Screening for breast cancer: candidacy and compliance

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.