Protocol of a Community Champion led breast cancer screening intervention for underserved groups

Background Breast cancer screening (BCS) is a key public health strategy for reducing cancer mortality through early detection. Despite strong evidence of effectiveness, BCS uptake in England has declined in recent years, falling well below national targets. Uptake is especially low in London, particularly in women from ethnic minority backgrounds and socioeconomically deprived communities, contributing to persistent inequalities in cancer outcomes. Existing interventions have had mixed success, with limited robust evidence for scalable, community-based approaches. Aim To evaluate whether a six-month, community champion led intervention increases BCS uptake in underserved populations compared with similar London boroughs without the intervention. Design and Setting This study uses a pragmatic, non-randomised, quasi-experimental design in the London Borough of Hounslow, an area characterised by high ethnic diversity, deprivation, and low BCS uptake. Uptake will be compared with that in matched, non-neighbouring London boroughs. Method The intervention combines co-designed resources, (animated videos, leaflets, wallet cards, and posters) translated into 10 different languages, with dissemination led by trained community champions. Dissemination is also supported by relevant staff from Hounslow Council (London Borough of Hounslow). There will additionally be bus stop adverts and targeted social media advertising through animated videos. A difference-in-difference analytical approach will compare screening uptake before and after the intervention between Hounslow and comparator boroughs, with inverse probability weighting to control for differences in eligible populations. Analysis of administrative screening data will be supplemented with surveys and focus groups to assess exposure, reactions to the intervention, and community champion feedback. Discussion This study will provide the first UK evidence on the effectiveness of a community champion model for increasing BCS uptake at scale. Findings will inform local and national strategies to reduce screening inequalities and may have broader relevance for other cancer screening and prevention programmes.