Breast cancer is the most common cancer diagnosed in women worldwide, causing over 2.3 million new cases and 670,000 deaths every year. In the UK alone, nearly 57,000 people are diagnosed each year, making it the most common cancer across England, Scotland, Wales and Northern Ireland.

Catching breast cancer early makes an enormous difference. If it’s caught at the earliest stage, more than 99% of patients survive at least five years. But if it’s not caught until the cancer has spread significantly, that survival rate drops to just 25%. This is why regular screening matters so much — it’s the best way to catch cancer before it progresses.

The British Journal of Cancer undertook a study which explored Black women’s decision about participating in breast cancer screening. In the UK, the NHS offers free breast screening (a mammogram) to all women aged 50 to 71, every three years. But not everyone takes up this offer equally. Women in poorer areas, women with serious mental health conditions, and women from ethnic minority backgrounds are all less likely to get screened.

Black women — those of Black African or Black Caribbean heritage — have the lowest screening rates of any ethnic group in the UK, a pattern also seen among Black women in the US. One study found that between 2016 and 2020, only 45% of Black women attended screening, compared to 63% of White women.

This gap has real consequences. Black women are far more likely to be diagnosed at a later, more dangerous stage of cancer — 25% of Black African women and 22% of Black Caribbean women are diagnosed at an advanced stage (III or IV), compared to just 13% of White women.

Until now, we’ve known relatively little about why this gap exists. Most previous research only spoke to Black women who already attend screening, missing the perspective of those who don’t. Earlier studies also tended to treat “Black women” as one single group, without considering how factors like religion, whether someone was born in the UK or abroad, or being Black African versus Black Caribbean might shape different experiences and attitudes.

What this new study did

To fill these gaps, researchers held seven group discussions with 47 women who were eligible for screening. Thirty of them attended screening regularly, while 17 had never gone or attended only occasionally. This let researchers compare the views of both groups, and explore how background and beliefs might play a role.

What they found

The conversations revealed six main reasons behind women’s decisions about screening:

Not knowing enough about it — gaps in awareness and understanding of what screening involves and why it matters.
Feelings and motivation — emotional reactions, fears, and what motivates (or discourages) someone to go.
Influence from other people — the role of family, friends, and community in shaping decisions.
Other priorities getting in the way — competing demands on time, energy and attention.
Barriers within the healthcare system — practical difficulties accessing or attending appointments.
Suggestions for improvement — ideas participants had for making screening services work better for them.

What this means going forward

The researchers used a well-established framework for understanding behaviour change to turn these findings into practical ideas. Their conclusion: screening programmes are more likely to succeed if they’re designed with Black communities, not just for them — using approaches that reflect their culture, values, and everyday realities, rather than one-size-fits-all messaging.

This is an edited version of a clinical study in the British Journal of Cancer. Click here to access the full article.