Background: Inequalities in uptake of cancer screening by ethnic minority populations are well documented in a
number of international studies. However, most studies to date have explored screening uptake for a single cancer
only. This paper compares breast and bowel cancer screening uptake for a cohort of South Asian women invited to
undertake both, and similarly investigates these women's breast cancer screening behaviour over a period of fifteen
years.
Methods: Screening data for rounds 1, 2 and 5 (1989-2004) of the NHS breast cancer screening programme and for
round 1 of the NHS bowel screening pilot (2000-2002) were obtained for women aged 50-69 resident in the English
bowel screening pilot site, Coventry and Warwickshire, who had been invited to undertake breast and bowel cancer
screening in the period 2000-2002. Breast and bowel cancer screening uptake levels were calculated and compared
using the chi-squared test.
Results: 72,566 women were invited to breast and bowel cancer screening after exclusions. Of these, 3,539 were South
Asian and 69,027 non-Asian; 18,730 had been invited to mammography over the previous fifteen years (rounds 1 to 5).
South Asian women were significantly less likely to undertake both breast and bowel cancer screening; 29.9% (n =
1,057) compared to 59.4% (n = 40,969) for non-Asians (p < 0.001). Women in both groups who consistently chose to
undertake breast cancer screening in rounds 1, 2 and 5 were more likely to complete round 1 bowel cancer screening.
However, the likelihood of completion of bowel cancer screening was still significantly lower for South Asians; 49.5% vs.
82.3% for non-Asians, p < 0.001. South Asian women who undertook breast cancer screening in only one round were
no more likely to complete bowel cancer screening than those who decided against breast cancer screening in all
three rounds. In contrast, similar women in the non-Asian population had an increased likelihood of completing the
new bowel cancer screening test. The likelihood of continued uptake of mammography after undertaking screening in
round 1 differed between South Asian religio-linguistic groups. Noticeably, women in the Muslim population were less
likely to continue to participate in mammography than those in other South Asian groups.
Conclusions: Culturally appropriate targeted interventions are required to reduce observed disparities in cancer
screening uptakes
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