Black patients and people with learning disability face longer breast cancer care delays

Black patients and people with a learning disability face longer waiting times at key stages of breast cancer care, according to a nationwide study led by the University of Surrey. The study of more than 86,000 patients is believed to be the first in the UK to measure these delays across the full breast cancer pathway.

Published in Breast Cancer Research, the study found Black patients had 29 per cent lower odds of being diagnosed through routine breast screening than White patients, and 37 per cent higher odds of being diagnosed after turning up in A&E or as an emergency. Cancers found in emergencies tend to be at a later stage, which lowers the chance of survival.

Patients with a learning disability waited 18 per cent longer, on average, for a breast cancer diagnosis after presenting to their GP with a symptom. One in four waited 29 days or more for a diagnosis, 10 days longer than the general population.

Once diagnosed, both Black patients and people with a learning disability waited longer to start treatment. Black patients waited around five days longer, on average, than White patients, while patients with a learning disability waited 8 per cent longer than those without.

The study was funded by Breast Cancer Now.

Dr Robert Kerrison, co-author of the study and Co-Lead for Cancer Care at the University of Surrey, said:

"Early detection and treatment of breast cancer are crucial for survival, and our study shows that the country currently has a system that is letting down the patients who already face the most barriers. Fewer Black women are being picked up through screening, more are being diagnosed in A&E, and patients with a learning disability are waiting longer at every stage. Each one of these gaps costs time, and in cancer, time costs lives."

The study examined anonymized health records from 86,564 adults diagnosed with breast cancer in England between 2009 and 2018. Records came from NHS general practices contributing to the Clinical Practice Research Datalink, linked to the national Cancer Registry.

Patients with severe mental illness and those living in the most deprived areas also faced similar gaps. The researchers found that patients in more than one of these groups fared the worst of all. For example, patients with severe mental illness living in the most deprived areas were more likely still to have breast cancer diagnosed in an emergency.

Around one per cent of UK adults have a learning disability. The researchers note that this group is under-represented in healthcare data, meaning real gaps in care could be larger than the study captures.

Tetyana Perchyk, lead author of the study from the University of Surrey, said:

"The inequalities we found are not down to one single thing. They add up across the system, and they add up most for the women who already face the most barriers. Patients with a learning disability, in particular, have been largely invisible in UK cancer research until now. Our work shows where the gaps are. The next job is to understand why, and to close them."

Manveet Basra, associate director of public health, inclusion and awareness at Breast Cancer Now, said:

"We know that people from marginalized groups, including certain ethnic communities, face inequalities at every stage of their breast cancer experience, and tragically this impacts their survival rates.

"This research helps us understand who is less likely to be diagnosed with breast cancer via screening, might wait longer to get diagnosed or experience delays in treatment, and knowing what barriers they face enables us to work towards eliminating them.

"Determined to improve breast cancer care and survival rates outcomes, we're funding world-class research that actively identifies and addresses inequities, working with policymakers to improve equal access to screening, and ensuring our information, campaigns and life-changing support services reflect the diverse needs of everyone affected by this devastating disease."