All women aged 50 to 71 who are registered with their GP are invited to get a mammogram as part of routine breast screening every 3 years. But even though anyone can be affected by breast cancer, mammography equipment is not accessible to many people who live with physical disabilities or mobility impairments.
In this section
This must change so that everyone is given the best chance to be diagnosed early via screening, regardless of their disability.
The issue
Standard mammography machines require women to hold themselves still in-position while an x-ray is taken. This allows a clear picture to be taken, which can then be used to look for signs of early breast cancer.
Screening units are expected to find and offer support to women with physical disabilities to make their services accessible, like ensuring step-free access or offering longer appointments. However, there are no specific standards or requirements for equipment or support that screening units must have to improve the accessibility and adaptability of screening equipment.
Because the UK National Screening Committee (UK NSC), who are responsible for making recommendations on screening, do not specifically recommend a different type of imaging (for example an MRI scan) when mammography isn’t possible, screening services do not offer any alternative to disabled women.
The impact
Women who are unable to complete screening at their appointment are given information about the signs and symptoms of breast cancer, encouraging them to be breast aware and contact a GP as soon as possible with any concerns.
While regular breast checking is an important way to help find breast cancer early, screening mammograms can find breast cancers before symptoms even have the chance to develop. This is why breast screening is the most effective way to find cancers at an early stage, with over 90% of screen-detected breast cancer being found at stage 1 or 2, when survival is close to 100%. That means the current system does not give women with disabilities who are unable to have a mammogram an equal opportunity to have their breast cancer diagnosed early.
Inaccessible screening equipment and barriers to screening access also have an impact on women’s wider wellbeing. As an organisation we’ve heard from women with disabilities who’ve had bad experiences trying to access mammography, with the process causing significant discomfort, pain, and emotional distress. Even some of those women who were able to eventually get success fully screened said the experience put them off attending again.
The evidence
Data on breast screening attendance is not broken down by disability, which means we don’t know the full scale of women missing out on screening because of inaccessible services and equipment.
However, previous research found that in England women with disabilities were 36% less likely to attend breast screening, and those with multiple conditions were even less likely to participate. Looking at UK-wide data, women with mobility impairments had significantly lower odds of having a mammogram taken than women without mobility problems. Women with mobility problems living in the most deprived areas were the least likely to have had a mammogram.
NHS England data on the number of women who attend but are unable to complete screening suggests that over 5,000 women in England in a year were recorded as having partial or incomplete mammography.
Over 50% of these cases were due to women having restricted mobility or being unable to attain and/or maintain a position, or due to restricted positioning because of using a wheelchair. So, for over half of the cases where screening was not fully completed, it was due to screening equipment being unable to adapt to women’s disabilities.
It’s also likely that these numbers underestimate the scale of the issue, as some disabled women won’t go to their appointment if they think they can’t undergo screening or have been put off by previous bad experiences.
What are we calling for?
NHS England are currently developing a new 10 year cancer plan, which we expect to be published in the coming weeks. One of the priorities we’ve called for in the plan is a focus on making breast screening services more accessible and flexible, including by:
- Including information from people’s health records, including reasonable adjustments automatically into breast screening databases so screening units are prepared to meet people’s needs
- Establishing a process of asking for and noting support needs, reasonable adjustments, or any information people want staff to be aware of ahead of their appointment, so they can get screened and have a positive experience
- Having a clear set of requirements for assistive equipment and adjustments that must be offered by services to make mammography more accessible and comfortable for women with disabilities
- Committing to work with clinical experts to determine what imaging can be offered as a safe and effective alternative to mammography, so all women can get screened and have an equal opportunity to be diagnosed early.
What else is Breast Cancer Now doing?
We’re funding research that’s looking to develop robotic assistive technology to support women with disabilities during the mammography process, so they can undergo screening and make the process more comfortable for them.
Share your experience
We’re keen to hear from women with disabilities or impairments about their experience in accessing routine mammography through the breast screening programme, so we can continue making the case for why change is needed.
If you’d like to share your story, please get in touch:
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