Breast Cancer Screening (Young Women)

Tuesday 30th November 2010 Westminster Hall

12:29

[Pat Glass (North West Durham) (Lab)]

Breast Cancer is the UK’s most common cancer. It affects thousands of families every year. Almost 48,000 people were diagnosed with breast cancer last year: 47,000 women and 277 men, and 125 women will be diagnosed with breast cancer today. Breast cancer incidence rates among women have increased by 50% over the past 25 years—5% in the past 10 years—and, because of lifestyles changes such as increased obesity and drinking in young women, those incidence rates will continue to rise, particularly for those under 50. Eight in 10 breast cancers diagnosed are in women aged 50 or over, but that means that two in every 10 are diagnosed in younger women, who may have young families. For young women the disease can be particularly virulent and aggressive, and the chances of survival are less good as a result.

[Ian Lavery (Wansbeck) (Lab)]

Does my hon. Friend agree that the time between the mammogram and the results is critical, and that the length of that period depends on the area and district a person lives in and the hospital they attend? It could be between a week and up to four weeks, depending on the hospital, which could mean the difference between life and death. At the same time, those with money have the opportunity to have a mammogram in the morning and receive the results in the afternoon.

[Pat Glass]

That is incredibly true. I am particularly concerned about young women, and in many cases the younger they are, the more virulent the disease is and the chances of survival are less good as a result, so that is particularly crucial. Every family in this country will be touched by this awful disease. Within my family, four close relatives have died of breast cancer in recent years, all aged well under 50; and a cousin, also under 50, is currently battling the disease for a second time.

However, it was an inspirational woman, Trish Greensmith, who runs the Chyrelle Addams breast cancer appeal trust in my constituency, who first brought home to me the number of young women who are being diagnosed with, and having to fight, breast cancer today. She told me that when she first visited an oncology clinic she was struck by the number of young women in the waiting room—young women who were trying to deal with virulent and aggressive cancers while bringing up young families. Under the current system, they would never be offered the opportunity for routine screening, which might have detected their cancers early and saved their lives. More women are surviving breast cancer than ever before, and the survival rates have steadily improved over the past 30 years, but 12,000 women and 70 men in the UK died from breast cancer last year.

[Alex Cunningham (Stockton North) (Lab)]

I congratulate my hon. Friend on securing this important debate. Few people will not have a friend or relative who will suffer from breast cancer and who would benefit from earlier diagnosis and improved information. I understand that Cambridge university has developed a computer programme called “Predict”, which allows any patient—or doctor—to go online and enter their symptoms and the kind of cancer they have, and it will predict their life expectancy and the likelihood of survival. Does my hon. Friend agree that that would be another useful tool to help inform and reassure women and men who are diagnosed with breast cancer?

[Pat Glass]

I am aware of the “Predict” computer system, which is an incredibly useful tool in the hands of clinicians, but I do not think it should be generally available for people to use in their own homes to calculate, using their symptoms, how long they have to live. I think they would find that very worrying. However, it would be incredibly useful for their doctor.

Of the women who died last year from breast cancer, 1,300 were under 50 years old. We know that women with a mother, sister or daughter who have been diagnosed with breast cancer have almost double the risk of being diagnosed themselves. We know that the risk increases with the number of first-degree relatives diagnosed, but even so, eight out of nine breast cancers occur in women with no family history of cancer whatsoever.

[Natascha Engel (North East Derbyshire) (Lab)]

A woman in Derbyshire, Wendy Watson, runs the national hereditary breast cancer helpline. What is my hon. Friend’s view on getting national funding for that helpline, which is a lifeline for many women suffering from hereditary breast cancer?

[Pat Glass]

I am aware of Wendy and the fantastic work she does; I also know that she is struggling to secure funding. Perhaps the Minister might look at that as a result of today’s debate. I thank my hon. Friend for making that point.

We know that obesity presents a risk, as do hormone replacement therapy and the use of oral contraceptives. In the binge capital of Europe, we are now told that as little as one alcoholic drink per day increases the risk of breast cancer by about 12%.

[Neil Carmichael (Stroud) (Con)]

Breakthrough Breast Cancer, which is an excellent organisation, has rammed home the point that awareness is important and that we should all do all we can to remind women of that. We should make women aware that they need to be aware.

[Pat Glass]

I absolutely agree.

Going back to the risk factors—obesity, HRT, oral contraceptives and alcohol—all of them are likely to affect women under 50 more than women over 50, and yet women under 50 are not routinely offered screening of any kind. About 1.5 million women in the UK are screened for breast cancer each year, and we must congratulate those involved in the routine screening programme on the many lives they save. The previous Government extended the screening programme so that from 2012, all women aged 47 to 73 will be invited for routine screening. That extension will save many more lives, but it will do nothing to help identify breast cancer in younger women.

Concerns have been expressed that wider screening could lead to over-diagnosis, but recent research is showing that the benefits of mammographic screening in terms of lives saved are greater than the harm caused by over-diagnosis. Those same arguments about over-diagnosis were used in the past to argue against extending screening for womb cancer and cervical cancer, but the response to those arguments has always been that it is better to be safe than sorry, and that, in the case of breast cancer screening, between two and two and a half lives are saved for every over-diagnosed case. Despite that, however, women under 50 are not currently offered routine screening.

It is also argued that film mammograms are not as effective for pre-menopausal women as for post-menopausal, as the greater density of breast tissue in pre-menopausal women makes it more difficult to detect problems. That is absolutely right. Screening of women under 50 may not be as effective as screening of women over 50, but it can still be effective, certainly in the absence of any other screening programme.

It is also argued that routine screening of women under 50 is not necessary, because the incidence of breast cancer is lower in that age group. I would say, “Tell that to the hundreds or thousands of young women battling this disease”, who say that any arguments about numbers are outweighed by the increased virulence of the disease in the young.

We are told that, because breast cancer is less common in women under 50, research trials have shown that regular screening of young women does not help to save lives. It is even argued that in other trials, regular mammogram screening is more of a risk than not screening. However, I say to the Minister, “Tell that to the young women currently undergoing chemotherapy”.

It is absolutely clear that mammogram screening is most effective among women who have gone through the menopause, but recent research shows that it can also be effective among those aged 35 to 50 and that, despite all the counter-arguments, there is now increasing evidence that there are significant gains to be made by routine screening of women from the age of 35 upwards.

[Grahame M. Morris (Easington) (Lab)]

I compliment my hon. Friend on securing time for this important debate. On routine screening and the value of targeting a particular age group, I, too, have received information from Breakthrough Breast Cancer—an excellent organisation—pointing out that 1,400 lives a year are saved by routine breast screening. However, Breakthrough Breast Cancer also says that any woman aged 70 or over is not routinely invited to attend for breast screening. It may well be advantageous, in terms of improving the health outcomes of those women, if a screening programme targeted them, too, in view of the high incidence of breast cancer among post-menopausal women.

[Pat Glass]

I thank my hon. Friend for that intervention.

I ask the Minister to consider the arguments that have been put forward and the increasing weight of medical evidence calling for routine screening from the age of 35 onwards. In his response, I ask him not to pull out the one argument that the coalition Government seem to have for everything: that there is no money. If we could set aside £9 billion last week to build more trains to make commuting more comfortable, surely we can consider routine screening. If we can find £9 billion to lend to the Irish in their hour of need, surely we can find the money to save young lives.

I understand that the Minister is unable to announce that routine screening for breast cancer will start tomorrow, but he could consider a long-term plan—over five years, for example—to reduce the age of screening to 45 in year one, 42 in year two, 40 in year three, 38 in year four, and to 35 within five years. Such a policy would be universally welcomed and could save precious lives.

I am aware of the Breakthrough Breast Cancer campaign. In particular, it seeks early breast screening for women from the age of 35 where there is a history of breast cancer. We must learn lessons from the highly successful cervical cancer screening programme. Early intervention is cost-effective—it saves the country money in the longer term, and it saves lives.

12:41

[The Minister of State, Department of Health (Paul Burstow)]

It is a delight to serve under your chairmanship, Mr Betts, and I congratulate the hon. Member for North West Durham (Pat Glass) on securing this important debate. As others have said, it is important that we do everything possible to increase awareness of breast cancer so that people are more aware of signs and symptoms and are able to present themselves at an earlier time and thus make the chances of survival much greater. I also congratulate the hon. Lady on the work that she does in raising funds and increasing awareness of the issue, as she has done today. I note the personal experience that she draws on.

Around 40,000 women a year are diagnosed with the disease—that is a third of all cancer diagnoses in women. The hon. Lady made a good speech setting out a powerful case that needs proper consideration. It is a shame that she made the point about Ministers trotting out certain lines about coalition funding and so on, as that added nothing to the debate. I was certainly not intending to go down that line because I want to try to give a substantive response to her remarks.

Breast cancer can strike women of all ages, although a person’s risk of developing it rises dramatically after middle age, with cases peaking among women in their early 60s. The prognosis for a person with breast cancer has transformed over the last 40 years. It has gone from a consistently lethal killer, to the second-least deadly form of the disease, if judged by five-year survival rates.

The NHS breast screening programme has played a major part in that success. Since it began in 1988, the programme has made a huge difference to a woman’s chances of surviving breast cancer. Around 83% of all women with breast cancer are still alive five years after diagnosis, and among those whose cancer is detected through screening, that survival rate increases to over 96%. That is a striking demonstration of the power of detecting cancer early on—that point has rightly been made in the debate—and that is why we will make earlier detection a key part of our forthcoming cancer reform strategy.

Experts believe that the current breast screening programme saves 1,400 lives a year among the 50 to 70-year-old age group on which it focuses. That point was made by the hon. Member for Easington (Grahame M. Morris). Therefore, the hon. Lady asks a fair question about whether there is scope to widen the net and whether that would be appropriate. Should we be looking to extend the programme to cover other age groups?

Under the current programme, women aged between 50 and 70 are routinely invited for screening, and women over 70 can request to be screened every three years. The hon. Lady suggested that women as young as 30 should be invited for screening. When it comes to health care, our priority is simple—to have outcomes that compare with the very best in the world. We will achieve that by handing power to front-line professionals and basing decisions on the best available evidence. That is where there is a debate. I am interested and I listened carefully to what the hon. Lady said about the emerging evidence. However, when it comes to extending screening to all women older than 30, as far as I can see, the evidence is not there.

[Pat Glass]

May I just clarify that I am talking about women between the ages of 35 and 47 rather than 30? That is the point at which screening would be most helpful.

[Paul Burstow]

I am grateful to the hon. Lady for that clarification. In 2006, the Institute of Cancer Research published the results of a 15-year study of the benefits of screening women from the age of 40. The study invited about 53,000 women to receive annual breast cancer screening over nine years and then compared them to a control group of women who received standard NHS treatment. The study found that the reduction in deaths due to screening was not statistically significant. I understand that, for the individual, it is 100%; I understand the hon. Lady’s powerful point. She might say that, if such measures save a single life, they are worth doing. However, the study pointed out, as she seemed to guess, that early screening had significant disadvantages. Almost one in four women in the study had at least one false positive, with all the resulting distress, anxiety and unnecessary follow-up, including invasive biopsies. Currently, there are about 7 million women aged between 30 and 49 in England. I accept that she wants to screen from 35 onwards, but if the take-up rate among that population were 75%, we would be screening about 5 million more women a year. Even if the minimum age were 35, it would create the issue of false positives.

[Ian Lavery]

Does the Minister agree that there is still a huge diagnosis problem, involving the time between mammogram and results, based on what is classed as a postcode lottery? We need to look at that and ensure that each patient, regardless of wealth or where they reside, gets her mammogram results within days, not weeks.

[Paul Burstow]

Yes. It is entirely right for the hon. Gentleman to make that point. That is why this Government will publish the first ever NHS outcomes framework, which will focus much more clearly on how we ensure that the system delivers the right outcomes in terms of cancer survival. We will publish that shortly, along with a new cancer reform strategy in due course that will say even more.

The Government’s view at present is that the risks of the change proposed by the hon. Lady outweigh the benefits. However, I want to ensure that the evidence that she has discussed is properly evaluated by officials in the Department. We will consider those points and her representations carefully, and I will write to her after we have had an opportunity to do so. However, the Department’s view and the Government’s view about maintaining the status quo is shared by most countries in Europe, as well as the Council of Europe, which recommends a breast cancer screening age of 50 to 69. The United States recommends screening every two years for women aged between 50 and 74. The position that this country has adopted for a considerable time is based on international practice and the best available evidence. One must be open to changes in evidence; that is important in an evidence-based approach to developing policy.

[Grahame M. Morris]

On best practice and targeting available resources, the figures suggest that in some areas, as many as one third of women within the target group aged 50 to 70 do not attend routine screenings. There are various reasons for that. It might have to do with misconceptions about the nature of the screening test. In some urban areas, it might have to do with the fact that there is a large transient population. In my area, where we also have the problem of people failing to turn up for routine appointments, they may be reluctant or poorly educated, or a number of—

[Mr Clive Betts (in the Chair)]

Order. Interventions are meant to be brief.

[Grahame M. Morris]

I apologise. The Minister will see the point that I am trying to make.

[Paul Burstow]

I understand fully. Today, the Secretary of State will make a statement in the House setting out this Government’s new commitments on public health and the clear lines that we are drawing on tackling health inequalities. Some of the issues clearly involve a social gradient that we must address, and we will address them in our new cancer reform strategy and public health White Paper.

[Pat Glass]

I appreciate what the Minister says about considering new evidence. Will he also take into account—this relates to the remarks by my hon. Friend the Member for Easington (Grahame M. Morris)—the issues that affect younger women and the cohort that those younger women are likely to come from? It is about obesity, hormone replacement therapy and alcohol. It is younger women from low socio-economic backgrounds who are likely to be hit hardest by those things.

[Paul Burstow]

I am grateful for those points, and I am coming to them, which is why I was smiling—it was not because of the subject, which is very serious.

Let me talk briefly about partial age extensions, which is another issue worth airing. The last cancer reform strategy committed the Government to extending the NHS breast screening programme to women between the ages of 47 and 73. Beyond 73 years of age, patients would still be able to self-refer. That extension will ensure that all women are invited for screening before their 50th birthday. The June revision to the NHS operating framework confirmed that the extension will begin this year—in 2010-11. By the end of March next year, we expect 60% of screening programmes to be screening that wider age group, and we obviously want to go as far and as fast as we can.

Our updated cancer reform strategy will focus on outcomes and on improving cancer survival rates. Although the one-year and five-year survival rates have improved in recent years, we still lag behind other European nations. If we could match the five-year survival rates of the best countries in Europe, we could save up to 10,000 lives every year in England. As has been said, therefore, early diagnosis is essential. In September, I announced funding for a new £9 million campaign to get people to recognise and, importantly, to act earlier on the signs and symptoms of cancer. We are talking not so much about a campaign as a series of 59 local campaigns, which will focus on the three big killers: breast cancer, bowel cancer and lung cancer. The campaigns will raise public awareness of symptoms and encourage people to talk to their GP at the earliest possible opportunity. We will target those populations that the hon. Member for Easington talked about, which are often harder to reach.

Our approach will also encourage GPs and others in primary care to act appropriately. The tragedy of these cancers is that they are preventable. As has been said, lifestyle—eating too much, drinking too much and not getting enough exercise—plays a big part. That is why the coalition is determined that public health will become a far more important part of overall public policy and practice nationally and locally. We will make sure that we treat and prevent cancer in that context. That is why we will, as I said, publish a White Paper later today to set out how we will provide the right leadership and the strategy to improve people’s lifestyles and to reduce their risk of getting cancer in the first place.

[Natascha Engel]

Will the Minister briefly outline his opinion regarding national funding for the hereditary breast cancer helpline? It is a national service and it needs national funding, but the Department of Health has said that it is more appropriate to fund it locally. This incredibly important service provides information and advice and helps women up and down the country. What does the Minister think needs to be done about it?

[Paul Burstow]

I am grateful to the hon. Lady, and I certainly pay tribute to the work that the helpline does, but it is important to stress that NHS organisations and commissions are responsible for such funding, so it is perfectly possible for them to collaborate to make the resources available.

The hon. Lady rightly refers to inherited cancers. It is perhaps important to stress that about 5% of women will contract breast cancer simply because it runs in the family. National Institute for Health and Clinical Excellence guidance published in 2004 recommends that women with a moderate or higher risk of familial breast cancer should receive annual screening. However, across the NHS, delivery is patchy, and we have heard examples of that patchiness in the debate. Women deserve better than that; they deserve a consistent service wherever they happen to live. For that reason, the NHS breast screening programme will soon take responsibility for ensuring that familial screening is regularly and routinely carried out.

In conclusion, I very much respect the points that the hon. Member for North West Durham has made, the passion with which she delivered them and the commitment that she clearly has to improving our ability to detect these cancers early and prevent them. We must do everything we can to improve survival rates and to improve the quality of life for those living with cancer. We will do that by focusing resources on what works and where the evidence demonstrates the risks are outweighed by the benefits. In this instance, the evidence at the moment is clear: extending annual breast cancer screening to all women over the age of 35 would not improve their chances of surviving the disease. However, it would mean that we would need to ensure that we did not place women in a situation where they felt unnecessary anxiety as a result of false positives. We will always act on best evidence, which is why I make the undertaking to take away the evidence that the hon. Lady referred to. At this time the evidence does not lead us to conclude that there is a case for change. But we will keep it under review.

I thank the hon. Lady for raising these matters today. The Government are determined to achieve the best possible outcomes for people with cancer through our public health strategy and our cancer strategy. We are committed to ensuring that the resources are there to avoid the postcode lottery that some hon. Members described, an inheritance that we are determined to deal with.

12:55

Sitting suspended.