{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:54:44Z","timestamp":1781718884199,"version":"3.54.5"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"1183","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Breast cancer is the most prevalent cancer among UK women. Screening aims to detect cancer early, improving treatment options, and survival. However, participation varies across England with lower participation and cancer detection rates in London than other regions. We postulate that demographic factors (age, ethnicity, deprivation, and migration) might explain some regional differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An ecological analysis of aggregated data compared English regions (April 2007-March 2020). Primary outcomes were breast cancer mortality, coverage rate, and rate of screen-detected invasive cancers. Linear regression analyses compared outcomes between London and other English regions, adjusting for age, ethnicity, deprivation, and migration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data included 104 observations aggregated from 26 202 645 screenings, of which 11.9% were in London. Coverage was lower in London (67.8%) than other English regions (73.6%-79.8%). London had significantly lower rates of screen-detected invasive cancers (mean=\u20096.2 per 1000, SD\u2009=\u20090.2) compared to 6 of 7 regions (ranging from 6.3 to 6.9 per 1000) and lower breast cancer mortality rate (mean\u2009=\u200931.7, SD\u2009=\u20090.8) than 4 regions (ranging from 33.4 to 36.1). Differences in coverage were attenuated and non-significant after adjustment for demographic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Regional differences in screening participation are associated with demographic factors, but breast cancer outcomes in London are not worse than the rest of England. Targeted interventions to improve screening accessibility for underserved communities could reduce inequalities. We describe challenges associated with combining several sources of information when performing our analyses and further research using individual-level data is recommended to confirm results and explore additional predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>This national ecological analysis demonstrates that lower breast screening coverage and invasive cancer detection rates in London are associated with demographic factors, particularly ethnicity, deprivation, and migration. Despite poorer participation, breast cancer mortality in London is not worse than in other English regions. The findings emphasize the importance of demographic factors in breast screening outcomes and improved data linkage to address regional inequalities in breast cancer screening and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqag030","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:20:27Z","timestamp":1771438827000},"page":"1331-1337","source":"Crossref","is-referenced-by-count":0,"title":["Demographic factors associated with differential uptake and outcomes of breast cancer screening in English regions: 2007-2020"],"prefix":"10.1093","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3573-2426","authenticated-orcid":false,"given":"Clare","family":"Oliver-Williams","sequence":"first","affiliation":[{"name":"East of England Public Health Specialty Training Programme, Cambridge, CB21 5BQ,","place":["United Kingdom"]},{"name":"West Northamptonshire Council Public Health, , Northampton, NN1 1ED,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer","family":"Choglay","sequence":"additional","affiliation":[{"name":"NHS England , London, SE1 8UG,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahjalal","family":"Ahmed","sequence":"additional","affiliation":[{"name":"NHS England , London, SE1 8UG,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Hudson","sequence":"additional","affiliation":[{"name":"Independent Research Consultant ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust Churchill Hospital, , Oxford, OX3 7LE,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khadidja","family":"Bichbiche","sequence":"additional","affiliation":[{"name":"NHS England , London, SE1 8UG,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"2026061713105581600_tqag030-B1","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1016\/S0140-6736(12)61611-0","article-title":"The benefits and harms of breast cancer screening: an independent review","volume":"380","author":"Marmot","year":"2012","journal-title":"Lancet"},{"key":"2026061713105581600_tqag030-B2","author":"Cancer Research UK","year":"2023"},{"key":"2026061713105581600_tqag030-B3","author":"National Cancer Registration and Analysis Service","year":"2011"},{"key":"2026061713105581600_tqag030-B4","year":"2024"},{"key":"2026061713105581600_tqag030-B5","author":"Breast Screening Programme, England 2019-20","year":"2024"},{"key":"2026061713105581600_tqag030-B6","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13174287","article-title":"Breast cancer\u2014epidemiology, risk factors, classification, prognostic markers, and current treatment strategies\u2014an updated review","volume":"13","author":"\u0141ukasiewicz","year":"2021","journal-title":"Cancers (Basel)"},{"key":"2026061713105581600_tqag030-B7","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.canep.2019.03.008","article-title":"The breast cancer paradox: a systematic review of the association between area-level deprivation and breast cancer screening uptake in Europe","volume":"60","author":"Smith","year":"2019","journal-title":"Cancer Epidemiol"},{"key":"2026061713105581600_tqag030-B8","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1186\/1471-2458-8-346","article-title":"Breast and bowel cancer screening uptake patterns over 15 years for UK South Asian ethnic minority populations, corrected for differences in socio-demographic characteristics","volume":"8","author":"Szczepura","year":"2008","journal-title":"BMC Public Health"},{"key":"2026061713105581600_tqag030-B9","doi-asserted-by":"publisher","DOI":"10.1186\/bcr3786","article-title":"Impact of index of multiple deprivation and ethnicity on breast screening uptake in the North West of England","volume":"17","author":"Bhola","year":"2015","journal-title":"Breast Cancer Res"},{"key":"2026061713105581600_tqag030-B10","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1136\/jech.200X.038398","article-title":"Socioeconomic deprivation, travel distance, location of service, and uptake of breast cancer screening in North Derbyshire, UK","volume":"60","author":"Maheswaran","year":"2006","journal-title":"J Epidemiol Community Health"},{"key":"2026061713105581600_tqag030-B11","author":"NHS England","year":"2024"},{"key":"2026061713105581600_tqag030-B12","author":"NHS England Digital","year":"2022"},{"key":"2026061713105581600_tqag030-B13","author":"Association of Breast Surgery","year":"2024"},{"key":"2026061713105581600_tqag030-B14","author":"Department of Health and Social Care. 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