title: Major ethnic group differences in breast cancer screening uptake in Scotland are not extinguished by adjustment for indices of geographical residence, area deprivation, long-term illness and education.
abstract: BACKGROUND
  Breast cancer screening data generally show lower uptake in minority ethnic groups. We investigated whether such variations occur in Scotland.
  
  
  METHODS
  Using non-disclosive computerised linkage we combined Scottish breast screening and Census 2001 data. Non-attendance at first breast-screening invitation (2002-2008) was compared between 11 ethnic groups using age-adjusted risk ratios (RR) with 95% confidence intervals (CI), multiplied by 100, using Poisson regression.
  
  
  RESULTS
  Compared with the White Scottish (RR=100), non-attendance was similar for Other White British (99.5, 95% CI 96.1-103.2) and Chinese (112.8, 95% CI 96.3-132.2) and higher for Pakistani (181.7, 95% CI 164.9-200.2), African (162.2, 95% CI 130.8-201.1), Other South Asian (151.7, 95% CI 118.9-193.7) and Indian (141.7, 95% CI 121.1-165.7) groups. Adjustment for rural vs urban residence, long-term illness, area deprivation and education, associated with risk of non-attendance, increased the RR for non-attendance except for Pakistani women where it was modestly attenuated (RR=164.9, 149.4-182.1).
  
  
  CONCLUSIONS
  Our data show important inequality in breast cancer screening uptake, not attenuated by potential confounding factors. Ethnic inequalities in breast screening attendance are of concern especially given evidence that the traditionally lower breast cancer rates in South Asian groups are converging towards the risks in the White UK population. Notwithstanding the forthcoming review of breast cancer screening, these data call for urgent action.
authors.affiliation: Edinburgh Ethnicity Health Research Group, Centre for Population Health Sciences, University of Edinburgh, UK. n.bansal@ed.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Bansal
authors.forename: R S
authors.initials: RS
authors.lastname: Bhopal
authors.forename: M F C
authors.initials: MF
authors.lastname: Steiner
authors.forename: D H
authors.initials: DH
authors.lastname: Brewster
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D002908:Chronic Disease / Q000208:ethnology; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D012606:Scotland; D013997:Time Factors