Yonder: ethnic inequalities in breast cancer, denigration of general practice, knee braces, healthcare on release from prison

Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.

Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature

Ethnic inequalities in breast cancer

In the UK, Asian and Black women are more likely to be diagnosed at a later stage and have poorer survival rates from breast cancer compared to White women. This UK database study aimed to investigate ethnic differences in breast cancer diagnostic intervals – time from first presentation in primary care to diagnosis – in patients diagnosed between 2017-2021 to understand to what extent this contributes to disparities in outcomes.¹ The median diagnostic interval was 24 days and was typically 39% longer for Black patients compared with White patients (ATR=1.39,95%CI:1.13-1.71). Most of this disparity was due to differences in secondary care interval, the period between first secondary care appointment and eventual diagnosis (median 11 days, 46% longer for Black patients compared with White patients, [ATR=1.46, 95%CI:1.07-2.00]). Unpicking why this is the case requires further investigation. There was no significant difference between Asian, mixed, Other, and White patients in diagnostic or secondary care interval.

Denigration of general practice

As a medical student, I remember my career aspirations to be GP being greeted with a measure of contempt. What’s the experience of those who’ve been training to be GPs more recently?  This longitudinal study in the north of England surveyed GP trainees from 2016-2024 on specific comments they had received about their career choice.² Over that period, at every bi-annual survey at least 5% of trainees reported hearing negative comments, with 22% reporting negative comments in the Feb 2022 survey. Commonly reported quotes included GPs being lazy, incompetent, making bad referrals, or that people would be ‘wasted’ being ‘just a GP’. This makes for depressing reading and needs to change: the authors advocate for a zero-tolerance approach to denigration which seems a reasonable starting point.

Knee braces

Knee osteoarthritis (KOA) is a common condition which can be painful and debilitating. Surgical management is cost effective but can take a long time to access, and there is a need for more effective non-surgical interventions earlier in care pathways. This randomised trial in England compared compartment specific knee bracing, advice, and exercise instruction to advice and exercise instruction alone in adults aged ≥45 years with KOA to see if there was a difference in pain, activities of daily living, function, and quality of life.³ Adding in a knee brace resulted in a significant improvement in pain and activities of daily living at six and 12 months, though there were some expected adverse events including skin irritation, redness, and – less commonly – blisters. Braces were acceptable to patients but only 66% of patient met the pre-set criteria for brace adherence (wearing the brace for one hour on ≥2 days a week). As a low-cost simple intervention with long waits for elective surgery, this seems worth considering as a potential treatment option.

Healthcare on release from prison

There is a high prevalence of mental health and substance use problems in the prison population, and with over 30 million released from prison globally each year there is a significant population with these issues returning to the community. This Scottish case-control study aims to explore services accessed for mental health and substance use on release from prison compared to a matched population who had not recently been in prison.⁴ The relative risk of contacts with all nine services examined (primary care, outpatient clinics, drug and alcohol services, NHS24, out-of-hours GP, psychiatric admissions, acute admission, A&E, ambulance) was higher in the study population, with higher relative risk ratios for more acute services (2.43 for primary care vs 10.68 for ambulance, 8.88 for A&E, 13.89 for acute admissions). The authors therefore conclude that “public health attention is needed to address the mental health and substance use needs of people released from prison, before they reach a crisis point requiring costly emergency care.”

References

1. Martins T, Lavu D, Hamilton W, Abel G, Neal RD. Assessing ethnic inequalities in diagnostic intervals of breast cancer among patients presenting symptoms to general practitioners in England. Sci Rep. 2026 Jan 28. doi: 10.1038/s41598-026-36070-8. Epub ahead of print. PMID: 41606009.
2. Wood A, Jones H, Graham G, Alberti H. Has denigration of career choice within medicine improved in the UK over the last decade? Educ Prim Care. 2026 Jan 27:1-3. doi: 10.1080/14739879.2025.2550292. Epub ahead of print. PMID: 41593026.
3. Holden MA, Nicholls E, Abdali Z, Birrell F, Borrelli B, Callaghan M, Dziedzic K, Felson D, Foster NE, Halliday N, Ingram C, Jinks C, Jowett S, Peat G; PROP OA trial team. Provision of knee bracing for knee osteoarthritis (PROP OA): multicentre, parallel group, superiority, statistician blinded, randomised controlled trial. BMJ. 2026 Jan 26;392:e086005. doi: 10.1136/bmj-2025-086005. PMID: 41587822; PMCID: PMC12829467.
4. Connell C, Kjellgren R, Savinc J, Dougall N, Kurdi A, Watson J, Haddow C, Brown A, Parkes T, Hunt K. Health service contacts for mental health and substance use on release from prison: a retrospective population-based data linkage study. BMJ Open. 2026 Feb 4;16(2):e107586. doi: 10.1136/bmjopen-2025-107586. PMID: 41638735.

Featured Photo by National Cancer Institute on Unsplash