Estimating attendance for breast cancer screening in ethnic groups in London

Abstract

BackgroundBreast screening uptake in London is below the Government's target of 70% and we investigate whether ethnicity affects this. Information on the ethnicity for the individual women invited is unavailable, so we use an area-based method similar to that routinely used to derive a geographical measure for socioeconomic deprivation.MethodsWe extracted 742,786 observations on attendance for routine appointments between 2004 and 2007 collected by the London Quality Assurance Reference Centre. Each woman was assigned to a lower super output (LSOA) based on her postcode of residence. The proportions of the ethnic groups within each LSOA are known, so that the likelihood of a woman belonging to White, Black and Asian groups can be assigned. We investigated screening attendance by age group, socioeconomic deprivation using the Index of Deprivation 2004 income quintile, invitation type and breast screening service. Using logistic regression analysis we calculated odds ratios for attendance based on ethnic composition of the population, adjusting for age, socioeconomic status, the invitation type and screening service.ResultsThe unadjusted attendance odds ratios were high for the White population (OR: 3.34 95% CI [3.26-3.42]) and low for the Black population (0.13 [0.12-0.13]) and the Asian population (0.55 [0.53-0.56]). Multivariate adjustment reduced the differences, but the Black population remained below unity (0.47 [0.44-0.50]); while the White (1.30 [1.26-1.35]) and Asian populations (1.10 [1.05-1.15]) were higher. There was little difference in the attendance between age groups. Attendance was highest for the most affluent group and fell sharply with increasing deprivation. For invitation type, the routine recall was higher than the first call. There were wide variations in the attendance for different ethnic groups between the individual screening services.ConclusionsOverall breast screening attendance is low in communities with large Black populations, suggesting the need to improve participation of Black women. Variations in attendance for the Asian population require further investigation at an individual screening service level.

Breast cancer risk scores in a standard screening population

“…In our sample, the white and black ethnicities were slightly over-represented compared with the borough population in general, and Asian women were under-represented, especially in the 60+ years age group. This can be compared with the study by Renshaw et al [26] in which attendance at screening was found to be low for both black and Asian women. Our sample covered the age range invited to screening well: women aged between 47 and 73 are sent appointments, and our sample reported a range of 46-74 years, with an average age of 56 years; 26% of the sample was aged 60 years or over.…”

“…Similarly, details are routinely recorded about women diagnosed with BC [23] or those who have died as a result of the disease [24]. In addition, specific groups recognized as underrepresented in screening populations, such as ethnic minorities [25,26] or those who choose not to attend [27], are also of interest. However, only the recent PROCAS study has collected basic data about risk factors in a UK screening setting and used it to calculate risk levels [28].…”

Exploring Factors Contributing to Low Uptake of the NHS Breast Cancer Screening Programme among Black African Women in the UK

“…This has been mostly attributed to a combination of genetic factors causing more aggressive tumours in Black women and advanced stages of the disease before presentation [6]. Late stage at diagnosis advances higher mortality from breast cancer [7]. Further evidence also suggest that differences in exposure to available breast screening services contribute to existing ethnic variations in breast cancer outcomes [8,9].…”

“…Black women are also known to develop breast cancer at a much younger age compared to their White counterparts [4,16]. Thus, early help seeking and stage at diagnosis have emerged as dominant predictors of breast cancer survival and can contribute significantly to reducing ethnic inequalities in breast cancer outcomes [7,15].…”

The State of Play in HIV Health Promotion for Black and Minority Ethnic Men Who Have Sex with Men

“…In the case of the ONS and in a study on breast cancer, reports at times contrast BME with "White British" and at other times contrasts BME with "White," which potentially includes non-British White groups (ONS 2003;Renshaw et al 2010). In speaking about her research project on BME groups, Bakare criticises the terminology "BME" as not being appropriate for "non-White groups," but then goes on to mention new ethnic communities in Britain, which in fact do include ethnic minorities commonly classified as White groups (most notably, Eastern European populations in the UK) (Bakare 2007).…”