Barriers to accessing breast and cervical cancer screening

Healthwatch Enfield wanted to look at the barriers for women attending cancer screening appointments.  They undertook a survey and focus groups.  They spoke to 184 people.

Key Insights from the survey on Cervical Cancer Screening Participation

• Over half of women were unaware they could bring a companion or request an NHS chaperone during screening.
• Nearly half (49%) expressed interest in an at-home self-test, although some had concerns about performing it incorrectly.

Non-Attendees (Last 5 Years)

•  20% had not attended screening.
• Past trauma was cited as the most common reason for non-attendance (39%), followed by embarrassment, anxiety, discomfort, negative past experiences, and childcare issues. Work-related scheduling conflicts were also noted.
• More than half (55%) supported home testing as a way to improve attendance. Convenient appointment times—particularly out-of-hours availability—were also suggested.
• The demographic with the lowest uptake of cervical screening was Asian/Asian British with 70% of respondents having been screened in the past 5 years, 10% below the survey average.

Attendees (Last 5 Years)

• 80% of eligible respondents had attended screening.
• The main reason for attendance was personal knowledge of the procedure’s importance (67%), followed by reminder letters/SMS notifications (59%). Public health campaigns had a limited impact, with only 8% citing them as encouragement.

The findings suggest that improving booking flexibility and ensuring staff training can enhance the overall screening experience.

Key insights from the survey Breast Cancer Screening Findings

• Mixed Experiences: Responses varied, indicating differences in care and accessibility.
• Invitation Issues: Nearly 19% of eligible women had not been invited for screening. Some linked this to the Covid-19 pandemic, a trend supported by NHS data showing screening coverage has not yet returned to pre-pandemic levels.
• Reasons for Non-Attendance: Among those invited but who did not attend, the most common response was ‘other’, with some citing physical disabilities, travel difficulties, or past trauma.

Motivations for Attendance: Personal knowledge of the procedure’s importance was the main reason people attended screening, with GP reminders also playing a significant role.

Focus Group Insights on Cancer Screening Experiences

To supplement the survey, focus groups were conducted to gain deeper insights from underserved communities.

Key Findings Across Groups

1. Lack of Awareness of Reasonable Adjustments: Many participants were unaware of adjustments they could request, such as longer appointments or support during screening.
2. Challenges with Appointment Letters: Complex language in screening invitations led to confusion. Some groups preferred easy-read formats, simpler wording, and image-based guidance.
3. Access & Cultural Barriers: Some communities, particularly Somali women, expressed mistrust of the NHS, preferred natural remedies, and noted a lack of diversity in NHS messaging and outreach.
4. Screening Concerns:
   • Older women questioned why cervical screening stops at age 64 and wanted continued access.
   • Disabled women faced difficulties with screening equipment and needed more compassionate care.
   • Some women preferred female doctors, but others felt this alone was insufficient for comfort.
5. Appointment & Accessibility Issues:
   • Booking difficulties and digital systems were seen as inconvenient by some.
   • Out-of-hours screening was widely requested to improve accessibility.
6. Experiences Varied: Some participants had positive screening experiences, often linked to long-standing relationships with nurses, while others felt rushed and unheard.