The Health Committee met on Thursday 22 January 2026 to discuss breast cancer screening in London and public health messaging on the Transport for London (TfL) network. Key discussions focused on the low uptake of breast cancer screening in London, the barriers faced by various demographic groups, and strategies to improve awareness and access. The Committee also explored the potential for utilising TfL's advertising space for public health campaigns, examining the current contractual limitations and opportunities for collaboration.

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 aged 50-71 attending appointments in 2023-24, falling short of the NHS target of 70%. This low uptake is attributed to a complex mix of factors, including:

• Awareness and Understanding: A significant percentage of women polled were uncomfortable with the screening process or worried about potential harm.
• Trust and Accessibility: Fears and issues around trust and accessibility are compounded in London due to its diverse population.
• Physical Barriers: Difficulty in reaching screening centres, particularly for those with physical accessibility needs, remains a significant barrier.
• Data Issues: High population transience in London leads to outdated contact information, making it difficult for the NHS to send invitations and follow up with non-attendees.
• Socio-economic Factors: Women in more deprived areas are less likely to attend screening. However, affluent boroughs in London also show low uptake, potentially due to high population turnover and a significant proportion of second homes.
• Demographic Specific Barriers:
  • LGBTQ+ Communities: Lesbian, gay, and bisexual women show lower attendance, often due to a misunderstanding that screening is not for them and a perception of the service as overly feminised. Transgender individuals face challenges with the invitation system, which is not designed to accommodate their needs, leading to them not being routinely invited.
  • Black Women and Women of Colour: Cultural barriers, fear and mistrust of the health service due to past experiences, and a lack of culturally appropriate materials contribute to lower uptake. Some women are also diagnosed under screening age and feel their concerns are not listened to.
  • Older Women: Women over 71 are no longer routinely invited for screening, despite evidence suggesting they may have worse outcomes and be diagnosed at later stages.

Experts from Breast Cancer Now, OUTpatients, and Black Women Rising highlighted the need for tailored messaging, culturally appropriate materials, and improved accessibility, including the potential for mobile screening units and co-location of services within community diagnostic centres. They also stressed the importance of addressing systemic issues within the screening programme, such as data accuracy and flexibility in appointment booking.

The Committee was informed that the NHS Breast Screening Programme commissioning will move to Integrated Care Boards (ICBs) from April 2026, which is seen as an opportunity to better tailor services to local communities.

The potential impact of Artificial Intelligence (AI) on speeding up and improving the accuracy of screening results was also discussed, with a cautious optimism for its safe and ethical implementation.

Public Health Messaging on the Transport for London Network

The Committee explored the potential for utilising Transport for London's (TfL) extensive advertising network for public health messaging. It was clarified that TfL's advertising estate is divided into non-commercial and commercial spaces. The non-commercial space is shared with the Greater London Authority (GLA), which has an allocation for campaigns aligned with mayoral priorities. However, the commercial advertising estate, managed by media partners JCDecaux and Global, operates under agreements that do not allow the Mayor or City Hall to direct advertising content.

While TfL uses its non-commercial space for operational messaging, safety information, and fare updates, the GLA utilises its allocation for campaigns reflecting mayoral priorities, such as youth programming, public safety, and initiatives like ending HIV by 2030. The Committee expressed a desire for this space to be more readily available for public health campaigns, particularly those addressing health inequalities, which is a statutory duty for the Mayor.

The discussion highlighted that while direct direction of commercial advertising is not possible due to contractual revenue-sharing agreements, there is potential for collaboration. The Committee was assured that the GLA is open to discussing public health campaign requests, and that any such proposals would be weighed against other mayoral priorities. The possibility of utilising TfL's announcement systems for public health messages was also raised, though concerns were noted regarding potential customer complaints about excessive announcements and the impact on neurodiverse individuals.

The Committee also discussed the banning of fast-food adverts on the TfL estate and the ongoing issue of gambling advertising. While TfL is aware of the concerns regarding gambling harms, the lack of a national definition for harmful gambling and the ongoing government review were cited as reasons for the current lack of a ban. The Committee requested further information on discussions with local authorities that have implemented such bans.

The potential for using unsold advertising space, particularly digital advertising which is sold in near real-time, was also explored as a possible avenue for public health messaging.

The Committee was informed that the National Cancer Plan is due to be published on 4 February 2026. Progress on transferring commissioning powers for the NHS Breast Screening Programme to ICBs is anticipated by April 2027, subject to legislative changes.

The Committee noted the report and delegated authority to the Chairman to agree any output arising from the discussions.

Attendees:

• Emma Best AM (Chairman)
• Krupesh Hirani AM (Deputy Chair)
• Marina Ahmad AM
• Andrew Boff AM
• Caroline Russell AM
• Alex Wilson AM (participated remotely)

Guests:

• Panel 1 (Breast Cancer Screening): Helen Dickens (Chief Support Officer, Breast Cancer Now), Lee Dibben (Education and Policy Manager, OUTpatients), and Leeanne Graham (Advocacy Lead, Black Women Rising).
• Panel 2 (Breast Cancer Screening): Dr Josephine Ruwende (Consultant in Public Health and Cancer Screening Lead, NHS England - London Region), Zara Gross (Programme Manager Early Diagnosis, South East London Cancer Alliance), and Dr Will Teh (Consultant Radiologist and Director, North London Breast Screening Service).
• Panel 3 (Public Health Messaging on TfL): Nicole Valentinuzzi (Assistant Director of External Relations, Greater London Authority) and Emma Strain (Customer Director, TfL).

Decisions Made:

• The minutes of the meeting held on 26 November 2025 were confirmed.
• The completed and outstanding actions from previous meetings, and additional correspondence received, were noted.
• The action taken by the Chairman under delegated authority to agree the Committee's Men's Mental Health in London report was noted.
• The report and discussion on breast cancer screening were noted, and authority was delegated to the Chairman to agree any output.
• The report and discussion on public health messaging on the TfL network were noted, and authority was delegated to the Chairman to agree any output.
• The Committee's work programme was noted.

Actions Agreed:

• NHS England to share the Roots to Cancer Diagnosis publication and the evaluation of the national breast cancer screening campaign.
• NHS England to confirm if preferential rates were offered for using TfL space for breast cancer screening campaigns and if the review of health inequalities for LGBTQ+ people is complete.
• Black Women Rising to confirm what they would like to see regarding ICB commissioning of Breast Cancer Screening.
• Breast Cancer Now to supply data on outcomes for London compared to other regions and on private breast screening provision.
• The GLA to provide a quarterly breakdown of non-commercial advertising space allocation to the GLA on the TfL estate for the past ten years.
• The GLA Health Team to confirm discussions with local authorities regarding the banning of gambling adverts.
• TfL to provide a summary of TfL campaigns and the definition of TfL operational messaging.
• The Committee's work programme was noted.
• The next meeting is scheduled for 4 March 2026.

Key Themes:

• Breast Cancer Screening Uptake: Significant challenges exist in London, driven by awareness, trust, physical access, data accuracy, socio-economic factors, and specific barriers for LGBTQ+ and Black women.
• Public Health Messaging on TfL: While commercial advertising is revenue-driven, there is potential for utilising non-commercial space and exploring innovative collaborations for public health campaigns, particularly those aligned with mayoral priorities.
• Systemic Issues: The Committee highlighted ongoing challenges in addressing health inequalities and the need for systemic change rather than reinventing the wheel.
• Data and Funding: The importance of accurate data, ring-fenced funding for inequalities, and sustained investment in health promotion was emphasised.
• Role of Community Organisations: The vital role of community organisations in reaching specific demographics and complementing NHS services was consistently highlighted.
• AI in Screening: The potential of AI to improve breast cancer screening accuracy and efficiency was acknowledged, with a call for safe and ethical implementation.
• National Cancer Plan and ICB Commissioning: The upcoming National Cancer Plan and the transition of breast cancer screening commissioning to ICBs were noted as key developments.

Recommendations Made:

• The Government should include a programme to tackle mental health stigma in its men's health strategy, with a London-specific approach developed by the Mayor and GLA Health Team.
• The Government should develop an action plan to increase access to Talking Therapies for men.
• The Mayor should use the Adult Skills Fund and Skills Academies programme to invest in training for counsellors and therapists, targeting men and demographic groups with the greatest need.
• The Government should provide sufficient funding to address waiting list times for vital mental health services for men in London, with the Mayor lobbying for this.
• The Mayor should work with the Government to roll out dedicated mental health emergency departments in London and update the Committee on progress.
• The Mayor and Thrive LDN should introduce a new programme, similar to Right to Thrive, specifically funding initiatives for men's mental health delivered by grassroots organisations.
• The Mayor and TfL should work with the NHS to advertise NHS 111 crisis services for mental health on TfL transport services and buildings.
• The Government should deliver more mental health education in schools, and MOPAC should integrate mental health into its school programmes.
• Following the publication of the Government's men's health strategy, the Mayor should convene partners to agree and fund a London-specific action plan.
• The GLA's Chief Officer should review GLA initiatives to support male employees' mental health and introduce new initiatives where gaps are identified.