Breast screening and ethnic minorities.

The concern for minority ethnic women is whether they are disadvantaged either in terms of the incidence of breast cancer or because of a lower uptake of screening. There are considerable worldwide variations in the incidence of breast cancer. The lowest rates are found in Chinese, Japanese and Arabic populations and women from the Indian subcontinent, and are 2-3 times lower than that of the UK. This may change in future generations. Although minority ethnic women are not a high risk group for the breast screening programme, in absolute terms breast cancer is a major health problem. Very few studies have measured ethnic differences in the uptake of screening, and they may be confounded by such factors as socio-economic group. When this is accounted for, uptake by Asian women may not necessarily be lower than by other women in the same area and can be higher for black than white women. One of the most important reasons for non-attendance is inaccurate screening registers, compounded for Asian women by their return, or extended visits, to the Indian subcontinent. A further organisational issue concerns poor awareness of minority ethnic naming systems, causing confusion over the receipt of invitations. Comprehension of the concept of screening may be difficult for minority ethnic women yet there has been little evaluation of strategies to promote understanding. However a randomised controlled trial of a linkworker intervention, designed to be feasible for implementation on a population basis, showed no increase in the uptake of breast screening by Asian women. This does not undermine linkworkers' role but suggests that their efforts should be used in other ways. It is essential to assess the relative importance of reasons for low uptake and evaluate measures to meet any unmet need, so that resources can be directed in the most effective way.