Assessing ethnic inequalities in diagnostic intervals of breast cancer among patients presenting symptoms to general practitioners in England

This retrospective-cohort study examined ethnic differences in breast cancer diagnostic intervals among women aged aged ≥40 years who were diagnosed in England between 2017 and 2021. We analysed primary care-linked hospital data, with diagnostic interval divided into primary care interval (period between first presentation and referral), referral interval (period between referral and first specialist appointment), and secondary care interval (period between first specialist appointment and diagnosis). Across the cohort, the median diagnostic interval was 24 days and was longer for women presenting with non-lump symptoms than for those with a breast lump (ATR = 1.56, 95%CI: 1.31-1.86). Black patients had longer diagnostic interval than White patients regardless of symptom type: [ATR = 1.38, 95%CI:1.11-1.71]. The median primary care interval was 1 day. It was longer for women with non-lump symptoms than those with a breast lump [ATR = 1.49, 95%CI:1.16-1.92], but shorter for Asian patients, especially those with a breast lump, compared to White patients [ATR = 0.89, 95%CI: 0.84-0.96]. The median referral interval was 11 days, with no evidence of variation by symptom type or ethnicity. The secondary care interval was also 11 days and was longer for patients with non-lump symptoms [ATR = 1.41, 95%CI:1.14-1.74] and for Black patients, particularly those with a breast lump, compared to White patients [ATR = 1.66, 95%CI:1.21-2.28]. Our findings highlight the need for targeted interventions to address ethnic disparities in breast cancer outcomes, including both lump and non-lump symptom presentations. Such interventions should prioritise optimising the entire diagnostic pathway-from initial presentation through to diagnosis-rather than concentrating solely on primary care, ensuring timely and equitable access across all healthcare settings.