OBJECTIVES: Reducing health inequalities is a policy priority for the National Health Service (NHS) in England. Breast cancer is the most common cancer in women in the UK; despite premature mortality rates declining, inequalities in care remain. The aim of this study was to model the potential impact of levelling up inequalities in the breast cancer care pathway for women in England.

METHODS: A targeted literature review and analysis of publicly available NHS data sources (2016-2022) were used to describe variation in the breast cancer pathway for women in England by socioeconomic deprivation, geography, and ethnicity. The potential additional life years (PALYs) saved if variations in stage at diagnosis were addressed was modelled using a parametric survival model to extrapolate NHS 5-year survival data.

RESULTS: Women living in the most deprived communities, and black women, experience significant inequalities across the pathway. Diagnosis via screening across socioeconomic groups and ethnicity was lowest for black women (23%) and women living in the most deprived communities (29%) compared to white women (34%) and women in the least deprived communities (36%). 22% of black women were diagnosed with late-stage cancer compared to 14% of white women. Women in more deprived communities had the highest incidence of late-stage cancer compared to women in less deprived communities. Levelling up inequalities in stage at diagnosis could result in black women in England gaining 6 additional months of life, and women in the most socioeconomically deprived communities gaining an increase of 3 months.

CONCLUSIONS: Addressing inequalities in the diagnosis and treatment pathway could improve survival outcomes for women with breast cancer in England. There are opportunities for health systems and stakeholders to work collaboratively to uncover the root causes of breast cancer inequalities to identify solutions to tackle these.