The effect of access factors on breast screening attendance on two Scottish islands

The National Health Service Breast Cancer Screening Programme began in the Argyll and Clyde Health Board area in 1990. The Health Board area is large and includes 26 inhabited islands, thus necessitating the use of mobile screening units. This study examined factors affecting attendance for mammorgraphy on two islands in the west of Scotland, Islay and Jura, using these mobile screening units. The methods used were a prospective postal questionnaire survey prior to breast screening and personal interviews with attenders after screening. All 313 women who were invited to attend for breast cancer screening on Islay and Jura were sent the pre-screening questionnaire. Five were returned by the Post Office with incorrect addresses. Of the remaining 308 women, 234 (76%) returned the questionnaire, with a differential response rate of 84% for participants and 55% for non-participants. One hundred and sixty-three women were interviewed after attending for screening. Non-participants lived further from the screening site than participants (p < 0.01). Non-participants also tended to be in the oldest age group (60-64 years old) (p < 0.05). According to the post-screening interviews, 14% of participants travelled more than 30 minutes to the screening site. Attendance was lowest in the afternoon, when public transport was difficult to obtain. These results suggest that access has an important effect on screening uptake in remote and rural areas. Further consideration should be given to using more than one site in rural areas with long distances and limited public transport.