Supporting access and tackling barriers to breast screening

Inequalities in screening uptake 

Health systems and healthcare professionals have a vital role in supporting informed choice in cancer screening.  

Being aware of the groups that are less likely to attend screening will support you to target and tailor interventions. The following groups of people may be less likely to take up breast screening:¹

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• Those invited for the first time or previous non-responders 

• Being younger (aged below 52) 

• Ethnic minority backgrounds 

• Living in the most deprived areas 

• People with physical or learning disabilities 

• People with severe mental illness 

Barriers to screening participation 

Understanding the barriers that people may face can enable you to facilitate screening uptake​:⁹

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• Appointments at inconvenient times (eg due to work or childcare commitments) 

• Fear of cancer or fatalism  

• Cancer stigma within a community 

• Concern that the test may be painful or previous experience of pain during screening 

• Embarrassment about removing clothing for the test 

• Lack of screening awareness including understanding that screening is for asymptomatic people or why screening is important 

• Language barriers 

• Distrust in the health system and concern about stigma or lack of cultural competence from health professionals  

• Cost of travel to the appointment or other expenses 

The reasons for non-attendance may be complex and multiple factors may be at play. 

Find out more in our blog on screening inequalities. 

Actions to support access to breast screening

It’s important to understand which specific demographic groups in your area face barriers which impact screening attendance.  

You could engage with local community groups and specialist teams (eg learning disability or mental health support nurses) to discuss barriers and potential interventions to ensure that they are more successful.  

Check out our guide for health professionals on reducing inequalities in cancer screening for more information and resources to support your practice. 

Reducing inequalities in cancer screening

Find nation specific information on addressing screening inequalities: 

• Equity in Screening Strategy 2023-2026(PDF) (Scotland)

• Screen Equity Strategy 2022-2025 (Wales)

• Breast screening: identifying and reducing inequalities (England)

Interventions that can support access to breast screening

There are evidence-based interventions that can be integrated into practice to improve screening attendance. 

Our breast screening information for the public has key information about eligibility, explains the test, discusses the benefits and harms of screening and has links to resources, including BSL videos and content for people with learning disabilities. 

Display and share our leaflets with your patients: 

• Spot breast cancer early 

• Easy read leaflet: Spotting cancer early saves lives 

Case Study

Muslim women in Glasgow and Edinburgh participated in workshops to identify key themes and delivery formats for educational material that could support their participation in cancer screening. The group co-designed four interventions, which were then presented to a sample of other Muslim women. Participants were recruited through snowball sampling using community organisations in the area. Participants reported positive views and increased knowledge of cancer screening. In focus groups, participants generally preferred face-to-face delivery and advised using translators for language barriers. They valued the faith-based element of the interventions but highlighted that the effect may vary between individuals. This case study shows that community-based approaches have the potential to tackle health inequalities in screening.

Read the full paper for more information about this case study²⁰

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Other facilitators which may support access to breast screening 

• Consider adding GP endorsement into screening communications, which can facilitate screening attendance, especially among groups who are less likely to attend.​⁹

  Prowse SR, Brazzelli M, Treweek S. What factors influence the uptake of bowel, breast and cervical cancer screening? An overview of international research. Eur J Public Health, 2024.

    

• Opportunistically discuss screening with patients during routine appointments, health visitor appointments, health checks, immunisation or phlebotomy appointments. 

• Offer a variety of screening appointment times and extra time for people who would like to discuss the screening process first. 

• Mobile mammography units may improve access to breast screening in rural and deprived areas.​⁹

  Prowse SR, Brazzelli M, Treweek S. What factors influence the uptake of bowel, breast and cervical cancer screening? An overview of international research. Eur J Public Health, 2024.

• Staff training to support effective communication with people about screening may be a facilitator for screening attendance.⁷

  Jack RH, Møller H, Robson T, Davies EA. Breast cancer screening uptake among women from different ethnic groups in London: a population-based cohort study. BMJ Open, 2014.

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  Allgood PC, Maxwell AJ, Hudson S, et al. A randomised trial of the effect of postal reminders on attendance for breast screening. Br J Cancer, 2016.

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  Westrop SJ, Thomas A, Williams A, et al. Impact of changes to invite methodology on equality of access to the National Breast Screening Programme in the South of England. J Med Screen, 2023.

• Work closely with mental health and screening services, to ensure that people with severe mental illness are made aware of screening and that adjustments can be implemented to support attendance.²¹

  Tuschick E, Barker J, Giles EL, et al. Barriers and facilitators for people with severe mental illness accessing cancer screening: A systematic review. Psychooncology, 2024.

Read more about breast screening