Black people are more than a third less likely than white people to be diagnosed with cancer via screening in England, according to the first study of its kind, prompting calls for targeted efforts to improve their levels of uptake.
Screening programmes save lives by preventing cancer from occurring or spotting it earlier, when treatment is more likely to be effective.
In England, screening for cervical cancer is offered to women aged 25 to 64, breast cancer screening is offered to women aged 50 to 70, and everyone aged 60 to 74 is offered a bowel cancer screening home test kit every two years.
The latest research, however, lays bare stark disparities in screening diagnosis rates between different ethnic groups for the first time. The study of more than 240,000 cancer patients over a decade found that 8.61% of patients were diagnosed via screening.
Broken down by ethnicity, the figure for white people was 8.27%, almost exactly the same as the national average, but among black people it was 5.11%. The findings suggests that black people are 38% less likely to be diagnosed via screening than white people.
Diagnosis via screening in mixed-race patients was much higher at 9.49%, and higher still in Asian patients at 10.09%, almost double the rate for black patients. The results were published in the British Journal of Cancer.
“Black patients in our sample were less likely to be diagnosed via screening, consistent with their lower uptake of screening opportunities,” said the lead researcher Tanimola Martins, a Cancer Research UK-funded post-doctoral research fellow at the University of Exeter Medical School. “More targeted efforts might be required to change this trend. We need to intensify efforts to improve uptake of screening.”
Jabeer Butt, the chief executive of the Race Equality Foundation, said the findings should prompt urgent action.
“Cancer screening saves lives,” he said. “That’s why it is so important that effective outreach and culturally appropriate interventions are prioritised to reduce health inequalities.
“We know that awareness of cancer symptoms is lower among minority ethnic groups, particularly black Africans, with higher reported barriers to seeking help. But we also know from previous research on colorectal cancer interventions that speaking to someone who explains the steps of the screening process ahead of time can lead to improvements in screening uptake in minority patients.
“Other strategies, like training physicians to effectively communicate with patients who have less experience of healthcare, have also been shown to be effective. It’s time to put these solutions into practice across the board and make inequality in cancer a thing of the past.”
The NHS says there are several benefits of cancer screening, including that health professionals can detect a problem early, before a patient has any symptoms. Finding out about a problem early may mean treatment is more effective.
For patients, finding out they have a health problem or an increased chance of a health problem can help them make better informed decisions. In some cases, screening can prevent deaths from bowel, breast and cervical cancer.
Michelle Mitchell, the chief executive of Cancer Research UK, which funded the research, said the lower screening diagnosis rates in black patients was concerning.
“There can be lots of reasons why people may not take up screening, from practical barriers around attending appointments to fear of a potential cancer diagnosis,” she said. “More detailed ethnicity data is needed to allow us to understand the full picture, and target interventions to improve screening uptake.
“Cancer screening programmes have a valuable role to play in diagnosing cancer earlier, when treatment is more likely to be effective, and reducing health inequalities. It’s vital that any barriers to screening are removed to increase cancer diagnosis and save lives.”
Martins said one possible solution could be for GPs to raise awareness of the benefits of screening. “As black patients frequently use primary care, this may provide the ideal setting for targeted interventions to improve the awareness and uptake of screening,” he said.
“A recent trial showed that targeted intervention to promote cancer awareness and help seeking was associated [with] improved consultation rates. Such intervention may be adapted to promote breast cancer screening uptake in black women.”
