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Barriers to seeking treatment for breast cancer

In a study published in British Journal of Cancer this week, 37% of women said they might not visit their GP with a potentially serious symptom because they would be worried about wasting the doctor's time. 47% of women said that fear of what the doctor might find could stop them going, 38% cited embarrassment and 29% lack of confidence in talking about their symptoms. In addition, South Asian and black women were significantly less likely than white women to regularly check their breasts or recognise non-lump symptoms of breast cancer.

45,000 women are diagnosed with breast cancer every year. The majority are diagnosed in good time, however, around 20-30% of women with symptoms of breast cancer wait three months or more before consulting their GP. The researchers from King's College London's Institute of Psychiatry (IoP) surveyed 1,515 women in East London, where women tend to have more advanced breast cancer and worse survival and than in other parts of England.

Dr Lindsay Forbes, lead author of the study at the IoP at King's says: ‘We were surprised at how common some of the reported barriers to going to the GP were, especially worry about wasting the doctor's time. It's important that women (especially women over 50) go to their doctor promptly - preferably within a week, if they discover any change in their breasts. We found that South Asian women had lower awareness of breast cancer than white women and reported many barriers to going to the doctor with a symptom that might be serious. Women from black ethnic groups had less knowledge of breast cancer symptoms than white women but reported similar levels of barriers to going to the doctor to white women.  Effective interventions to target this group of women must encourage and enable them to conquer these barriers.’

South Asian women (mainly Indian, Pakistani or Bangladeshi origin), were more likely than white or black women to report being too embarrassed to go see the doctor with symptoms (61% compared with 31% and 30% respectively). South Asian women were also much more likely (55%) than white or black women to report they lacked the confidence to talk about their symptoms (55% compared with 19% or 24% respectively). White women were more likely than black or South Asian women to report being worried about wasting the doctor’s time.

Professor Amanda Ramirez from the IoP at King's, who co-authored the paper, says: ‘Understanding healthy women’s awareness of breast cancer and barriers to symptomatic presentation is important in order to design effective interventions to promote early presentation. There is a national policy drive in the UK to get people to present more promptly with symptoms that might be cancer – especially people over 50 (the National Awareness and Early Diagnosis Initiative). A number of interventions are being implemented across England to promote early diagnosis – from one-to-one sessions to national media campaigns. These aren’t going to work for people belonging to minority ethnic groups unless they address their different information needs and barriers to presentation.

‘The information gathered from our research will help us design interventions to promote early presentation of breast cancer for women from non-white groups. For example, ensuring that interventions for South Asian women aim to mitigate the effects of embarrassment and worry about what the doctor might find, and boost their confidence to talk about symptoms.'

The study was funded by the Department of Health. 

Dr Forbes, Professor Ramirez and colleagues at King’s College London have recently been awarded a research grant by the National Awareness and Early Diagnosis Initiative (led by Professor Emma Ream of the Florence Nightingale School of Nursing and Midwifery) to undertake research into late presentation and diagnosis of breast cancer in black women in the UK. Dr Forbes and Professor Ramirez are part of the Department of Health Policy Research Unit on Cancer Awareness, Screening and Early Diagnosis. 

For full paper: Forbes et al. ‘Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London’, British Journal of Cancer (Oct 2011) doi: 10.1038/bjc.2011.406

For more information, please contact Seil Collins, Press Officer, Institute of Psychiatry at King's email: or tel: 0207 848 5377

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