Elsevier

Social Science & Medicine

Volume 58, Issue 1, January 2004, Pages 151-160
Social Science & Medicine

Screening for breast cancer: candidacy and compliance

https://doi.org/10.1016/S0277-9536(03)00156-4Get rights and content

Abstract

This paper is concerned with understanding why some women accept their invitation for free screening mammography and others do not. Free screening mammography is offered to women aged 50–64 in Britain. Uptake of invitations is about twice as high in leafy suburbs than in inner-city areas. Low uptake in inner-city areas has been attributed to ‘problems’ of black and minority ethnic women. The research reported here was carried out in Hackney, an inner city London borough with an ethnically diverse and socially deprived population. Hackney also has the lowest uptake of screening mammography in the country. Twenty focus groups were held. Participants included white, black and minority ethnic women. Eight focus groups were conducted in English; 12 in other languages. Some methodological issues raised by undertaking qualitative research in several languages are considered. The research demonstrates how the inclusion of white women in research which operationalises ethnicity minimizes the risk of developing an analysis focusing on ‘problems’ of black and minority ethnic women and encourages the development of general themes which may apply to all women. The analysis focuses on candidacy, that is, women's assessment of risk of their disease, and compliance, that is, the explanations respondents volunteered for accepting or refusing an invitation to attend for mammography. Candidacy and ethnicity emerge as similar constructs, manipulated by women to make claims about their risk of breast cancer. Other, non-medical reasons were given for compliance which serve as a warning about assuming that, when women accept their invitation, they do so for same the reasons the architects of the National Health Service Breast Screening Programme had in mind.

Section snippets

Data collection and analysis

The research was supported by the Multi-Ethnic Women's Advocacy Project attached to City and Hackney Community Health Council (CHC) until 1998. CHCs were set up in 1974 and disbanded in 2003. They were the channel through which the ‘patients’ voice’ was broadcast to the local NHS services. CHCs had considerable leeway to decide how best to serve their local community. The high fertility of the relatively young migrant communities led to the setting up of the Advocacy Project which was mostly

Candidacy

A consensus about what causes breast cancer failed to emerge in any of the groups. Indeed, in some, the question was hotly contested with women corroborating their own ideas or refuting those of others by drawing on their own experiences.

T1A ‘No, it [breast cancer] has nothing to with age.’

T1 B ‘No. I know a very young woman who had it. It has nothing to do with age. She never smoked or drank alcohol. I have heard here that her breast has been removed in Turkey.’

T1 C ‘It could be related to

Discussion

The findings reported here demonstrate the value of including white respondents in social research which operationalises ethnicity. Their presence has minimized the risk of jumping to unwarranted, simplistic conclusions about the beliefs and behaviours of black and minority ethnic women; it has also allowed general themes to emerge which suggest new approaches to thinking about all women's understanding of their risk of breast cancer and the reasons why they comply with or refuse their

Acknowledgements

The research was funded by the NHS Executive North Thames Research and Development Directorate. Thanks are due to the women who participated in the focus groups. The advocates of the Multi-Ethnic Women's Health Project, Janet Richardson, Robert Carpenter, Sylvia Denton, Christine Roberts, Clare Moynihan, Nina Hallowell, and the anonymous reviewers for their very helpful comments.

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