Black African and Black Caribbean women in the UK want clearer and more accessible information about breast cancer screening, according to a study from the University of Surrey.
Surrey researchers sought to understand why Black women are less likely to attend breast cancer screening than their white female counterparts. Focus groups and interviews were conducted with 47 Black African and Caribbean women aged between 50–71, the age group routinely invited for NHS breast screening, to learn why only 45 percent of Black women take part in screening compared to 63 percent of white women.
Lead author of the paper Anietie Aliu, a Postgraduate Researcher at the University of Surrey and a Registered Nurse, said:
"Diagnosing breast cancer early can dramatically improve a person's chance of survival. Breast cancer screening plays an important role in this by identifying the cancer and ensuring a person receives speedy treatment.
"Despite the importance of screening, Black women are less likely to attend appointments than white females. This puts them at risk of a potential cancer being diagnosed late and spreading to other areas of the body. We need to understand what is preventing Black women from attending these appointments and help identify ways to remove such barriers."
The study found a need to increase awareness of breast cancer screening, especially for women who are less familiar with this service. Some women, particularly those born outside the UK, had limited knowledge of breast screening before receiving their first invitation. Others questioned why screening was needed when they had no symptoms.
The importance of trusted conversations amongst this group was also identified.
Researchers found that some Black women expected their GPs to talk to them about breast screening, particularly before they reached screening age. Although breast screening is organised through national screening services, researchers note that GPs often have established relationships with patients and may be better placed to provide brief, opportunistic advice about preventive care, including breast screening information to women.
To improve knowledge and attendance at screening appointments, participants suggested stronger links between GP practices, breast screening services and Black community champions, so women can receive trusted information, ask questions and feel reassured.
Researchers also found that faith and religious beliefs influenced the decision-making of some of the women. For instance, some Black African Christians maintained that illness, including cancer, was not permitted by God in their bodies, whilst, in contrast, others saw screening as a personal choice that does not conflict with Christian faith.
Women from the Muslim faith noted the importance of indicating their religion in the medical appointment form to guarantee a female mammographer highlighting that religious beliefs can play a role in a woman's decision to attend screening.
Anietie Aliu added:
"Breast screening can save lives, but our findings show that attendance is shaped by multiple factors, not just awareness, although awareness remains important. Women need relatable screening information, reassurance, flexible appointments and services that are accessible within their communities. Many felt that invitation letters were too formal, and that leaflets and media imagery did not reflect them, making it harder to relate to screening."
Dr Afrodita Marcu, a Senior Research fellow at the University of Surrey and member of the research team added:
"We need a more collaborative approach, where primary care, screening services and community voices work together to support women before, during and after the invitation."
Researchers note that future interventions for breast cancer screening need to be designed with Black women, rather than for them. They emphasise that user-friendly, culturally relevant resources developed in partnership with communities, healthcare professionals and screening services could help improve understanding, reduce fear and make breast screening feel more accessible and reassuring.
Dr Robert Kerrison, Associate Professor of Cancer Care at the University of Surrey, also part of the research team, said:
"There is no question that breast screening can be lifesaving, but we need to make it easier for women to understand, access and feel reassured by the programme. This means improving communication, addressing practical barriers and making sure healthcare professionals and community partners are supported to provide clear and trusted information."
Building on these findings, the research team has also explored healthcare professionals' perspectives and worked with stakeholders to develop user-friendly intervention materials with Black women. Researchers believe this kind of co-designed approach is important because it ensures that breast screening messages are culturally relevant, practical and shaped by the people they are intended to support.
This study was published in the British Journal of Cancer
