Abstract
Background
The implementation of population-based breast cancer screening programs has been pivotal for early cancer detection, yet sociospatial disparities in participation rates may remain. Understanding and monitoring these variations is essential for improving participation, enabled by modern space-time approaches. This study aimed to (1) assess the existence of spatial clustering of participation in a breast cancer screening program, (2) evaluate temporal shifts in spatial patterns, and (3) assess the relative importance of area-level determinants in predicting participation rates.
Methods
We used the emerging hot spot analysis to mine and visualize space-time participation patterns. We assessed the determinants of screening participation using eXtreme Gradient Boosting combined with SHapley Additive exPlanations values for model interpretation. This approach was applied to a dataset of 482,318 georeferenced invitations sent from 2003 to 2020 by the breast cancer screening program in the canton of Geneva, Switzerland.
Results
Here we show that the overall participation rate of 41.5% falls below the national average of 46%, despite increases across all population segments. Initial analysis shows a clear periurban-urban pattern with lower urban participation. Space-time pattern mining further delineates this pattern into 13 distinct profiles, with rates varying from 27.8% in intensifying cold spots to 49.2% in intensifying hot spots. Modeling reveals higher screening participation in socioeconomically deprived areas and a negative association between accessibility to screening centers and participation rates.
Conclusions
The approach applied in this study enables a more nuanced monitoring of screening participation dynamics. Our findings support targeted interventions in prioritized areas to further reduce cancer screening inequalities.
Plain Language Summary
Breast cancer screening programs are essential for early detection, yet participation rates vary geographically. We analyzed whether screening rates differed based on where people lived and whether this changed over time. The dataset comprised 482,318 invitations sent between 2003 and 2020 in Geneva, Switzerland. There were differences in uptake based on where people lived, with people in socioeconomically deprived areas demonstrating higher participation rates. Having greater accessibility to screening centers was negatively associated with participation. These counterintuitive results challenge conventional assumptions about barriers to screening access. Applying such methods can guide targeted public health interventions to reduce geographic inequalities in cancer screening participation.
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Data availability
The breast cancer screening data used in this study are owned by the Geneva Foundation for Cancer Screening and are not publicly available due to the sensitivity of individual georeferenced health data. Researchers interested in accessing the data should contact Idris Guessous (Idris.Guessous@hcuge.ch), who can facilitate requests to the Geneva Foundation for Cancer Screening. Initial responses will be provided within six weeks. Access decisions are made by the Foundation and are subject to their data sharing policies; approved access will require a data use agreement. Source data files containing all numerical results underlying the graphs and charts presented in the main figures are available as Supplementary Data 1–4: Fig. 1 (Supplementary Data 1), Figs. 2 and 3 (Supplementary Data 2), Fig. 4 (Supplementary Data 3), and Fig. 5 (Supplementary Data 4).
Code availability
All code used for the analyses presented in this study is publicly available on GitHub at https://github.com/UEP-HUG/breast-cancer-screening-spatiotemporal/releases/tag/v1.0.024.
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Acknowledgements
The study was supported by the Fondation genevoise pour le dépistage du cancer, Switzerland.
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Conceptualization, I.G., S.J., B.A., and D.D.R.; methodology, D.D.R., I.G., and S.J.; formal analysis, D.D.R.; writing—original draft preparation, D.D.R. writing—review and editing, D.D.R., B.A., S.J., and I.G.; data visualization, D.D.R.; supervision, S.J., B.A., and I.G.; project administration, B.A. and I.G.; funding acquisition, I.G. All authors have read and agreed to the published version of the manuscript.
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De Ridder, D., Arzel, B., Joost, S. et al. Spatiotemporal dynamics of breast cancer screening across half a million invitations in Geneva, Switzerland. Commun Med (2026). https://doi.org/10.1038/s43856-026-01451-7
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DOI: https://doi.org/10.1038/s43856-026-01451-7
