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Background information

In 2020-21, screening uptake reached an all-time low.

While some of this will directly link to the COVID-19 pandemic, breast screening uptake has been declining for over a decade.

Barriers and interventions

There are several reasons why women may not attend breast screening. Dr Rebecca Leon, GatewayC GP Lead, spoke to Manveet Basra and Sadia Habib who lead Breast Cancer Now’s Public Health and Wellbeing team about the barriers to attending breast screening.

Key points:

There are a number of general barriers to engaging with and attending breast screening appointments. These can be broadly categorised as logistics or appointment barriers.

Logistics barriers include transportation, cost, lack of time and access; these are identified in general population studies as well as in BAME groups, and amongst people with physical disabilities.

Appointment barriers include a lack of risk awareness and understanding of the relevance of screening, fear of the screening process itself and what it entails, or a previous negative experience.

There is also concern that one of the measures taken to help the screening programme recover could be contributing to the drop in the number of women attending. Before the pandemic, invitations provided a timed appointment for breast screening. When screening restarted, most women were sent ‘open invitations’ which required them to book their own appointment. Research suggests women are less likely to attend when sent open invites.

It is essential to understand the reasons that your local population aren’t attending. This will allow for information and resources to be targeted more effectively.

GP practices can help patients make an informed decision about participating in breast screening:

  • Improving awareness of the programme
  • Encouraging re-attendance when invited, even if previous tests have been normal
  • Discussing potential barriers
  • Engaging with non-responders
  • Discussing opportunistically at other healthcare appointments
  • Using different communication methods to engage with patients (such as texts, telephone calls and targeted letters)

Innovation: North Midlands Breast Screening Service

With the help of digital PR and communications agency, the North Midlands Breast Screening Service linked with local GP practices that had active Facebook pages and promoted the service on local Facebook community groups popular with women over 50.

The team posted information aimed at encouraging women to spread the message about the benefits and importance of screening.

Its social media initiative led to a 13% increase in first time breast screening attendances in Stoke-on-Trent.

Read in-full here

Additional information

Link: Effect of second timed appointments for non-attenders of breast cancer screening in England, The Lancet Oncology (2017)
Link: How the North Midlands Breast Screening team uses Facebook to increase breast screening uptake, Public Health England Screening Blog (2019)

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