Breast Cancer: Younger Women

Debate between Clive Jones and Wera Hobhouse

Tuesday 12th November 2024 Westminster Hall

[Wera Hobhouse]

I will come to that later in my speech, but I absolutely agree with the hon. Gentleman. We are here to make the case for earlier screening programmes for younger women, because it is becoming such an issue—the rates are increasing. It is because of Lucy’s struggle to get a diagnosis that she felt the need to speak up on behalf of the countless young people who would not question decisions made by medical professionals.

[Clive Jones (Wokingham) (LD)]

I congratulate my hon. Friend on securing this important debate. After I survived breast cancer, one of my many emotional conversations with my daughters was about having the BRCA gene. Currently, there is a postcode lottery for the availability of counselling with proper genetic guidance for those who are identified as having the gene. Does my hon. Friend agree that NHS England should ensure equitable access to information and counselling services, and that fixing the system should be a feature of the Government’s future cancer strategy?

[Wera Hobhouse]

I am sorry to hear that my hon. Friend went through a cancer diagnosis, and I am glad that he recovered. Breast cancer in men is not as well known; people do not necessarily recognise that men can develop breast cancer. Once a diagnosis is made, it is quite traumatic for the whole family. Counselling services need to be adequate, and I agree that there should not be a postcode lottery.

The description of Lucy’s story is in no way meant as an attack on the NHS. Since she was diagnosed, Lucy has received the top-class care for which the NHS is renowned, but she is not alone in having her age used against her. There are countless similar stories of women of a similar age or younger who have found it difficult to receive an initial diagnosis, with concerns often dismissed too early by doctors as hormones, anxiety or tiredness. This is by no means the doctors’ fault; they are forced to make difficult decisions about who to prioritise because of the impossible time and budget constraints that are imposed on them. That does not, however, make it acceptable.

There is a long-standing myth that breast cancer only affects older women, but there has been a global surge in cancers among the under-50s over the past three decades—sadly, the issue is not limited to breast cancer. Last year, a study found that cancer cases in under-50s worldwide are up nearly 80% in the last 30 years. More than a million under-50s are dying of cancer each year, and that figure is projected to rise by 21% by 2030.

I draw attention to the “Jess’s Law” petition, which has more than 350,000 signatures, to improve the awareness and diagnosis of cancer in young adults. It points out the struggles young adults face in getting diagnosed, even though adults aged 25 to 49 contribute around a tenth of all new cancer cases. According to Cancer Research UK, cancer rates in 25 to 39-year-olds in the UK increased by 24% between 1995 and 2019. In 2019 alone, almost 35,000 people in that age bracket were diagnosed with cancer.

The trend is especially alarming in breast cancer. Diagnoses of breast cancer have increased steadily in women under 50 over the past two decades, but in recent years the increase has been even more stark. In 2013, breast cancer cases in women under 50 topped 10,000 for the first time. To the alarm of experts, breast cancer diagnoses in women under 50 have risen by more than 2% annually over the past five years, so the trend is clearly an increase. That is deeply concerning, especially since women under 50 are nearly 40% more likely to die from breast cancer than are women over 50.

It is truly alarming that in the UK, breast cancer accounts for 43% of all cancers diagnosed in women aged 25 to 49. Despite that, we continue to wait until women are 50 or older to begin routine screening. Why are we delaying early detection when the rates of breast cancer in younger women are rising year on year? Cervical cancer screening is available to women from the age of 25, but of the top 10 cancers detected in those aged 25 to 49 in the UK, breast cancer outweighs cervical cancer by more than five times, so that discrepancy simply does not make sense. If we can screen for other cancers earlier, we should do the same for breast cancer. We all know that early detection saves lives, so we must ensure that all women, regardless of their age, have the opportunity to access lifesaving screenings.

Young women are more likely to develop aggressive forms of the disease. Breast cancer is the most common cancer in women, and it remains one of the leading causes of death in women under 50 in the UK. Unfortunately, as Lucy’s story shows, younger women often face more challenges to diagnosis. They are more likely to be diagnosed at a later stage of the disease, with larger tumours and greater lymph node involvement. Cancer in younger women is also more likely to be biologically aggressive: sub-types such as triple negative breast cancer are harder to treat and have poorer outcomes. As a result, younger women have significantly worse prognoses, with a higher risk of recurrence and death than older women. We cannot ignore that stark reality.

Premature death from breast cancer among women in their 40s accounts for the same years of life lost as those in their 50s, and substantially more than those diagnosed in their 60s. That is crucial. A death of a woman in her 40s or 50s represents not just a loss of life, but a tragic loss of potential life years.

Researchers also found an increase in the diagnosis of stages 1 and 4 tumours, which suggests that if stage 1 tumours are missed in younger women, they tend not to be found until they reach stage 4, at which point the cancer is incurable. Early detection can make all the difference. During the previous Parliament, a petition calling for funding to extend breast cancer screening to women from the age of 40 got more than 12,000 signatures. That widespread public support reflects the growing concerns about early detection.

The Government’s response was deeply disappointing. They continue to use the Marmot review as their main reference point, citing the lower risk of young women developing breast cancer and the fact that women below 50 tend to have denser breasts, reducing the accuracy of a mammogram. It is true that the risk of younger women developing breast cancer is lower, but statistics show that rates of breast cancer in women aged 25 to 49 are rising fast, and that upward trend demands urgent attention.

Although mammograms can be less effective in women with denser breast tissue, that should not limit our approach to early detection. We should continue to use modern digital mammography, but the Government should expand the use of automated breast ultrasounds. Ultrasounds are especially effective in detecting abnormalities in dense tissue that might be missed on a mammogram. The technology is not invasive; it is quick and radiation-free, and it is often used for secondary screening for women with dense breasts. Automated breast ultrasounds can detect up to 30% more cancers in women with dense breasts than mammograms alone. By embracing both mammography and ultrasound, we can significantly improve detection rates, ensuring early and more accurate diagnosis.

Last week, in the light of Sir Chris Hoy’s bravery in sharing his story about his struggle with prostate cancer, the Health Secretary asked the NHS to look at the case for lowering the screening age for prostate cancer, particularly for people with a family history of the disease. That is an important and welcome step, but we must look at extending that approach to breast cancer too. Both diseases share a significant genetic link, and a family history often increases the risk. Aligning the screening policies for prostate and breast cancers in recognition of the shared genetic risks would provide a better safety net for those affected.

Various parts of the NHS are competing for investment, but it is clear that short-term investment in this area will save money in the long term, with fewer women needing extensive long-term treatment if breast cancer is caught early. According to Breast Cancer Now, breast cancer will cost the UK economy almost £3 billion in 2024, and the annual cost could rise to £3.6 billion by 2034.

I call on the Department of Health and Social Care to review the national breast cancer screening programme to identify where changes can be made to increase capacity in the system, to ensure that, where appropriate, a woman’s initial screening appointment can happen at a lower age. I also call on the Government to investigate the merits of early optional ultrasound for women aged 30 to 49. Finally, we must educate healthcare professionals and increase resources so that younger women who seek help are always taken seriously and investigated thoroughly, and never dismissed.

It is about not just policy change, but giving people the best possible chance to fight back against cancer and live healthier, longer lives. I hope that the Minister has heard Lucy’s story and will actively look at changing the way we screen for breast cancer for good.