Breast Cancer Screening

Baroness Masham of Ilton Excerpts

Thursday 3rd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness makes an incredibly important point. To refer back to the Statement, I think that the word used was “may” and that an upper range was given. I want to distinguish between two things. The first is the national campaigns that take place—I think there were 14 in the past eight years—to encourage women to check for their own symptoms and take up opportunities for screening programmes. Those will continue; that is part of the overall programme. In terms of writing to the women who are still alive who may have been affected, that is a separate and discrete process. It will start with a letter. It is easy for us to track down those who are registered with a GP in England and we are working with colleagues in the devolved Administrations, as noble Lords would expect, to make sure that we can write to those who have moved to those countries, and to provide resources to those countries so that they can provide screening. A helpline is also included that has been publicised.

On the point about the number of deaths that may have occurred, it is a difficult issue. On the one hand, we have received advice that that may be the case and we felt that it was wrong not to be honest and transparent about it. At the same time, there is not a clinical consensus about the benefits of breast cancer screening for women aged 70 and over—that came as something of a surprise to me—because of the non-malignancy or low malignancy of some tumours that can be spotted and the harms that can follow from treatment.

So we need to be cautious. What we have projected as a range is based on statistical modelling and not based on scrutiny of actual case note reviews. Of course, we deeply hope that the number will come down as we carry out that inquiry.

[Baroness Masham of Ilton (CB)]

My Lords, why is there the magical cut-off point of 72? In the paper the Minister just read, what are the non-threatening cancers in older people and what are the harmful tests and treatment? If they are harmful for older people, what about younger people?

[Lord O’Shaughnessy]

The noble Baroness asks an excellent question. The clinical advice that we received, which is the reason for the extension of screening from up to the age of 70 to up to the age of 73, is part of a clinical trial. There is no evidence that screening necessarily benefits women in general; of course, it will benefit some women in particular. There are breast cancers—I cannot claim to be able to describe them because that is well beyond my clinical knowledge—that women can have at that age and live with, and, indeed, they can die of something else at a later age. The treatment process, whether it is chemotherapy, radiotherapy or surgery, can be very debilitating, harmful and in some cases unnecessary, although, having found a tumour, a woman may well want to progress with that treatment. We have been driven by that age range, with 72 as the cut-off, and the wider description of this lack of clinical consensus. I assure the noble Baroness that we have been informed by a clinical advisory group throughout the process to make sure that we are as accurate and effective as possible.

[Baroness Masham of Ilton]

I am glad it is not the case that older people are not worth treating.

[Lord O'Shaughnessy]

Certainly not.