# Participation behaviour of different migrant groups in breast cancer screening – palpation of the breast and mammography. Results from the German national cohort (NAKO)

## TL;DR

The study finds that migrant women in Germany participate less in breast palpation screening compared to native Germans, but mammography participation is similar across groups.

## Contribution

This study provides new insights into how migration status and language proficiency affect participation in two breast cancer screening methods in Germany.

## Key findings

- Migrant women, especially Turkish, have lower odds of undergoing breast palpation compared to native Germans.
- Mammography participation is similar across migrant and non-migrant groups.
- Language proficiency affects breast palpation more than mammography participation.

## Abstract

•breast cancer screening programs in Germany covered by health insurance include palpation of the breast by a physician (from age 30) and mammography (age 50 to 75).•Palpation of the breast was less frequently utilized in all migrant groups with odds ratios ranging from 0.5 (95 % CI 0.4–0.6) for Turkish women to 0.9 for women from western countries (95 % CI 0.7–1.1) compared to autochthone Germans.•Lower German language proficiency further decreases its use.•Mammography participation did not differ substantially compared to Germans with odds ratios ranging from 0.8 to 1.2.•German language proficiency had little effect on mammography participation.

breast cancer screening programs in Germany covered by health insurance include palpation of the breast by a physician (from age 30) and mammography (age 50 to 75).

Palpation of the breast was less frequently utilized in all migrant groups with odds ratios ranging from 0.5 (95 % CI 0.4–0.6) for Turkish women to 0.9 for women from western countries (95 % CI 0.7–1.1) compared to autochthone Germans.

Lower German language proficiency further decreases its use.

Mammography participation did not differ substantially compared to Germans with odds ratios ranging from 0.8 to 1.2.

German language proficiency had little effect on mammography participation.

For early detection of breast cancer, clinical palpation of the breast is offered yearly to all women aged 30 and older, and the German Mammography Screening Programme (MSP) offers biennial mammograms to all women aged 50 to 75 years. We investigated the utilization of both screening methods across various migrant groups in Germany, as well as the effect of German language proficiency.

Cross-sectional data on participation frequencies from the baseline examination (2014 to 2019) of more than 100,000 women of the German National Cohort study (NAKO) were analysed by migrant status. Adjusted logistic regression analyses were conducted for palpation and MSP to compare screening uptake among six migrant groups, and non-migrant population.

Palpation of the breast was less frequently utilized in all migrant groups with odds ratios ranging from 0.5 (95% CI 0.4–0.6) for Turkish women to 0.9 for women from western countries (95% CI 0.7–1.1) compared to autochthone Germans. Lower German language proficiency further decreases its use. In contrast, odds ratios for MSP participation did not differ substantially compared to Germans ranging from 0.8 to 1.2. German language proficiency had little effect on MSP participation.

In contrast to earlier studies, our findings suggest that MSP participation and motivation does not significantly differ by migration status or language skills. This may indicate that information on MSP is broadly accessible through established invitation procedures in Germany. However, lower uptake of breast palpation by a physician in some migrant populations highlights potential gaps in broader preventive care engagement.