Breast Cancer Screening

Baroness Donaghy Excerpts

Thursday 3rd May 2018 Lords Chamber

[Lord O’Shaughnessy]

As always, the noble Baroness makes a very incisive point. The inquiry must look at whether there were signals and whether they were missed. That may be at the macro level or the micro level, with individual women saying to their GP, “Hang on, this is odd, I haven’t got this”. The problem has arisen because of the interaction between the screening process, which is due to run until a woman’s 71st birthday, and the extension, which was meant to run from a woman’s 71st birthday to the end of her 73rd year but was taking women into this clinical trial prematurely and randomising them. Hence, women in their 70th year did not get anything. It was the interaction of the two. It is technically quite devilish. A 70 year-old woman might or might not have known that she was due to have another one. This is one of things we have to get to the bottom of because, as the noble Baroness said, although this is about technology and computers, ultimately humans are at the centre of this problem.

The inquiry is primarily focused on the incident itself, but I imagine that if, during the course of its work, it finds out or establishes that other issues need to be pursued, such as increasing screening rates variation and so on, it will have the freedom to make those recommendations.

[Baroness Donaghy (Lab)]

My Lords, this is very close to home for me—I am probably not the only one in the Chamber. It was probably the breast screening programme that saved my life. I had no symptoms and if it had not been for regular mammograms, I would not have known. I am grateful to the health service, just as the noble Baroness, Lady Maddock, is.

The worry I have is that although I had a regular mammogram directly resulting from treatment every year for eight years, I was then told last summer at the age of 73 that the following year I would not be able to have a mammogram unless I went private. This seems to rely too much on people taking individual responsibility for their own health, which I support, but does not provide sufficient back-up for those who are perhaps fearful of having a mammogram. It is extremely painful for some women. The fear of it is still there. That explains why some of the take-up is quite poor. We have a duty of care for those in that position. Those of us who are vocal will do our best to look after ourselves.

My final point is that the cut-off is arbitrary and has a sniff of age discrimination about it. I agree with the noble Baroness, Lady Masham: there is sometimes an element in hospitals whereby perhaps you are not worth it any more. I feel obliged to say that I am still very active and working, just to make sure people think I am worth saving. That should not be the case and it ought to be reviewed. There is age discrimination. It might be just a clinical thing, but I cannot help thinking that there is some self-limitation when some of these clinical groups get together and decide what is appropriate for a woman, without consulting them as individuals.

[Lord O'Shaughnessy]

I know that the whole House will join me in saying that the noble Baroness is definitely worth it. Indeed, I am pleased to hear that her care was successful and that she is with us today. It is a very interesting question about age discrimination. We have again to separate it from the clinical advice, which I am reassured, having spent time with those involved in putting it together, is based on a proper weighing of costs and benefits—of course, that is inevitably in aggregate because we are talking about whole populations. Clinicians have autonomy to do things differently. Indeed, the offer we have given to women aged over 72 is that they can refer themselves and they will have an appointment if they want one. I can provide that reassurance to the noble Baroness.

There is perhaps a separate issue. There are sometimes problems of age discrimination in society and in the national health system itself. Could that be an issue regarding why signs were missed? We know that in some instances, the National Health Service has not been very good at listening to women on some of the issues we have debated in this House and that my noble friend Baroness Cumberlege is looking at in her review. This is a very good point that needs to be investigated properly: are there cultural reasons why signs that might otherwise have been picked up during these nine years were not? I can reassure her that the inquiry will look at this.