The following article was originally published in Transitions Online.

PECS, Hungary—When Kata Orsos first suggested that her mother see a doctor for a mammogram, the older woman balked at the idea.

"When I told her, "You have to go and check your breasts," she said, 'No, because what if the doctor is a man?'" Orsos recalled, widening her brown eyes to imitate her mother's incredulous stare.

Orsos, a young Romani woman from Hungary, said many women in the Romani community are scared to schedule doctor's appointments that involve baring their breasts. "Roma women are shy, and this is a cultural thing," Orsos said. "They don't really like to go to the doctor and show them their naked bodies."

Glancing at the other Romani women she had left cheerfully assembling tents in preparation for a community event in the southern city of Pecs, Orsos quietly added, "But we have to start doing it."

The International Agency for Research on Cancer reports that in Hungary, more than 2,300 women die from breast cancer each year. According to the Open Society Institute in Budapest, Romani women are three times more likely to succumb to the disease than are non-Romani women.

But the high mortality rate among the Roma only in part is due to women's ingrained cultural modesty about their bodies. Romani women also frequently lack information about and access to breast cancer screenings, or they shy away from doctors because they fear ethnic prejudice. Moreover, because many of the women live in poverty, their lifestyles often include breast-cancer risk factors, such as poor diets.

The Roma are Hungary's largest ethnic minority, comprising roughly 2 percent of the country's population of 10 million. Many Roma live at or below the poverty line and bear the burden of high disease rates. According to Human Rights Watch, life expectancy among the Roma is a decade less than the national average.

Hoping to stem the tide of breast cancer deaths among Roma, OSI recently teamed up with several international and Hungarian organizations for a pilot screening and awareness program called "Equal Chances Against Breast Cancer." Launched in early September, it included medical conferences and community health days at three locations in Hungary.

The last stop in the program was Pecs. After a conference that included local doctors, medical groups, and Romani associations, organizers met on a sunny Friday morning in Balokany liget, a city park, to prepare for the community health day. Orsos, who works as a program manager for Khetanipe, a Pecs-based group that assists the local Romani population, said her organization had been planning the event for weeks.

Munching on a clump of grapes, Orsos said that in addition to a traditional Romani stew being stirred in vats by women in brightly colored scarves and skirts, visitors would receive nutritious food like fruits, bottled water, and fresh bread. They also would have access to free information about breast cancer and healthy living from the Red Cross and various cancer organizations. "We wanted it to be (organized) so that you can find many things in one place," Orsos said.

But the heart of the event had taken place earlier that morning, when approximately 80 Romani women gathered by Khetanipe went to a local hospital for mammograms. Similar numbers were gathered at the program's other two sites, the towns of Tiszadob in the east and Kiskoros in the south. Gesturing to the wooden stage where traditional music and dancing would soon begin, Orsos said the women who received screenings would be arriving in the afternoon for the "cultural program."

"The event will probably last until 10 at night," Orsos said of the party to come. "Hopefully everyone here will be happy and cancer-free."

Serving Up Knowledge

Chattering loudly to be heard over the speakers pulsing music over the crowd in Pecs, Timea Petrovics, 31, described receiving her first mammogram.

"It's like getting a scan when you're pregnant," she said of her experience in the morning.

"I never went before because honestly, I never knew I could do this," she continued. "No one recommended it." Petrovics added that her situation isn't unusual; Romani women often are unaware of breast cancer screenings or of how to protect themselves against the disease. Many don't regularly visit doctors to receive health advice.

Providing information about breast cancer to a population that doesn't readily have access to it is a key goal among the organizers of "Equal Chances," explained Marianna Jo, the program's driving force. Jo works for the American Jewish Joint Distribution Committee and the cancer organization Susan G. Komen for the Cure, founded by a former U.S. ambassador to Hungary.

"The women have to have good thinking about their own health," Jo said.

At the Pecs event, women could pick up pamphlets about breast cancer causes, tests, and treatments. And to promote overall healthy living, the Red Cross offered free blood pressure readings - Jo strapped her arm in at one point to show curious bystanders how it's done - as well as finger pricks for diabetes checks.

But the most important information available to women came by way of experience and example, thanks to the mammograms in the morning. According to the European Parliamentary Group on Breast Cancer, 90 percent of breast cancer cases could be cured if detected early. Jo said with such statistics in mind, the organizers of "Equal Chances" wanted to encourage women to learn about where, how, and why to receive mammograms, especially if they are over the age of 45.

The cost of a combined doctor visit and mammogram is approximately 2.40 euros - a minimal fee that nonetheless can be too high for poor people. In 2002, however, Hungary instituted a nationwide program through which women between the ages of 45 and 60 receive scans every two years free of charge. They receive government letters of invitation to participate in the program, which is subsidized by the National Health Insurance Fund.

According to data from the Department of Health Policy, the rate of breast cancer screening - or the number of women who receive at least one mammogram in two years - doubled from 26 percent in 2001-2002 to more than 53 percent in 2002-2003. Still, experts monitoring the nationwide program say participation must increase, and organizers of "Equal Chances" say participation among the Romani population in particular needs to grow.

"Breast cancer scanning is officially paid for by the health care system, but often it is in another location, so you have to go to a regional center, usually to a hospital," Jo said. "People don't go. It's free of charge, but they still don't go. . Sometimes, they can't organize it." Moreover, many Romani women are not registered with Hungary's health care system, Jo added.

To encourage Romani women throughout the country to receive regular mammograms, organizers chose locations with varying demographics. In Pecs, which is home to 150,000 people, Romani women were invited by the official health office for scans in the city. In Kiskoros, a town of 16,000 people, a bus equipped with a mobile scanning unit was stationed centrally for two weeks. And in Tiszabob, a village of only 4,000 people, 90 percent of whom are Roma, women were bused to a regional center for scans. Any associated costs were covered by the NGOs in charge.

Bernard Rorke, head of the OSI's Roma Participation Program, said more than 100 women were scanned in Tiszabob. Laszlo Sztojka head of Baxtale Rom, a social and educational outreach center for Roma based in Kiskoros, said more than 800 women of various ethnic backgrounds were scanned by the mobile unit in his town, including 73 Roma the day of the community health event.

"I was a little bit nervous of what the Roma women would say about this, what their approach would be, because I know very few Roma women attend regular breast cancer scanning," said Sztojka, who traveled to Pecs for the final event. "We had to make a really big campaign to make Roma women understand what a great thing this prevention and attitude (about health) is." He said he believes that because of the "Equal Chances," Romani women will keep getting scans in higher numbers than usual.

His wife, Melinda, was one of the Romani women in Kiskoros to receive a scan, her first ever. "My mother and aunt had breast cancer and had to have mastectomies," she said. During her scan doctors found something suspicious, so Melinda said she would be going a clinic soon for a follow-up appointment.

"I know it's very frightening," Jo said with a worried glance at her fellow organizer. Melinda added, however, that the experience spurred her to alter her lifestyle and to augment her work as an activist. "I am going to do self-exams more often," she said. "And I have encouraged everybody to go (get scans) because of my own family example.

The theme of protecting yourself against cancer didn't deter these visitors to the health event in Pecs.

Removing Other Barriers

Shouldering her purse after picking through jars of honey and other health foods displayed on a small plastic table, Maria Ignacz, 46, proudly said her first mammogram "wasn't even scary or painful at all."

At the Pecs event, Ignacz said she decided to get a scan when invited to do so largely because of her age, which places her at higher risk of developing breast cancer. But she added that without encouragement, she doubts many Romani women would follow her lead.

"I think that among Gypsy women, the reason why they aren't going to the doctor is because they have a natural shyness, and they don't like doctors," she said. "I think also there is discrimination in health care."

Maria Ignacz went for a mammogram, but thinks other Romani women are reluctant to do so out of shyness and fear of discrimination in the Hungarian health system.

Indeed, the Roma's status as a poor minority and the target of discrimination extends into the doctors' offices. Romani women frequently are segregated from other women in maternity wards. Excluding Budapest, close to a fifth of the Romani population live in settlements that lack a general practitioner, according to data published by the European Roma Rights Center in 2004. And the ERRC reports that while doctors may offer poor clients, including Roma, less expensive care, they also communicate with them less frequently and often harbor notions that the patients are unable to reduce their own health risks.

Moreover, the ERRC says that despite Roma's increased risks for various diseases, a "significant number of GPs...do not regard the Roma community as more eligible for increased screening and prevention or intervention which might reduce the incidence of disease among them."

Jo acknowledged that historical discrimination is a factor affecting many Romani women's decision not to see doctors about breast cancer. She hopes "Equal Chances" will change the situation, not only by prompting women to seek out care but also by demanding that the health establishment focus more attention on women's health needs. The three conferences that preceded the community health days connected the Romani NGOs with doctors, health ministry officials, nurses, and other medical professionals and fostered discussions about how to better serve Romani women.

"We wanted to establish sustainable relationships between the NGOS and the medical profession so that there can be follow-up, so that this wasn't seen as a one-time event but rather as the beginning of a more sustainable contact," Rorke of the OSI said.

And to change habits, Jo said women can and should monitor their own breast health. She pointed to a table where women could learn to do self-exams to feel for suspicious breast lumps. As a health instructor watched, a Romani woman pressed her manicured fingers into an "unhealthy" rubber breast and nodded in understanding when she sensed an unusual mass.

But while self-exams are crucial, the organizers of "Equal Chances" said they are no substitute for lifestyle changes or mammograms. Eliminating reservations about scanning, promoting healthful living, providing access to health care, and working to eliminate discrimination are all key to shrinking the number of Romani women who become breast cancer victims.

For her part, Orsos has been able to convince her mother to make mammograms a routine.

"She's going every year now," Orsos said with a grin.

Seyward Darby, of the U.S.-based Hart Fellowship program, is a TOL assistant editor based in Prague.