Nationwide Study Finds Breast Cancer Diagnosis and Treatment Delays for Black Patients and People with Learning Disabilities

Black patients and people with a learning disability in England face longer waits at critical points along the breast cancer care pathway, according to a nationwide study led by the University of Surrey and published in Breast Cancer Research. Analysing anonymised health records from 86,564 adults diagnosed with breast cancer in England between 2009 and 2018, the research team is believed to be the first in the UK to measure these delays across the full patient journey, from the route by which a cancer is first detected through to the start of treatment. The records came from NHS general practices contributing to the Clinical Practice Research Datalink, linked to the national Cancer Registry.

The route to diagnosis emerged as one of the starkest contrasts. Black patients had 29 per cent lower odds of being diagnosed through routine breast screening than White patients, and 37 per cent higher odds of being diagnosed after arriving in A&E or as an emergency. This distinction matters clinically because cancers found in emergencies tend to be at a later stage, which lowers the chance of survival.

Patients with a learning disability faced a different but equally consequential pattern of delay. After presenting to their GP with a symptom, this group waited 18 per cent longer, on average, for a breast cancer diagnosis than the general population. One in four waited 29 days or more for a diagnosis, 10 days longer than the general population. Because the clock starts at the first symptomatic presentation, the finding points to delays accumulating after a patient has already entered the system.

Waiting times did not end at diagnosis. Once breast cancer was confirmed, both Black patients and people with a learning disability waited longer to begin treatment. Black patients waited around five days longer on average than White patients, while patients with a learning disability waited 8 per cent longer than those without a learning disability. The researchers emphasise that these gaps compound across the pathway: a later route to diagnosis, a longer diagnostic wait and a slower start to treatment stack together for the same patients.

The study also examined groups beyond ethnicity and learning disability. Patients with severe mental illness and those living in the most deprived areas of England faced similar gaps in care. Crucially, patients belonging to more than one of these groups fared worst of all. Patients with severe mental illness who also lived in the most deprived areas, for example, were more likely to have their breast cancer diagnosed in an emergency. This pattern of compounded disadvantage suggests the inequalities are not attributable to any single mechanism but accumulate across multiple, overlapping barriers within the health system.

Tetyana Perchyk, lead author of the study from the University of Surrey, said the inequalities could not be explained by one single factor. “They add up across the system, and they add up most for the women who already face the most barriers,” she said, noting that patients with a learning disability had been largely invisible in UK cancer research until now. “Our work shows where the gaps are. The next job is to understand why, and to close them.”

Dr Robert Kerrison, co-author of the study and Co-Lead for Cancer Care at the University of Surrey, framed the findings in terms of the clinical stakes of delay. “Early detection and treatment of breast cancer are crucial for survival, and our study shows that the country currently has a system that is letting down the patients who already face the most barriers,” he said. “Fewer Black women are being picked up through screening, more are being diagnosed in A&E, and patients with a learning disability are waiting longer at every stage. Each one of these gaps costs time, and in cancer, time costs lives.”

The researchers also flag an important limitation that may make their estimates conservative. Around one per cent of UK adults have a learning disability, and this group is known to be under-represented in healthcare data. If patients with learning disabilities are missing from the linked records used in the study, the true scale of the delays they experience could be larger than the analysis captures.

The study was funded by Breast Cancer Now, whose associate director of public health, inclusion and awareness, Manveet Basra, said people from marginalised groups, including certain ethnic communities, face inequalities at every stage of their breast cancer experience, with tragic impacts on their survival rates. She said the research helps identify who is less likely to be diagnosed via screening and who might wait longer for diagnosis or treatment, and that understanding these barriers enables work towards eliminating them, including through collaboration with policymakers on equal access to screening and support services that reflect the diverse needs of everyone affected by the disease.

As the first UK study of its kind to trace these inequalities across the entire breast cancer journey, the research provides health services with a quantified map of where the system loses time for the patients who already face the most barriers, with the stated next step being to understand the causes of each gap and to close them.

Subject of Research: Inequalities in breast cancer diagnosis routes, diagnostic waiting times and treatment delays among Black patients and people with learning disabilities in England

Article Title: Breast cancer care falls short for Black patients and people with a learning disability, warns first-UK study of its kind

Article References: Breast cancer care falls short for Black patients and people with a learning disability, warns first-UK study of its kind. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

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Keywords: breast cancer, health inequalities, learning disability, diagnosis delays, cancer screening, emergency diagnosis, NHS, treatment waiting times, severe mental illness, deprivation, England, population-based study