Lobular Breast Cancer

Mary Kelly Foy Excerpts

Tuesday 10th December 2024 Westminster Hall

[Helen Hayes]

I thank the hon. Lady very much for that intervention and for sharing her personal story.

I pay tribute to Dr Michaelis for her research and campaigning on lobular cancer. I hope that all Members have received their Dr Susan Michaelis rose this week, named in her honour, and will plant it as a reminder of the urgency of her work.

There are so many other stories. Katie Swinburne was 47 when she was diagnosed with invasive lobular cancer in her left breast, leading to a double mastectomy, radiotherapy and 10 years of targeted chemotherapy. She writes:

“It is very hard to accept that none of my treatment is specific to lobular breast cancer and no one can tell me if it is working or has been effective…I find myself living in fear of recurrence. I deserved to have an early diagnosis. I did not get this. I deserve a specific treatment; I do not have this. I have three young children; they deserve to have a mum. I deserve effective follow up; I do not get this. I need you to change this for me, my husband, my family, all the women with a lobular diagnosis and all the women who will be diagnosed in the future.”

Emma Hunwick writes:

“I was a happy, healthy and relatively fit 49-year-old professional woman when I noticed a tiny pull in my right nipple. No lump, no other obvious external changes. An annual medical and referral just 12 days later resulted in a clear mammogram and a clear second 3D mammogram. An ultrasound then reported an area of 2 cm of concern. I rapidly went from ‘caught early’ to borderline stage 2 breast cancer. After my mastectomy I was informed that I was in fact stage 3c invasive lobular breast cancer…I am now at high risk with predicted survival outcomes at 10 and 15 years of approximately 45% and 30% respectively...I need to know that the vital scientific research into lobular breast cancer is being done now. Not next year or in 10 years but starting now, so that I might survive longer and continue to work with less worry about whether the standard monitoring tests that missed my first cancer, will miss a recurrence.”

Kirstin Spencer’s story is also typical. Diagnosed in 2018, she and had a double mastectomy, but was warned that, especially in the first two years afterwards, the disease could recur in areas such as the scar tissue, chest wall and surrounding skin. She was told that vigilance and well-managed medical follow-up were everything. Within a year of her diagnosis, she developed red-flag symptoms that were repeatedly dismissed by her breast specialist. She was refused follow-up treatment and sent for psychological counselling. By the time that a new GP listened to her concerns, substantial recurrence was confirmed, with extensive metastatic disease.

My mother-in-law Cressida’s story is very different from Heather’s, and we are all so grateful to the doctors who treated her and for the subsequent 22 years of health that she has had and continues to enjoy. Cressida did not have any grandchildren when she was diagnosed, but a prompt diagnosis meant that she has been able to be closely involved in the lives of eight subsequent grandchildren, as a much-loved granny. But Cressida’s outcome was about luck rather than design, so much so that it was only very recently, when reviewing her medical notes, that she found out that the type of cancer she had was lobular.

Breast cancer survival rates are directly impacted by the stage of diagnosis. Late diagnosis, which is all too common for lobular breast cancer, leads to far worse outcomes. To improve this situation, we need much better awareness of the full range of breast cancer symptoms, including the very small skin changes that are typical of lobular cancer. Not all cancers cause lumps. A clear mammogram does not provide absolute reassurance, because lobular cancer typically does not show on a mammogram. We need lobular-specific research and treatments.

Staff at Manchester Breast Centre have stated that they are able to do the research to understand the complete pathology of lobular breast cancer—research that has never been done—to pave the way for bespoke treatments to be developed. This will take five years and cost £20 million—moonshot funding that will be recouped many times over in the tax revenue paid by women like Heather, who would be able to continue working, and in the NHS costs that will be saved.

Hundreds of MPs in the last Parliament and this one have listened to the stories of constituents affected by lobular breast cancer and pledged their support for the Lobular Moon Shot Project. Lobular cancer is the sixth most common cancer in women. It is more common than ovarian, brain, central nervous system, non-Hodgkin lymphoma, pancreatic and kidney cancers. I know that the Minister cares deeply about women’s health equality and I put it to her that lobular cancer is a women’s health equality issue.

[Mary Kelly Foy (City of Durham) (Lab)]

I thank my hon. Friend for raising this very important issue. I was diagnosed with, treated for and cured of breast cancer this year, in a very timely way. I was very grateful to be told that it was one of the best cancers to have, because there is so much research into it and treatment for it. It is unimaginable that someone could be treated for a different type of breast cancer for which the research and treatment are not available. I am sure my hon. Friend will agree that this situation needs to be addressed immediately, because we cannot have these inequalities. Lobular cancer should be on a par with other breast cancers in terms of treatment.

[Helen Hayes]

I thank my hon. Friend for that intervention. She makes the point extremely well. How can it be that there are so few targeted programmes to improve the diagnosis and treatment of a cancer that affects 15% of breast cancer patients? How can it be that such poor information is provided to women that does not empower them to seek help when the symptoms of lobular cancer recur? How can it be that women are lured into a false sense of security when they receive a clear mammogram, or are fobbed off when they raise concerns?

We need to do better for women affected by lobular breast cancer, in memory of Heather and many more women like her who will not live to see their children grow up. We need to do better for women like Dr Susan Michaelis, who are living today with their lobular cancer being held just about at bay by generic breast cancer treatments, but who live with the constant anxiety that one day the treatment will stop working. We need to do better for the 22 women today and the 22 women tomorrow—the 22 women every single day—who are diagnosed with lobular cancer.

I have a number of asks to make of the Minister. Will she commit to investigate why there are so few targeted programmes to improve diagnosis, research and treatment of a cancer that affects 15% of breast cancer patients? Will she confirm that lobular cancer will remain a priority in the Government’s women’s health strategy? Will she take steps to address the lack of information given to women about mammograms, so that every woman is reminded to remain vigilant for non-lump changes in their breasts, including very small changes? Will she take steps to improve the education of primary care doctors on the symptoms of lobular breast cancer, so that women are not provided with false reassurance, but promptly referred for diagnostic tests?

For patients treated for ductal breast cancer, the first five years are critical, but for lobular breast cancer the risk will remain for 10 years and sometimes beyond, yet lobular patients are typically released from surveillance care after only five years. Will the Minister take steps to ensure that there is a specific follow-up pathway for lobular breast cancer? Will she support Manchester Breast Centre’s call for Lobular Moon Shot funding—£20 million over five years—to enable the basic pathology of lobular cancer to be fully understood as the foundation for developing bespoke treatments? Will she look at the fairness of the distribution of research funding to ensure that this funding can be identified without further delay?

I know the heartbreak that Heather's death has caused for all who knew and loved her, and most especially for her family. We can act to ensure that, in future, women like Heather who are diagnosed with lobular cancer can live to see their children grow up, and it is imperative that we do so.

Tobacco and Vapes Bill

Mary Kelly Foy Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

I declare an interest as the co-chair of the all-party parliamentary group on smoking and health. Just over a year ago, I welcomed the previous Government’s Tobacco and Vapes Bill. As the House may know, I have called for a smokefree generation for many years. I was not best pleased when the Conservatives voted down my amendments to the Health and Social Care Bill in 2021. Those amendments called for a ban on flavours and packaging targeted at children, which the shadow Secretary of State has just brought to the House’s attention. If they had not been voted down, we would already have regulations to protect children from smoking and vaping.

I join the Secretary of State in congratulating the former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak) on bringing the Smoking and Vapes Bill forward, but it was regrettable that the previous Government did not fast-track it in the wash-up before the general election. Nevertheless, I am grateful to the Labour Government for bringing this Bill forward. It is stronger than the previous legislation, and it responds to many of the issues that I and others raised in Committee with the previous Bill.

The comprehensive regulation of all vaping and nicotine products is important for addressing the concerns that vaping has become too widespread among young people. I strongly support regulations to reduce the appeal of such products, but we must ensure that the regulations are enforceable, robust and fit for purpose. My first of many questions to the Minister is this: will he confirm that a detailed policy paper will be forthcoming, setting out the policy objectives on vaping and how the new regulations will deliver against the objectives?

The Labour manifesto made a bold commitment on halving the gap in healthy life expectancy between the richest and poorest regions in England. Tobacco control is the best way to close the gap. We cannot say it enough: the range of diseases that smoking causes is extraordinary, from stillbirths and asthma in children to heart disease, stroke, dementia in old age, poor mental health and many cancers.

It will never cease to amaze me that there are people in this place who are happy to be lobbied by the tobacco companies—including, I am guessing, the shadow Secretary of State—some of whom we have heard from already, knowing full well the damage caused to individuals, families and communities, as well as to our health services. That includes communities such as mine in the north-east of England, where smoking is still the key driver of health inequalities and has been the cause of 26% of all deaths in the last 50 years and the cause of 125,000 deaths since 2020.

In my constituency of City of Durham, smoking costs us over £95 million a year, and more than £3 million is spent on healthcare. In County Durham, smoking costs us over £500 million a year, and over £21 million is spent on healthcare. In the north-east, the cost is over £2 billion, with healthcare costs at over £93 million. Nationally, smoking is still the greatest cause of preventable death, still the leading cause of premature death and disability, and still responsible for half the difference in healthy life expectancy between the rich and poor. That is why I have asked time and again in this Chamber for action.

It is a tragedy when we consider the further health implications. According to Cancer Research UK, the most deprived communities will not be smokefree until 2050. I urge the Government to restate their intention to publish a road map to a smokefree country and outline how support will be targeted at those who most need to quit. Smoking is also directly and indirectly linked to poor mental health. Nearly 40% of those who have a severe mental health problem smoke, and smoking accounts for two thirds of the reduction in life expectancy among that group.

I want to touch on the “polluter pays” levy. The Darzi review found that our health service is in real trouble. The Secretary of State is right that to rebalance supply and demand in our healthcare system, we need a major shift from sickness to prevention. The Khan review and the all-party parliamentary group on smoking and health have advocated for a “polluter pays” levy, which could raise £700 million a year to create a smokefree fund. That would ensure that the tobacco companies—not the public—pay for the harm that they inflict. Will the Minister consider that approach to fund the work needed to reduce smoking across society and to protect the NHS?

I should add that public health initiatives to tackle smoking are remarkably good value for money and that failing to fund efforts to tackle smoking is a false economy. Initiatives such as Fresh—the north-east’s tobacco control programme—have led the way in tackling smoking in our region. Fresh and others could provide best practice for the Department.

The Minister will know that the UK Government are party to the World Health Organisation framework convention on tobacco control. Article 5.3 seeks to protect policymaking from industry influence, but we have already seen that influence even at this stage of the Bill. Will the Minister confirm that the Government will live up to their obligations under the FCTC and commit to protecting the Bill from industry influence throughout its parliamentary process and the following regulations?

I am proud to vote for a Bill that will improve people’s lives and extinguish the injustice that smoking causes to individuals and society. Smoking is never about choice, and it is pathetic that some Members have argued that this is an issue of freedom; it is absolutely nothing of the sort. Tobacco companies target children and young people. Smoking is an addiction, and the only free choice is that first cigarette. When someone is in hospital, struggling to breathe because of smoking-induced lung cancer, where is their freedom? Today, we have the opportunity to give people the freedom to live healthy lives, free from disease and the inequalities that smoking causes.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

Woman and Equality: North of England

Mary Kelly Foy Excerpts

Tuesday 5th November 2024 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

I beg to move,

That this House has considered inequalities faced by women in the north of England.

It is a pleasure to serve under your chairmanship, Sirusb Christopher. This debate is about the “Woman of the North” report, published in September 2024 by Health Equity North. I thank Health Equity North for the report and for their support for today’s debate, as well as all those who contributed to that vital research.

Women in the north of England face unequal challenges and inequalities in their lives and their health, compared with the rest of the country. They are more likely to work more hours for less pay and be in worse health. They are also more likely to be an unpaid carer, live in poverty and have fewer qualifications. In fact, the inequality between women living in the north of England and those in the rest of the country has grown over the past decade. It has harmed women’s quality of life and work and harmed their communities and families.

Today, I am going to debate the key findings of the research and highlight the report’s recommendations. The report does not make for easy reading. Even though the Minister, like me, will be all too aware of the impact of austerity on our communities, many of the findings will, I am sure, come as a shock, as they did for me.

I will not be able to cover everything, but I hope the debate will begin a dialogue between the Department and the contributors to this important research.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this issue forward. First, there is an anomaly—there are two and a half times more self-employed men than women, with jobs and opportunities. Women have the skills and the talent, but one of the things that holds them back is childcare. It does not matter where someone is in this great United Kingdom of Great Britain and Northern Ireland: if they do not have childcare, they have nothing—they cannot get the opportunities. Last week on the TV it said that the cost of childcare for some families is as much as the mortgage. That is a massive issue.

[Mary Kelly Foy]

I could not agree more. That is why I am pleased that the Labour Government will be bringing in thousands of new nursery places and breakfast clubs, which will hopefully alleviate some of the problems of childcare. I know that childcare is an issue not just in the north of England but also in the north of Ireland.

I shall begin with employment. Employment rates for women in the north are lower than the national average of 72.2%. In my region, the north-east, the rate is just under 70%; in Yorkshire and the Humber, it is just over 70%; and in the Minister’s region, the north-west, it is just over 71%.

Disability and long-term sickness is a major issue in the north. All northern regions have levels of disability and long-term sickness higher than the national average, and considerably higher than the south-east. The report states that the resulting estimated economic cost is around £0.4 billion per annum. Compounding that is the fact that the median weekly wage for women in the north is below the national average for both full-time and part-time employment. For instance, the average weekly wage for a full-time working woman in the north-east is £569. That is much lower than the national average of £625 and considerably lower than the average weekly wage for women in London, £757. Overall, women in the north could be losing out on around £132 million a week.

In terms of education, the number of women without qualifications is higher in the north than it is in the south and the south-east. That leads to the next point about women and poverty—an issue that is worth its own debate. A higher percentage of families in the north are on universal credit than in regions in the south. In fact, the average number of families on universal credit across the north is 3% higher than in the south. The figure is even higher if London is excluded.

All 12 local authorities in the north-east have rates of absolute child poverty above the English average. By contrast, all 30 local authorities in the south-west have rates of absolute child poverty below the English average.

The north is also the region of unpaid care, with 12% of women in the north-east providing it—just under 2% higher than the national average. Health Equity North estimates that women in the north are providing around £10 billion a year in unpaid care. Harrowingly, it also estimates that, in the last decade, the life expectancy of girls born in the north of England has begun to stall and in some cases decrease. In addition, girls born in the north will not live as long in good health compared with the national average. For older women, menopause is often cited as a potential driver of change in women’s health, which makes it all the more concerning that there are regional differences in levels of hormone replacement therapy, with lower levels of HRT being prescribed in the north of England.

The picture is even more bleak when we consider pregnancy and reproductive health. We have seen the biggest increase in abortion rates between 2012 and 2021, and there has been a demonstrable relationship between austerity, the implementation of the Tory two-child limit and the increased rate of abortions. I should also add that the two-child limit itself affects over a million children in the country, and it impacts over 60,000 babies, children and young people in the north-east alone. Right now, over 25% of pregnant women in the north of England are living in the most deprived 10% of areas, with 40% of pregnant women living in the top 20% most destitute areas. Tragically, stillbirths are the highest in the most deprived communities, and highest among black African and Caribbean women living in the areas of greatest deprivation. Also, women living in poverty are at increased risk of death and depression. Subsequently, babies are at a higher risk of stillbirth, neonatal death, pre-term delivery and low birth weight.

The report also refers to smoking and pregnancy; I am glad to see that the Tobacco and Vapes Bill will receive its First Reading today. It would be good to hear from the Minister whether the Government will continue to fund the financial incentives scheme for pregnant smokers.

Women in the north of England have the highest rates of domestic violence abuse in the country, which is something that many children are exposed to. That also deserves its own debate. When we consider mental health, the report highlights that, in a cohort of over a million women aged between 16 and 65, from 2005 to 2018, the prevalence of mental illness was higher in three northern regions compared with the south of England. With severe mental illnesses, such as bipolar disorder and schizophrenia, the north-west and the north have higher prevalence rates. Lastly, the report covers the reality of marginalised women in the north, which includes a range of areas, from criminal justice to education and health, as well as issues related to homelessness and substance abuse. I do not have time to go into each point, but I encourage the Minister to read that section if he has not already, and I will either write to him about those issues or table parliamentary questions.

The report’s recommendations are spread across multiple departmental areas, so the Minister may want to follow up in writing if he prefers. One key recommendation of the “Woman of the North” report is that central Government should deliver a national health inequalities strategy—one that convenes Government Departments from across Whitehall to put health at the heart of all policies to address the wider determinants of health. Many of the policies announced in the Budget, as well as the Employment Rights Bill, will be welcome, such as uprating universal credit in line with inflation and tackling zero-hours contracts. Of course, we wait in anticipation for the child poverty taskforce strategy next year, and I sincerely hope that we will see an end to the Tory two-child limit. In addition, the report recommends that the Treasury should consider targeted support for pregnant women, as well as improving childcare. When it comes to local and regional government, which I know the Minister has experience in, the report suggests targeted support delivered to 11 to 18-year-olds through careers hubs in the areas of greatest deprivation and a higher level of the adult education budget for the north. Greater support is also required for women navigating the social security system and for social security uptake, and for women to transition back to their families and integrate into their communities after involvement in the criminal justice system.

Finally, with health and social care, NHS England could provide additional support and investment for women’s health hubs, and health services should be supported to collect routine data on ethnicity and other key demographic data. That would help deliver better information for service development and improve our understanding of different health needs. It would also explore the ways in which the services’ work can be adapted to address health inequalities across different population groups, with examples including providing cultural sensitivity training, adopting a trauma-informed approach to care and promoting person-centred approaches.

I have been an MP since 2019 and have spoken about health inequalities ever since I was elected. Today’s debate is not pleasant, but I am genuinely hopeful that we can turn a page under a Labour Government. We have already seen positive measures, such as those in the Employment Rights Bill and the Budget. I look forward to the Minister’s reply and hope to work with him alongside Health Equity North to deliver happiness and dignity for women in the north, which is long overdue.

Oral Answers to Questions

Mary Kelly Foy Excerpts

Tuesday 15th October 2024 Commons Chamber

[Wes Streeting]

The right hon. Alan Milburn is alive, he is safe and we are treating him well.

[Mary Kelly Foy (City of Durham) (Lab)]

October is Breast Cancer Awareness Month, and I stand here today as someone who was diagnosed, treated and cured of breast cancer this year by the amazing staff in the north-east, but not enough women are taking up their breast screening appointments. Will the Minister do more to raise awareness of, and access to, breast screening appointments, and may I urge all women to check themselves regularly?

[Andrew Gwynne]

I pay tribute to my hon. Friend for her work in this area and for setting out eloquently her own personal experiences. Of course this Government will do more to raise awareness and enable more women to access breast screening services.