Health Inequalities in Breast Cancer in England: A Pragmatic Review to Inform National Institute for Care and Excellence (NICE) Recommendations.

Health inequalities refer to systematic, unfair and avoidable differences in health across the population and between different groups in society. We reviewed health inequalities related to breast cancer to inform National Institute for Health and Care Excellence (NICE) recommendations. This was a pragmatic, targeted review to identify examples of health inequalities related to breast cancer in England. The search focused on national cancer registries, screening programme datasets, patient experience surveys and reports from key organisations. The results were synthesised using 5 domains of interest, covering health status, risk factors, wider determinants, access to and quality and experience of care. These domains were subdivided across 4 dimensions of health inequalities, including deprivation, geography, protected characteristics, and inclusion health groups. It was found that although breast cancer is less common in more deprived groups, these groups have worse health outcomes and higher mortality rates compared to less deprived groups. Many disadvantaged groups are less likely to participate in breast cancer screening, leading to delayed diagnosis and more advanced cancers. Behavioural risk factors such as obesity, physical inactivity and alcohol consumption vary across groups and impact breast cancer risks and outcomes. While people from ethnic minority groups have lower breast cancer incidence, evidence suggests that the incidence of breast cancer in some groups is increasing. Ethnic minority groups are also often diagnosed at advanced stages due to presenting through non-screening routes. Low health literacy is an issue for many disadvantaged groups. This review demonstrates that late diagnosis and low screening uptake significantly contribute to health inequalities among different groups, including deprived and ethnic minority groups. There are many gaps in the evidence, and this review further highlights potential research areas for the broader health and care system from the perspective of health inequalities.