The role of a lack of social integration in never having undergone breast cancer screening: Results from a population-based, representative survey in the Paris metropolitan area in 2010 Claire Rondet a,b, ⁎, Marion Soler a , Virginie Ringa c , Isabelle Parizot d , Pierre Chauvin a a INSERM, UMRS 707, Research Team on the Social Determinants of Health and Healthcare, 75012 Paris, France b UPMC Univ Paris 06, School of Medicine, Department of General Practice, 75012 Paris, France c INSERM, UMRS 1018, Research Team on Gender and Sexual and Reproductive Health, 94270 Le Kremlin-Bicêtre, France d CNRS, Centre Maurice Halbwachs, Research Team on Social Inequalities, 75014 Paris, France abstract article info Available online xxxx Keywords: Breast cancer screening Social integration Social support Paris France Objectives. This study aims to investigate the association between social contact and social support and women's breast cancer screening (BCS) practices, taking their socioeconomic status (SES) into account. Methods. The SIRS survey was conducted in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For the 784 women aged 50 years or older with no history of breast cancer, multivariate logistic regressions and bootstrap methods were used to analyze the factors associated with never having undergone BCS. Results. 6.5% of these women had never undergone BCS. In multivariate analysis, being older, having a low education level, having poor-quality health insurance, and having one or less than one social contact per 3-day pe- riod were significantly associated with never having undergone BCS during their lifetime, but the level of social support was not. The strength of the association with a low frequency of social contact tended to increase with age. Conclusion. This study analyzed the role of social contact in social inequalities in BCS practices in the Paris metropolitan area. Like SES, social integration and social isolation should be taken into consideration by public health professionals and practitioners when planning BCS programs and incentives. © 2013 Elsevier Inc. All rights reserved. Introduction In France, breast cancer is the most frequent cancer among women, with an incidence of 52,600 new cases in 2010. Breast cancer screening (BCS) is done either through the national BCS program, in which screening is proposed to eligible 50- to 74-year old women every other year, or as an individual, opt-in screening procedure (Duport and Bloch, 2004; Duport et al., 2008). France's organized screening pro- gram has been in operation since 2004. Previously, only individual, opt-in BCS was available to women. In 1988, before there was an orga- nized program, 10.3% of women aged 55 to 64 were screened annually and at the beginning of the 1990s, 3 million mammograms were already being conducted in France every year in women of all ages (Le Galès et al., 1990). We sought to determine the characteristics of never-screeners. Studies that have explored the relationship between women's social network and/or social support and their BCS practices have yielded mixed results, with some finding supporting evidence (Allen et al., 2008; Champion, 1994; Klassen and Washington, 2008; Paskett et al., 1996) and others not (Lerman et al., 1990). No study has ever examined these dimensions in the context of BCS in France, al- though this has been done for cervical cancer screening (Rigal et al., 2011). Social network interventions, which draw upon the influence of naturally occurring social systems, are increasingly used to promote BCS (Curbow et al., 2004; Legler et al., 2002; Lewin et al., 2005). These interventions, which are based on individual-level premises within one's social network, use “peer advisors” or “lay health workers” who are uniquely situated to provide information, role-modeling and social support in order to reduce logistical or emotional barriers to screening participation (Earp et al., 1997; Spitler et al., 2002). The objective of our study was to determine the association between a lack of social in- tegration, together with socioeconomic status (SES), on never having undergone BCS among a representative sample of women living in the Paris metropolitan area. Materials and methods Study sample and outcome The SIRS survey (SIRS: a French acronym for “Health, Inequalities and Social Ruptures”) was conducted in the winter of 2009–010 among a Preventive Medicine xxx (2013) xxx–xxx ⁎ Corresponding author at: Inserm UMRS 707, Université Pierre et Marie Curie, 27 rue de Chaligny, 75012 Paris, France. E-mail addresses: rondet@u707.jussieu.fr (C. Rondet), soler@u707.jussieu.fr (M. Soler), virginie.ringa@inserm.fr (V. Ringa), isabelle.parizot@ens.fr (I. Parizot), Chauvin@u707.jussieu.fr (P. Chauvin). YPMED-03655; No. of pages: 6; 4C: 0091-7435/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ypmed.2013.06.016 Contents lists available at SciVerse ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed Please cite this article as: Rondet, C., et al., The role of a lack of social integration in never having undergone breast cancer screening: Results from a population-based, representative..., Prev. Med. (2013), http://dx.doi.org/10.1016/j.ypmed.2013.06.016