Ecological analysis of breast screening uptake and coverage in East London

Objective

To provide descriptive analysis of observational data on breast screening uptake and coverage in North East London with a focus on health inequalities.

Setting

Areas in North East London with amongst the lowest breast screening uptake, coverage and breast cancer survival in England.

Methods

We investigated screening uptake and coverage for 163 general practices (GPs) served by the NHS Central & East London Breast Screening Service retrieved from Public Health England's Fingertips resource. The 10 highest and 10 lowest GPs by uptake and by coverage were identified. We summarised pre-treatment T-stage (tumour size) over time and by age group.

Results

Overall, uptake and coverage were lowest in City & Hackney, Newham and Tower Hamlets, with uptake of 7–26%, 13–26% and 24–28% respectively. GPs with the highest uptake and coverage rates tended to be in Waltham Forest (uptake 56–65%). The maximum uptake observed in 2022 was 72%, above the national uptake target of 70%, for one practice.

For women receiving a breast cancer diagnosis, the proportion of larger-sized tumours seemed to increase during the 2020–2021 Covid-19 pandemic period (implying later diagnoses), eventually returning to pre-pandemic levels. Smaller tumours were identified at the screening ages 50–70 (<20% T3/T4, implying earlier diagnoses) compared to younger (∼25% T3/T4) and older (∼30% T3/T4) women.

Conclusions

Breast screening uptake varied between areas and GPs. City & Hackney, Tower Hamlets and Newham were identified as areas with low screening uptake and coverage.