The Health Committee of the Greater London Authority Council met on Thursday 22 January 2026 to discuss breast cancer screening in London and public health messaging on Transport for London (TfL) services. Key discussions focused on the low uptake of breast cancer screening in London, the barriers contributing to this, and potential solutions. The Committee also explored how TfL's advertising estate could be better utilised for public health campaigns, particularly those aligned with the Mayor of London's priorities.

Breast Cancer Screening in London

The Committee heard that London has the lowest uptake of breast cancer screenings in England, with only 62.8% of eligible women attending appointments, falling short of the NHS target of 70%. Several factors were identified as contributing to this low uptake, including:

• Awareness and Understanding: A significant percentage of women reported not attending due to discomfort with the procedure, fear of pain or harm, and a lack of understanding about the screening process.
• Trust and Accessibility: Issues of trust in healthcare settings, particularly for minority ethnic groups and LGBTQ+ communities, were highlighted. Physical barriers, such as the distance to screening centres and the need for accessible facilities, also play a role.
• Data Issues: High population churn in London leads to outdated contact information for many women, meaning invitations are not received. This affects both GP records and the Breast Screening Programme's ability to follow up with non-attendees.
• Specific Community Barriers:
  • LGBTQ+ Communities: Lee Dibben from OUTpatients noted that some individuals felt breast screening was not for them due to its perceived hyper-feminised nature and negative past healthcare experiences, leading to medical mistrust. Transgender individuals, particularly transgender men with breast tissue and transgender women who have taken oestrogen, face challenges with the invitation system, which is often based on gender markers rather than anatomy.
  • Black Women and Women of Colour: Leeanne Graham from Black Women Rising highlighted cultural barriers, fear, mistrust due to past experiences, and a lack of culturally appropriate materials. Some women are also diagnosed under the screening age, and there is a perception that Black people do not get breast cancer, which is untrue and detrimental.
• Systemic Issues: Helen Dickens from Breast Cancer Now pointed to systemic issues within the screening programme, including data management, flexibility in appointment booking, and the short-term nature of funding for projects aimed at improving uptake.

Proposed Solutions and Actions:

• Improved Invitation Process: Implementing an opt-in update for invitations, particularly for transgender individuals, was suggested.
• Targeted Messaging and Outreach: Tailoring communication to specific communities, using culturally appropriate materials, and engaging with spaces where target groups gather (e.g., churches, community groups) were recommended.
• Mobile Screening Units: While acknowledging the advantages of mobile units for accessibility, concerns were raised about the increasing difficulty in finding suitable parking locations and power supplies. Static sites were generally preferred where possible.
• Digital Transformation: Enhancing digital systems for booking appointments and accessing information was seen as crucial for convenience and flexibility.
• Risk Stratification: More research into risk-stratified approaches to screening was advocated to better target resources.
• Addressing Stigma: Recognising and actively working to reduce the stigma associated with breast screening and cancer was deemed essential.
• Collaboration and Learning: Sharing best practices and learnings from successful local initiatives across London was strongly encouraged.
• Integrated Care Boards (ICBs): The move of screening programme commissioning to ICBs from April 2026 was seen as an opportunity to reduce fragmentation and foster cross-collaboration, but the importance of maintaining relationships with existing expertise, such as Cancer Alliances, was stressed.
• AI in Screening: The potential of AI to speed up and improve the accuracy of mammogram analysis was discussed, with a call for research to ensure its safe, responsible, and ethical use, trained on diverse datasets to avoid bias.

Impact of Low Uptake: Dr Will Teh confirmed that lower screening uptake is likely to lead to later stage cancer detection and therefore worse prognosis for Londoners.

Public Health Messaging on the Transport for London (TfL) Network

The Committee discussed the potential for utilising TfL's advertising estate for public health messaging, particularly concerning men's mental health and breast cancer screening.

Current System:

• Non-Commercial Estate: TfL has a network of non-commercial advertising space used for its own operational messaging (e.g., safety, fares, service improvements). A limited allocation of this space is shared with the Greater London Authority (GLA) for campaigns aligned with mayoral priorities.
• Commercial Estate: This space is managed by media partners (JCDecaux and Global) under commercial agreements. These agreements do not allow the Mayor or City Hall to direct the allocation of advertising space. TfL's revenue from commercial advertising is reinvested into maintaining and improving the network.

Challenges and Opportunities:

• Limited GLA Allocation: The GLA's allocation of non-commercial space is limited and planned quarterly, making it difficult to accommodate numerous campaigns.
• Mayor's Priorities: The Mayor can influence messaging on the non-commercial estate if it aligns with mayoral priorities, such as public health initiatives like ending HIV by 2030 or addressing health inequalities.
• Contractual Limitations: TfL cannot unilaterally direct its commercial partners to carry other organisations' campaigns without potential financial compensation or contractual changes, which would impact TfL's revenue. The current commercial contracts run until 2033.
• Definition of Operational Messaging : There was discussion about what constitutes operational messaging versus mayoral messages, with the Committee arguing that some TfL adverts promoting cycleways or emission standards could be considered political rather than purely operational.
• Potential for Collaboration: While direct control over commercial space is limited, the GLA and TfL acknowledged that conversations could happen if the NHS or other partners approached City Hall with specific public health campaign requests that align with mayoral priorities.
• Creative Messaging: The Committee explored the possibility of using other TfL channels, such as Tannoy announcements, for public health messages, but TfL noted that these are primarily used for transport information and safety, and customer complaints about too many announcements exist. The potential for additional information boards at stations was also discussed, but funding for increasing non-commercial space is limited.
• Gambling Advertising: The Committee raised concerns about gambling advertising on the TfL estate, noting that TfL's response cited a lack of national guidelines for harmful gambling. Discussions are ongoing with the Government's review of gambling harms.

The Committee expressed frustration at the perceived lack of flexibility in utilising TfL's advertising space for vital public health messages, particularly given the Mayor's stated commitment to health inequalities. They urged for a re-evaluation of how this space could be better used to promote public health, especially in light of the success of public health campaigns in increasing screening uptake.

Action Taken Under Delegated Authority

The Committee noted that the Chairman, in consultation with party group lead members, had agreed the Committee's report on Men's Mental Health in London.

Health Committee Work Programme

The Committee noted its work programme, with the next meeting scheduled for 4 March 2026, focusing on violence against healthcare workers.

The meeting concluded with the Committee delegating authority to the Chairman to agree any output from the discussions.