17/07/2024

Addressing inequalities in the breast cancer care pathway for women in England and Scotland could deliver additional months of life for black women and those in the most socio-economically deprived communities.

New research conducted by Pfizer, Shine Cancer Support, and Lane Clark & Peacock (LCP) highlights that significant disparities exist across the entire breast cancer care pathway for women in England and Scotland, with socio-economic deprivation, ethnicity, and geography all impacting the experiences of women with breast cancer. Modelling the levelling up of these inequalities has shown that additional months of life can be saved for black women and those in the most socio-economically deprived communities.

This research highlights how broader access to local data sets could further support decision makers in identifying where and how to target interventions to tackle inequalities, unlock these potential health gains and improve outcomes for individual patients and the wider healthcare system.

The white paper highlights that women living in the most deprived communities, and black women, face significant inequalities throughout their entire breast cancer care journey (screening, referral, diagnosis, and treatment). Diagnosis via screening across socio-economic groups and ethnicity was lowest for black women (23%) and women living in the most deprived communities (29%) compared to white women (34%) and women in the least deprived communities (36%). The median time to treatment indicated that black women wait five additional days for treatment than white women. Women in more deprived communities had the highest incidence of late-stage cancer compared to women in less deprived communities, and a higher percentage of black women (22%) were diagnosed with late-stage cancer compared to white women (14%).

Removing socio-economic deprivation inequalities to improve earlier diagnosis could result in 6,000 potential additional life years (PALY) per year overall, with those in the most deprived communities having an increase of three months of life per patient in England. Similarly, removing ethnicity inequalities for black women could result in 1,000 PALYs per year overall, and an increase of six months of life per patient in England and five months in Scotland.

There are notable differences in breast cancer stage at diagnosis, route to diagnosis and treatment waiting times across Cancer Alliances in England and Health Boards in Scotland and this highlights the need to look at all areas of the pathway, rather than one in isolation when assessing the extent of inequalities and targeting interventions.

The analysis utilised public data published by the National Health Service (NHS) and Office for National Statistics. Data for male breast cancer patients, those with disabilities and the priority NHS groups (CORE 20PLUS5 ‘PLUS’ populations) with breast cancer were not readily available. More detailed publication of such data would make for a more comprehensive assessment.

To address these inequities, the white paper puts forth several recommendations:

• NHS England and Scotland should publish and improve access to more data on health inequalities in breast cancer, thereby increasing the ability to dig into the granularity of disparities and enable stakeholders to support the NHS in addressing them effectively.

• NHS leaders should utilise local data to identify the key drivers of health inequalities in their respective areas and seek to implement targeted interventions that build on the success of existing initiatives.

• The involvement of multiple stakeholders, including patient groups, healthcare professionals, and pharmaceutical companies, is crucial in identifying solutions to address the root causes of health inequalities and improve survival rates through pathway improvement.

By understanding these inequalities and acting, we can improve outcomes for all patients.  Download the full document to learn more and join us in the fight against breast cancer inequalities.