods: In the Lyon metropole area, France, in 2025, a quantitative analysis explore geographic participation rates disparities. A qualitative semi-structured interviews analysis to women conducted across different levels of urbanization and deprivation, allowed describing perception to screenings. Results: Mammography screening is well known and appears to be part of women routine, in contrast colorectal screening remains less integrated, women need more support, particularly at the time of first participation and whilst awaiting the results. In favored and urban areas, distance from services has a limited influence on participation in screening, whereas trust in healthcare professionals appears to be the main determining factor. Conversely, in more deprived peri-urban areas, although mobility does not prevent access to screening, geographical proximity plays a central role in the use of health services, and the level of deprivation has an indirect but significant impact on decision-making, via social isolation, trust in institutions and professionals, and the circulation of information within the community. Conclusions: This pilot research uses mixed methods with a small number of interviews proposed place-based measures to improve promotion and prevention policies tailored to the local environment. Key messages: • Context—not distance—drives screening: trust in providers matters most in advantaged areas, while proximity and social context shape participation in deprived communities. • Colorectal screening lags behind mammography: targeted, place-based strategies and stronger support at first uptake are needed to reduce inequalities.
SN - 1101-1262
SN - 1464-360X
ER -