Policy paper

Tackling the uptake challenge: a review of progress and next steps

Published 19 February 2026

Applies to England

Foreword

Giving more women time with their loved ones is an ambition we can all get behind.

Around one in seven women are diagnosed with breast cancer during their lifetime, but we know that, when diagnosed at an early stage, 98% of women survive their breast cancer for five years or more. 

The NHS screens more than 2 million women for breast cancer each year, preventing an estimated 1,300 deaths. In 2024/25 NHS breast screening services detected cancers in 19,291 women across England, which otherwise may not have been diagnosed or treated until a later stage. This is why we do what we do. We are passionate about delivering a service that gives women the best chance of beating cancer. Yet, despite more people coming forward, more than one-third of women are still not attending.  

We’ve worked hard to understand the reasons why and tackle them head-on.

Last year we delivered the first ever national breast screening awareness campaign, which put screening front-of-mind for millions more women. We’ve worked tirelessly behind the scenes, investing in staff training for those who deliver the service every day, and reviewing and adapting our policies and guidance to help providers offer the best service possible. But we know there’s more to do.  

Local knowledge and expertise is crucial to improving uptake and reducing health inequalities – local services know their communities best and it’s important that they continue to lead the charge in their own areas. Today we’ve published a review of actions we’ve taken at a national level so far, as well as setting out where our focus will be going forward, to support local services to drive uptake even further.

Next steps include redeveloping the technical infrastructure that supports the breast screening programme. This unlocks benefits such as reducing the amount of paper used in breast screening, access to data when you move areas in England and allowing women to receive their breast screening appointments digitally via the NHS app.

We’ll also be harnessing the power of AI in breast imaging, with the introduction of a new research screening platform to support the clinical trials of image reading AI in screening. It’ll enable clinical trials in any site across England to be approved in weeks rather than months, boosting the speed at which we can rollout trials of this new tech.  

We’re committed to doing more to learn from the best and reach into the beating heart of those communities where we know uptake is lowest. There’s great work going on already across the country, such as in Manchester where the team is taking an innovative approach to engaging with women with learning disabilities. They offer appointments for women to go and look around the screening facilities with a carer, with no time pressure or obligation, and adjustments made like turning lights down or playing the music they like to support them if they decide to have their mammogram. Or in Bedfordshire where they have shown the power of a simple phone call to those who are overdue their screening - with more than half of those contacted going on to make an appointment.

Commissioners, providers, and key charity sector partners all have a role to play here, and I’m confident that together we can get more women through our doors, and more cancers diagnosed at the earliest possible stage. Giving more mothers, grandmothers, daughters, sisters, friends time back with their families and loved ones is an ambition I think we can all get behind.

Michelle Kane

Director of Vaccination and Screening Delivery and Transformation, NHS England.

Background 

The NHS Breast Screening Programme (NHSBSP) aims to diagnose breast cancer at an early stage when treatment is more successful, leading to earlier detection, appropriate referral, and improved health outcomes. 

In England, women from the age of 50 up to their 71st birthday, are invited for breast screening every 3 years as part of the NHS routine programme, with the first invitation offered between their 50th and 53rd birthday. Women aged 71 or over can also self-refer for screening. Women identified as being at a very high risk of breast cancer are invited annually as part of the NHS Targeted Very High Risk (VHR) breast screening pathway.

The current picture 

Breast screening services were severely affected by the COVID-19 pandemic, with most services pausing screening activity for three months, and restarting with capacity constraints, infection control measures and required lockdowns and isolation rules all leading to a backlog of invitations. This had a negative impact on uptake figures but because of the hard work and commitment across all service providers, this backlog was cleared by summer 2023.  

Not only has the backlog been cleared, but uptake has begun to improve.  

The latest NHS England data for 2024/2025, published in February 2025, showed that: 

• Uptake of invitations by women aged 50-<71 increased to 70.6%, up from 70.0% in 2023/24, continuing to meet the acceptable threshold of 70%

• Uptake increased in all regions ranging from 63.4% (London) to 73.3% (South East). The number of first invitations for women aged 50-<71 increased by 6.9% from 2023/24, the majority of first invitations were in the 50-52 years age group, up by 7.4%. 

• 1.94 million women who received an invitation were screened by the Programme (excludes short term recalls or self-referrals), up from 1.75 million in 2023/24. 

Self-referrals:  

• 175,351 women self-referred for screening, an increase from 169,119 in 2023/24. 63.6% of self-referrals are women aged 71 years or over. The remainder are women who would have been invited aged 50-<71 years, but may not have accepted at that time and then contacted the service later. 

• Women who self-refer are recorded in total screening activity but are not included in invitation and uptake statistics due to their own request for screening. Consequently, the number of self-referrals in women aged 50<71 has a small negative impact on the rate of screening uptake nationally. If these women were included in reported rates, the overall 50-<71 uptake rate of the Programme for 2024/25 would be expected to increase by up to 2.3 percentage points with 63,656 more women included. 

Inequalities and barriers

Studies have shown growing disparities in uptake between different socio-economic groups and between deprivation quintiles, which are continuing to widen​. There is currently limited data to quantify other possible contributing factors linked to health inequalities, such as ethnicity and language. 

National insight work has highlighted that the most common barriers to people coming forward include: difficulty accessing services; competing priorities in their life; logistical difficulties such as transport and childcare; cultural or language barriers; embarrassment and fear of pain.

Our aim is to address these barriers for all women, with a particular focus on less well-served communities.

National actions to improve uptake, and next steps

Over the last couple of years, since the COVID-19 backlog was cleared, we have focused efforts to improve uptake across four national priority areas:

1. Expanding access
2. Reducing inequalities
3. Learning and support
4. Data

Here we look back over what has been delivered so far and set out next steps for further improvement.

1. Expanding Access

Digital Innovation  

Modernising and making the programme more flexible and responsive to people’s needs will be key to providing accessible and efficient screening to everyone eligible. The delivery of the NHS Digital Screening programme to modernise systems will facilitate this.  

The NHS has begun to test new digital-first communications using the NHS App and text message to invite eligible people to breast screening. Testing was carried out in three areas in January 2025 (Dorset, South West London and Milton Keynes) and will be rolled out as part of a wider breast screening digital transformation.

The move to digital-first communications follows the NHS Cervical Screening Programme which successfully rolled out digital communications earlier in 2025, where they are seeing 9 out of 10 invitations being delivered digitally.

People who don’t use the NHS App or get text messages will still get paper letters:

• Your breast screening invitation will first be sent as a message in the NHS App.
• If you have the NHS App, but don’t have notifications on, you might get a text message to tell you that you have a message in the app.
• If you don’t read the message in the NHS App in 24 hours or do not have the NHS App, you’ll get a text message.
• If you don’t get the text message, you’ll get a paper letter.

Currently, the NHS sends over 25 million letters annually by post, costing £14.7 million. Using the NHS App and text messages will help reduce these costs, whilst delivering quick and convenient messages for many people.

Transitioning to digital-first communications brings significant benefits for screening programmes and the people they serve. It improves accessibility – offering more language options and faster communication through modern channels. Digital messages also work with device features such as magnification and text-to-speech.

Evidence based service provision 

Supported by resources from the NHS Cancer Programme Cancer Service Delivery Fund, NHS England commissioned the team at the Centre for Cancer Screening, Prevention and Early Diagnosis, The Wolfson Institute of Population Health, Queen Mary University of London (QMUL), to conduct a series of evaluative projects. These looked at barriers to screening and measured the effectiveness of invitations and telephone calls. 

Findings showed that invitations with a timed appointment already booked for the woman was the best approach and were most effective in driving uptake in: areas with high deprivation and ethnic diversity; services with low overall uptake; and first-time invitees to screening. Direct telephone contact increases attendance amongst non-attenders – 41% of those contacted attended within 90 days.

An online survey of non-attenders to identify barriers to attendance at a national scale found that the top three barriers to screening attendance were personal logistics, health problems and appointment issues. 

The recommendations from the projects were used to support operational changes to service delivery, including revising the service schedules and specifications for 2025/2026  

The full reports are available to NHS services on the NHS Futures platform. The academic team at QMUL will publish findings in peer reviewed journals to share the evidence widely. 

NHS England secured capital funding for breast screening services to enhance accessibility to the service for women, including telephony systems and answering machines. 

NHS England service schedules and specifications for 2025/2026 now state that all services should introduce text messaging reminders to support attendance and have communication systems in place to support women, such as answer phones, call waiting and call back systems, email access, and timely responses. Services should also promote flexibility through greater use of out-of-hours, evening, and weekend clinics, and extend appointment times for first-time attendees and women who need reasonable adjustments.  

Operational Quality Improvements   

NHS England aims to ensure better on-site support to those with adjustment needs (for example, because of learning or physical disability, autism, or severe mental illness), by improving the NHS record of these needs and investing in relevant services and staff training.  

The Breast Screening Programme delivered a training webinar for breast screening providers, led by the NHS England Autism National Specialty Advisor. This aimed to raise awareness of the needs of people living with autism and provide training and resources to support screening services to make reasonable adjustments during the screening journey. A recording of the webinar is available on the NHS Futures platform.  

Since 2024/25, breast screening is included in the national GP Primary Care Network (PCN) contract, raising awareness of ‘making every contact count’ (MECC) objectives to promote attendance for breast screening.

Next steps to expand access:

• Develop targeted inclusion projects for the LGBT+ community.   

• Optimise the service user experience by working with key stakeholders and charities to develop a better understanding of what a good service looks like in terms of satisfaction and experience for women. Plans include development of a service user feedback template to facilitate ongoing service improvements based on women’s experiences and customer care training for frontline staff. This could inform a future digital product to capture feedback to continuously review and enhance service provision. 

2. Reducing inequalities

While a lack of granular uptake and outcome data by ethnicity limits the evidence base available, NHS England has focused efforts on tackling the distinct barriers to screening in communities where breast screening attendance is lower than the national average.  

NHS England has delivered several initiatives to address inequalities challenges, including:  

A national awareness campaign 

NHS England ran its first-ever national breast screening campaign between 17 February - 30 March 2025 to promote awareness and understanding of the importance of breast screening. 

The campaign launched across national TV, radio and online channels. The campaign also targeted women from Black, South Asian and Eastern European communities. Insights show there are significant cultural barriers that can stop women from these communities attending their breast screening appointment. In particular, barriers about the process of screening, what happens, as well as fear of getting a cancer diagnosis. Communication focused on addressing these barriers with clear and open information about what happens, encouraging women to come together, support each other, prioritise their health and to attend their breast screening when invited. Activity focused on the 10 London boroughs with the lowest uptake, targeting those from: Muslim, Bangladeshi, Pakistani, Eastern European, Somali, Orthodox Jewish and Black African/Black Caribbean groups.  

In the first week of the campaign launch there were: 32,432 visits to NHS breast screening advice pages (Monday 17 February – 24 February) – an increase of 145% in just a week; a 97% increase in clicks to the breast-screening-services finder, where women, aged between 50 and 71, can see where they can get screened in their local area; and Google Trends data showed the highest volume of Google searches for ‘Breast screening’ in England in the last five years. A full evaluation of the campaign impact is currently underway.  

A suite of campaign resources is available to all NHS communications colleagues and can continue to be used to promote screening locally and regionally.    

Updated publications 

NHS England has refreshed patient-facing information, including the ‘Helping You Decide’ leaflet and invitation and results letters, to reflect the latest insights work about barriers to breast screening. This was part of a full publications review of all screening programmes. 

The new patient information leaflet, was reviewed by charities representing patient groups, direct patient testing, clinicians, commissioners and providers.  

The revised leaflet, ‘Your guide to NHS breast screening’ was published in May 2025, with online translations available in 30 languages. Other accessible formats including easy read, large print and Braille, are in development. 

Additionally, NHS.uk has published a new video showing people what to expect when they attend their breast screening (mammogram) appointment.

Training webinars for staff

NHS England delivered a Health Equity Audit Webinar and Toolkit to upskill national and regional staff to support completion of the Office of Health Improvement and Disparities Health Equity Audit Toolkit, and utilise the SHAPE software to support reducing inequalities, with a focus on those from more socially deprived areas.   

NHS England worked with the LGBT Foundation to deliver a webinar to increase awareness and knowledge of the barriers faced by the LGBTQ+ community in accessing breast screening services and how to reduce inequalities in engagement and uptake. This included sharing resources and information for services to use locally.  

Access for disabled women

Providers of NHS screening services are required to make reasonable adjustments to ensure that their services are accessible to disabled people, offering longer appointments at accessible sites to support women with physical disabilities to have a successful screening. Services are expected to make reasonable adjustments, within the constraints of equipment, to ensure that disabled people are offered the opportunity to have breast screening.

However, we know that despite best efforts, the limitations of mammography imaging equipment means that screening is not possible for a small number of disabled women. The Breast Screening Programme team have engaged with all mammography equipment manufacturers on how current designs may restrict imaging of people with physical disabilities and discussed possible solutions to support more women with physical disabilities to access screening. As a single purchaser, one of the advantages of the NHS is its ability to influence the products available on the market – and we will use that ‘purchasing power’ to create a market for mammography machines that are accessible to people with physical disabilities. The Programme has also begun a scoping review of evidence for possible alternatives for these women.

Next steps to reduce inequalities include:  

• Engage with primary care partners to undertake initiatives to support breast screening within their community. 

• Support and evaluate the impact of the roll out of provider-based Health Improvement roles focused on improving uptake and service user experience.  

• Work with the NHS England Health & Justice team to support a review of uptake for people within detained estates. 

• Make it easier for transgender and non-binary people to access mammography, by developing new guidance to support awareness conversations in primary care. We will also scope the options available to improve access to breast screening for transgender individuals. 

• Enable the inclusion of the reasonable adjustments flag within the breast screening IT systems (for example: Learning Disability, autism, severe mental illness etc) and support screening services to meet individuals’ needs.  

• With system partners, scope initiatives to support people with financial constraints to enable them to attend appointments, including travel and parking costs, and supported time off work  

• We have revisited the evidence and are scoping possible alternatives for disabled women who are currently impacted by our evidence-based policy and the next steps are to assess if changes are required.   

3. Learning and support

There is limited information on evidenced based interventions that drive improvements in uptake, and we need to improve our understanding of what works best.  

To support this, NHS England has published on the NHS Futures platform a bank of initiatives and projects that are already working well on the ground, to support shared learning amongst local teams. Commissioners and providers can submit case studies for inclusion, so teams can make the most of shared learning. NHS England also held a national uptake improvement workshop to share learning on planned or completed initiatives to improve uptake in breast screening. 

Next steps to improve learning and support:  

• Develop new training and induction material that covers subjects such as customer care.  

• Develop an induction pack for new Directors of Breast Screening on how to manage, lead and oversee the service effectively. 

• Commence a programme of work to review the training and education requirements for the workforce. The focus is on the programme management staff and encompasses administration and clerical staff, office managers and programme managers.  

4. Data ​

Not all service level data is currently at a granular enough level to help services improve uptake and service user experience. Services have patient level data and post codes, but they may be missing ethnicity, language and sometimes disabilities status. 

Data and analytics work commenced in 2023/24 to provide GP practice data for regional commissioning teams and providers to support local action plans and initiatives. The workplan utilised analytical tools and approaches developed during the COVID-19 pandemic, with continued work to provide ethnicity estimate data in 2024/25. 

New digital services will better support and manage participants through the screening process, reducing the need to collect data multiple times, and support the tracking of participants’ progress more effectively, freeing up time for staff, and allow providers and commissioners to better target their work to continually improve services. 

Next steps to improve data:

• NHS England will progress its work to provide robust data on all protected characteristics including but not limited to:
• Individual level deprivation data (IMD)
• Individual level ethnicity data
• Individual level disability and autism flags
• Individual level data for those in detained settings

• Population level data for those in the Military.

• Provide GP level uptake rate data to support local action plans and initiatives. 

• Improve activity planning by regularly reviewing and using data, for example to identify which communication, outreach and education resources to prioritise. 

• Continue to scope the process to access NHS England Master Person Service data to provide individual level deprivation and ethnicity data 

Our commitment to deliver the next steps

The NHS 10 Year Health Plan for England, published earlier this year, shows a clear commitment to the shift from sickness to prevention, and screening will play an important role in helping to achieve that aim.   

We will continue to work collaboratively with integrated care boards (ICBs), local authorities, and health and care providers in our continuous drive to improve screening uptake and address inequalities, putting women’s experiences at the forefront of our plans.  

A service fit for the future

Alongside this work to improve uptake, we will ensure that we continue to drive forward our digital-first communications, eventually allowing everyone who would like to receive their invitations through the NHS App to do so.

We will also maximise the benefits of artificial intelligence (AI) in breast imaging. Nearly 700,000 women across 30 sites are taking part in a world-leading trial to test how cutting-edge AI tools can be used to catch early cancers through screening.

The technology will assist specialists in reading mammography images for screening patients to identify changes in breast tissue that show possible signs of cancer and refer them for further investigations if required. Currently, two specialists are needed per mammogram screening. This technology enables just one to complete the same mammogram screening process safely and efficiently. If the trial is successful, it could free up hundreds of radiologists and other specialists across the country to see more patients.  

Delivering trials in screening relies on a suite of underpinning technology, so to support this work we’re developing a new research screening cloud platform for clinical trials of image reading AI. The platform will provide a single secure hosting environment for AI products which can be linked to image data held locally. Creating these vital foundations for information sharing will enable clinical trials in any site across England to be approved in weeks rather than months.