Background: Mapping factors that sustain the care equity gap and identifying pathways into action have the potential to improve outcomes for minority ethnic women with breast cancer.

Aim: To integrate the narratives of women with breast cancer with survey data to understand what factors drive inequities across the care pathway. To use these findings to identify measures to improve breast cancer services and reduce inequities.

Methods: Qualitative-oriented, sequential-explanatory, mixed methods design underpinned by the transformative, intersectionality, and candidacy frameworks. Secondary data analysis using the 2017/2018 English National Cancer Patient Experience Survey to examine differences in care experienced among women with breast cancer, followed by semi-structured interviews. Mixed data were integrated into a joint display table.

Quantitative results: In adjusted multivariable analyses, Black (OR=0.67 [0.46, 0.97]) and Asian women (OR=0.52 [0.41, 0.67]) were more likely to rate their overall care experience less favourably than White British women. Subsequent analyses of all survey questions suggested that care inequities extended along the cancer pathway and may be driven by individual, interpersonal, and system-level factors.

Qualitative results: Four qualitative themes elucidated the processes influencing differences in care experienced by minority ethnic women, including feeling stereotyped by healthcare professionals (HCPs) and social networks, perceived barriers in healthcare services, HCPs’ knowledge, attitudes, and behaviours, and influence of cultural beliefs.

Mixed methods results: Minority ethnic women negotiated complex systems of discrimination relating to the intersection of their gender, ethnicity, and social position with structural power within the healthcare system. These multidimensional systems partially explained the exacerbated inequities in care experienced by UK Black and Asian women with breast cancer.

Conclusion: Policymakers, commissioners, and clinicians should be cognisant of minority ethnic women’s intersecting experiences within the cancer care system. By evaluating and reformulating policies and services through an intersectional lens, reducing inequities in breast care can be achieved.