We explore why some people struggle to access vital breast screening, and what can be done to change this.
Here we explore why some people struggle to access vital breast screening, and what can be done to change this.
In February 2023, new data showed that the proportion of women taking up their breast screening invite in 2021/22 remained at a record low, only 62%, for the second year in a row. While there was a sharp drop in screening attendance during the COVID-19 pandemic, the truth is the uptake of routine breast screening was declining in England, well before the pandemic.
Breast screening uptake also varies among communities; for example, women living in areas of higher deprivation and those from certain ethnic backgrounds are much less likely to attend regular breast screening. These same groups often face higher rates of late-stage diagnosis and therefore, poorer outcomes. While not the only reason, lower levels of screening is an underlying factor driving health inequalities in breast cancer survival rates.
There are lots of potential issues that can make getting screened challenging for some people. In many cases, there is not a single ‘reason’ or barrier deterring people from screening, but there are the common types of problems that affect people.
Accessibility barriers
There are practical challenges and hurdles that stop eligible people getting screened. Some women have found it difficult to get in touch with their local screening service to book or reschedule their appointment, or are not able to take time away from work or caring responsibilities to attend screening. Without more convenient, flexible routes into breast screening, like online booking and walk-in appointments, these problems will continue to stop many from taking up their invite.
In other cases, the challenges lie in the location of the screening service. Being unable to travel to a venue or get there using public transport can be an issue. This is especially the case for people in more rural areas where screening services may be based further away, or where mobile units are only in the area for a limited amount of time. Breast screening services must also be easy to find, and be located somewhere women feel safe visiting at all times of day. Accessibility barriers are much more likely to affect women with physical and mental disabilities, which is why information about the support and adjustments available to assist them is so vital.
There are also technical problems that can arise in the programme. Difficulty transferring screening records between services when people relocate, not being registered with a GP, or not having the right information on record, can all result in people eligible for screening not being invited.
Informational barriers
A lack of information and misunderstandings can lead to fewer people taking up their invite. While a lot of progress has been made recently, making sure people are given health information, including their breast screening invite, in the language and format that is right for them is still a challenge.
People need to have the chance to ask questions and get more information about breast screening from trusted sources. Many women have questions or concerns about screening – what they should wear, how long it will take, whether it’s painful, will they been seen by male staff – and about breast cancer generally. When these questions go unanswered, fear and anxiety can deter them from getting screened.
There are also common but wrong assumptions about screening that must be debunked. Women who are invited to screening need to understand that the offer is open to those without any symptoms, and that even women who are relatively young, healthy and have no family history can still develop the disease. Screening should be promoted as the best way to find breast cancer early, when survival rates are highest, to ensure women realise how important regular screening is.
Social and cultural barriers
There are also societal factors which may be less obvious, but can still have a negative impact on breast screening uptake.
Myths and misconceptions about cancer as a source of shame, moral failing, or punishment for wrongdoing are still found in some communities, along with the view that any type of cancer diagnosis is fatal. These factors can lead women to avoid screening due to fear of social isolation, or fear it could represent a death sentence.
In some communities there can be a real fear about facing stigma when accessing health care, especially if they’ve had bad experiences in the past. Cultural or religious beliefs about modesty and related concerns about maintaining dignity, can be a significant obstacle to attending breast screening as well. Screening services must be equipped to understand and adapt to individuals’ needs, to ensure everyone feels welcomed, respected and supported when invited to breast screening.
More broadly, the Women’s Health Strategy published last year highlighted the lack of open, frank conversations about women’s bodies and conditions that predominately impact women, and noted many women feel unable to prioritise their own health ahead of the needs of others. These dynamics only increase the need for breast screening to be seen as highly important and easily accessible, so as many eligible women as possible take up their invite.
What we’re doing to improve access to breast screening
We need breast screening that is accessible to all eligible women and has enough staff and resources to offer the care women deserve, now and in decades to come.
More Government funding is needed to remove barriers to screening, support units and modernise the programme. This is why we’ve launched a petition demanding the government urgently invest in breast screening to detect cancer early and prevent more breast cancer deaths. Because when it comes to breast cancer, there really is #NoTimeToWaste.
Here’s how you can take action.