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Cancer Keys

Delayed diagnosis of breast cancer in Black women

Published: 17 October 2024
Stock image Mature Woman Doing Self Breast Exam At Home

Key points: 

  • Black women are more likely to receive a late-stage breast cancer diagnosis. 
  • Black women are less likely to attend breast screening compared to other communities in the UK. 
  • Language, communication, patient education, and cultural factors are key barriers to Black and ethnic minority groups when accessing health care services. 
  • More education is needed for health care providers to understand the needs of Black and ethnic minority groups to improve their cancer care. 

A 2023 analysis published in BMJ open revealed that Black women of Caribbean and African descent are up to twice as likely to be diagnosed with cancer at a later stage.

This analysis is the first to show that ethnicity plays a significant part in the late-stage diagnosis of breast cancer, with African women being 71% more likely to receive a late-stage diagnosis of breast cancer when compared to the white cohort.  

Pitfalls:

Following a breast cancer diagnosis, Black women tend to have poorer outcomes. This is due to factors such as:  

  • Screening uptake – Black women are less likely to attend their breast screening appointment compared to other communities in the UK. 
  • Patient education – A YouGov survey carried out for Cancer research UK, found that women from ethnic minority backgrounds, were more likely to report that they did not know of any warning signs or symptoms of cancer when compared to white women.  
  • Tumour type – Black African women are around three times more likely to be diagnosed with oestrogen receptor negative and HER2+ breast cancers, which can be more aggressive breast cancers and have implications for the appropriate treatment choices. 
  • Socioeconomic deprivation – Women in deprived areas are more likely to receive a late-stage breast cancer diagnosis. 

The race equality foundation has found that language and communication appear to be the two of the largest barriers to health care services and engagement with Black and minority ethnic groups. 

Cultural factors also contribute to a lack of engagement in Black and ethnic minority groups, and research has shown that cancer stigma may be contributing to a lower cancer screening uptake. When considering stigma and screening uptake, it is important to consider how screening may be avoided for social, cultural, and religious reasons. Cancer stigma can stem from fear surrounding the subject of cancer so it is not talked about, and therefore these communities may have a lower awareness of cancer. Education for these communities is therefore important to help address this stigma. 

The race equality foundation has also found that health care providers have a poor understanding of the needs of the Black and minority ethnic communities and that Black and minority ethnic patients report more negative experiences of cancer care. 

Research from Breast Cancer Now has found that a third of women from ethnic minority groups, said that they didn’t understand breast cancer and found the subject difficult to talk about.  

Appropriate counselling and education from healthcare professionals is essential for engagement with minority ethnic groups.  

Helpful hints:  

Addressing these health inequalities in breast cancer outcomes in Black and ethnic minority groups, needs a multifaceted approach among all levels of the health care system, communities, and the government.  

What can we do to help in primary care? 

  • We should try and encourage face-to-face appointments – Cancer research UK has found that patients from ethnic minorities were significantly more likely to have had remote consultations when compared to those from white backgrounds.  
  • Tailor appointment times and the length of appointments – Consider longer appointments for certain patients, particularly when an interpreter is required. Take into account that Friday afternoon appointments can exclude Muslim users who attend formal prayer sessions.  
  • Education for patients – Consider allotted clinic time for health care professionals to counsel patients from ethnic minorities on breast cancer and screening.  
  • Accessible information on cancer – Provide patient information on cancer in the appropriate language and for patients who have a low literacy level.  
  • Cultural and religious factors – Consider cultural and religious factors when referring patients on a suspected cancer pathway and when managing palliative patients.  
  • Find out what is going on in your local community and PCN – There are community groups, voluntary support services and health inequality programmes aimed to educate and support patients from ethnic minorities and the barriers they face with accessing healthcare.  

Practice takeaway: 

Macmillan provides information on cancer for patients in different languages and this includes a breast cancer fact sheet. Click on this link to access these resources. 

Macmillan also provides cancer information in easy read and audio book formats. Clink on this link to access these resources. 

Find out more:

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