Breast cancer is the most common cancer among women world-wide
. In Europe, there were 331,000 breast cancer cases in 2006, accounting for 30 percent of all cancer cases among women; with approximately 90,000 deaths in 2006, breast cancer is the second most common cause of death among women in Europe
. Based on European guidelines, population-based breast cancer screening programs were implemented in most countries to reduce breast cancer mortality and start treatment earlier and thus to enhance recovery chances
In Germany, a nationwide population-based breast cancer screening program was implemented from 2005 onwards
. Implementation has been completed in 2009 and about 10 million women between the ages of 50 and 69 years are served by 94 screening units. Women in the eligible age group are invited by mail to undergo a mammography in the specialised screening unit in their area of residence every other year
. By 2009, more than half (54.4 percent) of the women officially invited actually participated in the breast cancer screening program (this figure includes some who attended before the automatically generated invitation reached them). The European guidelines recommend a participation ratio of at least 70 percent to ensure effectiveness of the screening program
. In 2005–2006, a slightly larger proportion of women participated (57.3 percent) than in 2007 (53.6 percent)
. There are large regional differences in screening participation: In the federal states of Bavaria and Schleswig-Holstein, 45.4 percent of the eligible women attended the screening in 2009 while in Saxony, Bremen, Saxony-Anhalt and Mecklenburg-West Pomerania, the ratio was over 60 percent
Factors affecting the probability of failing to participate in screening have been shown to include older age, lower educational status, not owning a car, having no children and no partner and several other factors
[6–10]. In addition, there is evidence for differences in breast cancer screening participation between migrant and non-migrant women in several European countries
[8, 9, 11–13]. For example, Lagerlund et al.
 show a lifetime participation of 90 percent among Swedish women, while participation among migrant women from non-Scandinavian European countries, South America and Asia (80 percent), Africa (76 percent) and North America (73 percent) was lower. A study from the Netherlands shows a participation of 44 percent among Turkish migrants (1995–2005) compared to an overall participation of 79 percent. Older Turkish women were less likely to participate (40 percent) than younger Turkish women (50 percent)
. Participation among Turkish migrants increased from 50 percent in 1997–1998 to 62 percent in 2007–2008. This, however, is still much lower than the overall participation of 80 percent in 1997–1998 and 83 percent in 2007–2008
Germany hosts a total of 16 million migrants (for the purpose of this paper defined as immigrants or their direct descendants), which is equivalent to more than 19 percent of its population. About 3 million people (more than 3 percent of the total population and almost 20 percent of the migrant population) residing in Germany are of Turkish origin. Among the group of Turkish migrants there are about 334,000 women aged 45 to 75 years
. In the next decades the proportion of older (Turkish) migrants will increase considerably
, and so will the number and the proportion of migrants eligible for breast cancer screening.
There is evidence for a lower participation in preventive measures among migrants in Germany
. For example, the participation of adult migrants in routine health examinations is lower than in the majority population
. To date there are no studies on breast cancer screening participation among migrants in Germany. Our research questions are: Does the chance to participate in breast cancer screening differ between women of Turkish origin compared to women of non-Turkish origin? And, is the chance to participate in breast cancer screening among women of Turkish origin dependent on their age?