Uncovering and addressing ethnic inequities in breast cancer diagnosis

July is Ethnic Minority Cancer Awareness month. As the month draws to a close, we explore new data on how rates of early diagnosis vary between different ethnic groups in England, and what can be done to shrink the early diagnosis gap.

Newly shared NHS data from 2019/20 to 2022/23 highlights major inequities in breast cancer diagnosis. Black women at any age and South Asian women aged 18-71 are much less likely to have their breast cancer found early when compared to white women. These same women are also significantly more likely to be diagnosed with secondary breast cancer, which has spread to other areas of the body by the time it’s detected.

Although white women are more likely to be diagnosed with breast cancer, black and south Asian women are less likely to survive a breast cancer diagnosis. This is because late-stage breast cancers often have fewer treatment options, are less likely to be treated successfully, and have a higher rate of recurrence.

There are a lot of factors behind the inequities in early diagnosis. Differences in deprivation, along with other socio-economic factors, are likely to contribute. Women living in more deprived areas are at greater risk of being diagnosed with breast cancer late, and women from ethnic minority communities disproportionately live in deprived areas.

But overall, the gap can’t only be explained by deprivation, as differences in early diagnosis rates also exist between different ethnic groups living within the same highly deprived areas. For example, this new data shows that in multiple areas, early diagnosis rates are still lower for south Asian women than for white women experiencing the same levels of deprivation.

Therefore, it's very important to understand the other factors that might make women from some ethnic minority communities less likely to be diagnosed early. Differences in access to healthcare, exposure to breast cancer risk factors, awareness of the signs and symptoms, and beliefs around breast cancer are all likely to play a role.

Our previous research found that a third of women from ethnic groups said they didn’t understand breast cancer and found it hard to talk about. A quarter believed there was shame associated with breast cancer. Twice as many women from minority ethnic communities (28%), compared to white women (14%) believed there were myths about breast cancer in their community. These myths, including the belief that cancer is contagious or represents a death sentence, may mean that some women feel less able or willing to get screened or go to their GP if they develop possible cancer symptoms.

There may also be biological factors driving some inequities. Evidence suggests that black women are more likely to be diagnosed with more aggressive forms of breast cancer, which develop quickly and are harder to find early and treat successfully.

Access to and uptake of breast screening is clearly an area of inequity, which is significant as screen-detected breast cancers are the most likely to be found early.  Previous data has shown that women from black and other ethnic minority communities are much less likely than white women to be diagnosed with breast cancer through screening.  Our own research has previously found that women from ethnic communities are also less likely to be aware, or know about the benefits, of breast screening compared to white women.

This new data clearly shows the impact of the screening uptake gap. The pause in breast screening during COVID-19 damaged early diagnosis rates across all women. But the post-pandemic recovery in early diagnosis has been weaker for black women of screening age, compared to both white and south Asian women.  

What are we doing about this?

There is no single solution that can fully solve these inequities, but we have a key role to play in representing the diverse community of people with breast cancer.

We’re committed to helping narrow the diagnosis gap for women from minority ethnic communities. We’re doing this through:

• Our ‘Improving Public Health, Equity and Wellbeing’ scheme, which funds research on breast cancer inequities.
• Influencing policy makers to implement the actions in our Transformation Blueprint and Screening Equality Consensus Statement to improve equal access to screening.
• Hosting dedicated events with clinicians and health policy makers to discuss the experiences and challenges faced by different communities
• Making sure all our health information, resources, and campaigns reflect the diversity of people affected by breast cancer and are translated into a wide range of languages
• Tailoring our public health messages and activities, including using audio formats to address literacy barriers, and delivering our public health talks in community spaces including places of worship like mosques and churches
• Ensuring there are accessible and inclusive opportunities for everyone to get involved with Breast Cancer Now’s work, so we are shaped and led by the diverse voices of people within the breast cancer community