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The National Health Service Breast Screening Programme set up 20 years ago in the UK has to evolve continuously to meet changing needs as a result of fundamental transformations in the age and ethnic profile of the population. This article draws on evidence generated as part of the Healthcare Commission's national study aimed at identifying issues that may contribute to different groups not having equal access to, experience of, or outcomes from services relating to breast screening and breast cancer treatment. Findings indicate that ethnicity has an effect on the awareness of services and of breast cancer. Access to screening and the experience of screening and treatment are influenced by the interaction of ethnicity with age. Younger women from certain black and minority ethnic groups face particular barriers. There can be additional barriers experienced by those from linguistic minorities. Equality of access, experience and outcomes does not mean treating everyone the same way.