Adam Morris: Awareness high but attendance still low

Millions of pounds are raised for research into the disease which kills around 200 Lothian women every year, and experts say there is more chance of survival now than ever.

But despite the massive amount of attention drawn to it by events like the MoonWalk and Race for Life, thousands of women in the at-risk bracket are snubbing the offer of free NHS screening for the disease, even though it is a straightforward procedure.

New statistics show that in the three years up to the end of 2009, 71.9 per cent of women aged between 50 and 70 had accepted an NHS Lothian invitation for a free check.

This is a decrease on previous years, and below the national average. Only in Glasgow and Lanarkshire were the figures worse.

Various reasons have been cited for women refusing to attend. Surveys have shown in the past that an alarming number say if there is something wrong with them, they don't want to know.

It has also been pointed out that busy lives make it difficult to attend, but NHS Lothian has extended hours beyond 5pm and to weekends.

Audrey Birt, the director of the Breakthrough Breast Cancer charity in Scotland, said: "The challenge is getting them through the door, because once they have attended, the research shows they come back every three years.

"But there is still an embarrassment factor, and fear of discomfort, and the not wanting to know if something is wrong.

"There are also cultural issues with some ethnic minorities, so it's important we can show it will be women carrying out the screening and circumstances will be comfortable."

She added that while breast cancer was no longer a taboo subject - far from it - the growing familiarity did not seem to have impacted on the public's knowledge of the subject.

"Research actually shows a woman now is no more likely to know the symptoms than previous generations, even if she is more likely to know someone who has had it," she added.

So what more can be done to entice women in for screening? The irony is that the system within NHS Lothian is one of the best in Europe. All the various departments, from radiology to the laboratories, are well joined-up and work extremely efficiently together, making the procedures the envy of many other health boards.

NHS Lothian's detection rate of breast cancer is also higher than the rest of Scotland - 3.6 per 1000 women screened compared to 3.4 nationwide.

Ms Birt said one of the most important ways of persuading people to take part was for them to have a trusted source selling the idea.

In wealthy areas this can be a GP, but schemes in other parts of the UK have aimed to widen that field. A project among African communities in London has seen hairdressers trained to wax lyrical about the merits of breast screening.

"The reason we see such a high take-up in rural areas is because the mobile van goes into the community, people talk about it and it becomes a trusted way," she said.

"That is something we could look at for the more deprived places too, to have champions for it."

As exists with almost every area of health, there is concern about the rich/poor divide with screening.

The ISD Scotland figures showed that 81 per cent of the least deprived women attended for screening, compared to 65 per cent in the group deemed most impoverished.

Dr Sue Payne, a consultant in public health medicine for NHS Lothian, said: "We have systems in place to invite all eligible women to come forward for breast screening.

"And we offer extended hours for mammography. We also run mobile screening units across Lothian."

There is no doubt breast cancer will continue to receive the publicity it warrants, the challenge will be getting everyone to take notice of it.

[email protected]