Barriers to and enablers of the early diagnosis of breast cancer among women from ethnic minority backgrounds in the UK: protocol for a qualitative evidence synthesis

Introduction: Breast cancer is the most commonly diagnosed cancer in women of all ethnic groups in the UK. The largest single ethnic groups in the UK are white, Indian, Pakistani, Black African and Black Caribbean. Previous studies have shown that women from ethnic minority groups are more likely to be diagnosed with more advanced disease at presentation compared to women from white backgrounds which is associated with poorer outcomes. Understanding the factors that prevent or enable women from ethnic minority backgrounds to have an early diagnosis of breast cancer is essential to inform the development of interventions or policies that seek to promote early diagnosis of breast cancer in these groups. This qualitative evidence synthesis will identify and synthesise what is known about the topic. Methods and analysis: The proposed review will synthesise studies that report on the experiences of women in the UK from the ethnic groups of interest on the early diagnosis of breast cancer. A search strategy was developed by two researchers and an information specialist. The Medline (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), PsycINFO (OvidSP) and Cochrane Library (via Wiley) databases will be searched for published articles. Relevant policy documents and reports will be searched for by browsing cancer37 related organisational websites and using Google Advanced Search, and dissertations and theses using ProQuest. Studies will be included if they utilise qualitative methodologies and are about the early diagnosis of breast cancer in UK women aged 18 years and over from the ethnic minority groups of interest. Studies that utilise quantitative methodologies], or collect data using qualitative methods but analyse quantitatively (e.g. open-ended survey questions where free text responses are analysed using descriptive statistics) will be excluded. To maximise inclusion of suitable studies, the search will not be limited by language and start from database inception. Data will be managed using Covidence, and managed for analysis using NVivo. An assessment of the methodological limitations of each study will be performed using the Critical Skills Appraisal Programme tool, and the PRO EDI framework will be used to assess equality, diversity and inclusion in the synthesis. The data will be analysed thematically based on, but not limited to, the Health Belief Model using a best-fit-framework. The confidence in the final synthesised findings will be assessed using the Grade-CERQual tool. Ethics and dissemination: Ethical approval is not required as this is a systematic review of published or publicly available qualitative findings. Results will be published in a peer-reviewed scientific journal, publicised at relevant conferences and on social media. The results will provide comprehensive information on the barriers to early diagnosis of breast cancer in ethnic minority groups, which will inform breast cancer care policies to improve access and delivery of health services, and influence the design of future interventional and qualitative studies. PROSPERO registration number CRD42024579776