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.