In a study of nearly ninety thousand English women and men diagnosed with breast cancer, researchers from the University of Surrey have traced a quiet but consequential unfairness along the road from first symptom to treatment. Black patients were less often caught by routine screening and more often arrived at emergency care, where cancers tend to be found later and survival grows less likely. People with learning disabilities waited longer after first seeing a GP, and both groups waited longer to begin treatment. The records, drawn from general practices and linked to national registry data
Black Patients and People with Learning Disabilities Face Longer Breast Cancer Care Delays, Study Finds
Emergency diagnoses are linked to later-stage cancers and lower survival chances, with the greatest delays falling on women facing multiple disadvantages.
Each gap costs time, and in cancer, time costs lives.
Mark
What's new here? Haven't we known about inequalities in cancer care?
Mimi
Parts of it, yes. What's new is measuring delay across the whole pathway, from screening through diagnosis to treatment, in 86,564 patients. It's believed to be the first UK study to do that.
Mark
The Black patient figures seem to be about how the cancer is found.
Mimi
Right. They had 29 per cent lower odds of being diagnosed through screening and 37 per cent higher odds of an emergency diagnosis. Emergency routes tend to mean later-stage cancers.
Luke
Worth being careful there. Those are odds, not a count of deaths. The study shows the route of diagnosis differs; the survival link is the general pattern for emergency diagnoses, not something measured here.
Mark
And for people with a learning disability?
Mimi
Delays after seeing a GP: 18 per cent longer on average, and one in four waited 29 days or more, ten days longer than the general population. Then 8 per cent longer to start treatment.
Luke
Do we know why? The reporting doesn't say. The lead author says the next job is to understand why, so the causes are still open.
Mark
Does the data capture everyone?
Mimi
Not fully. People with learning disabilities are under-represented in healthcare data, so the researchers say real gaps could be larger.
Luke
That's their caveat, and it's a reasonable one, but it's an expectation, not a measured figure. Also, the records end in 2018, so we can't say from this how things look now.
Mark
Anything about overlapping disadvantage?
Mimi
Yes. Patients in more than one group, such as severe mental illness and living in a deprived area, fared worst.
Il Polso
- Black women are roughly a third more likely to reach cancer care through an emergency door rather than a screening call, and that gap can mean a diagnosis that arrives too late.
- Patients with learning disabilities wait 18 per cent longer after a GP visit, and one in four is left waiting 29 days or more for an answer.
- Those who sit at several disadvantaged points at once, such as severe mental illness and deprivation, face the sharpest delays and the most emergency diagnoses.
- Researchers warn the true picture may be worse, because people with learning disabilities are largely missing from UK cancer and health records.
- Policymakers and Breast Cancer Now are now under pressure to understand why these gaps exist and to make screening access equal in practice.
In a study of nearly ninety thousand English women and men diagnosed with breast cancer, researchers from the University of Surrey have traced a quiet but consequential unfairness along the road from first symptom to treatment. Black patients were less often caught by routine screening and more often arrived at emergency care, where cancers tend to be found later and survival grows less likely. People with learning disabilities waited longer after first seeing a GP, and both groups waited longer to begin treatment. The records, drawn from general practices and linked to national registry data across 2009 to 2018, suggest that disadvantage here is not a single failure but a slow accumulation, and that the people least visible in the data may be the ones most affected.
A study of 86,564 adults diagnosed with breast cancer in England has found that Black patients and people with a learning disability wait longer at key moments on the path from first symptom to treatment. Led by the University of Surrey and funded by Breast Cancer Now, it is believed to be the first in the UK to measure these delays across the full pathway.
The anonymized records cover diagnoses made between 2009 and 2018, drawn from NHS general practices and linked to the national Cancer Registry. For Black patients, the gap opens at detection: they had 29 per cent lower odds of being found through routine screening and 37 per cent higher odds of arriving through A&E or an emergency route, where cancers tend to be caught later.
For patients with a learning disability, delays appeared after a GP visit. They waited 18 per cent longer for diagnosis, and one in four waited 29 days or more. Both groups also waited longer to start treatment, with Black patients around five days longer on average and people with a learning disability 8 per cent longer.
Patients who belonged to several disadvantaged groups fared worst. Those with severe mental illness living in the most deprived areas were especially likely to be diagnosed in an emergency. Because people with learning disabilities are under-represented in health data, the researchers believe the real gaps may be larger.
Dr Robert Kerrison, a co-author, said each gap costs time, and in cancer, time costs lives. Lead author Tetyana Perchyk said the inequalities add up across the system rather than arising from one cause. The next task, both researchers and Breast Cancer Now agree, is to understand why these gaps exist and to close them.
A study of 86,564 adults diagnosed with breast cancer in England has found that Black patients and people with a learning disability wait longer at key points along the route from first symptom to treatment. Led by the University of Surrey and funded by Breast Cancer Now, it is believed to be the first in the UK to measure these delays across the full breast cancer pathway.
The records are anonymized and cover diagnoses made between 2009 and 2018. They come from NHS general practices that contribute to the Clinical Practice Research Datalink, and were linked to the national Cancer Registry. The findings were published in Breast Cancer Research.
For Black patients, the gap opens at the point of detection. Compared with White patients, they had 29 per cent lower odds of being diagnosed through routine breast screening. They also had 37 per cent higher odds of being diagnosed after arriving in A&E or as an emergency. Cancers found that way tend to be at a later stage, which lowers the chance of survival.
For patients with a learning disability, the delays showed up after a GP visit. On average they waited 18 per cent longer for a diagnosis after presenting with a symptom. One in four waited 29 days or more, which is 10 days longer than the general population.
Once diagnosed, both groups waited longer to begin treatment. Black patients waited around five days longer, on average, than White patients. Patients with a learning disability waited 8 per cent longer than those without.
The researchers saw similar gaps among patients with severe mental illness and those living in the most deprived areas. Patients who belonged to more than one of these groups fared worst. Those with severe mental illness who lived in the most deprived areas, for example, were even more likely to have their cancer diagnosed in an emergency.
About one per cent of UK adults have a learning disability, and the researchers note that this group is under-represented in healthcare data. That means the real gaps in care could be larger than the study captures.
Dr Robert Kerrison, a co-author and Co-Lead for Cancer Care at the University of Surrey, said the system is letting down patients who already face the most barriers, and that each gap costs time, and in cancer, time costs lives. Lead author Tetyana Perchyk said the inequalities do not come from one single cause but add up across the system, and that patients with a learning disability have been largely invisible in UK cancer research until now. She said the next job is to understand why the gaps exist and to close them.
Manveet Basra, associate director of public health, inclusion and awareness at Breast Cancer Now, said the findings show who is less likely to be diagnosed through screening or more likely to face delays, and that knowing the barriers makes it possible to work on removing them. She said the charity is funding research on inequities and working with policymakers on equal access to screening. The study identifies where the gaps are; the work of explaining them is still ahead.
Citazioni salienti
The inequalities we found are not down to one single thing. They add up across the system.— Tetyana Perchyk, lead author, University of Surrey
Each one of these gaps costs time, and in cancer, time costs lives.— Dr Robert Kerrison, University of Surrey
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