Cancer Strategy

Craig Tracey Excerpts

Thursday 22nd February 2018 Commons Chamber

[Craig Tracey (North Warwickshire) (Con)]

I am delighted to be taking part in today’s debate. I know that this is an important area for the Government. I congratulate the members of the all-party parliamentary group on cancer on securing time for the debate today. Since 2010, the Government have recognised the need to improve cancer services offered by the NHS and to make the UK a world leader in cancer research, diagnosis, treatment and care. Many innovations have been introduced, including the cancer drugs fund and the implementation of the independent cancer taskforce’s strategy. Cancer survival rates are at a record high, and access to the world’s leading cancer drugs continues to improve. It is clear that a lot of great work is already being done.

I would like to focus specifically on breast cancer. It has been a real honour for me to be co-chair of the all-party parliamentary group on breast cancer for the past three years. This has given me the chance to meet and work with a range of really inspirational people, from patients through to clinicians. It is great to see two former chairs of the group representing both Front Benches here today. During his time as chair, the Minister in particular did some really good work on age-related risk, and it is good to see that he is carrying that on. I hope that we will be able to tempt him to talk about some of the work he is doing when he speaks later.

As we know, breast cancer is the UK’s most common cancer, with 11,500 women and 80 men dying from the disease every year. That said, great strides are being made in diagnosis and treatment, leading to survival rates doubling in the past 40 years. One of the key recommendations in the cancer strategy is on early diagnosis, with a target that, by 2020, 95% of patients will be diagnosed and receive results within four weeks. I want to concentrate my remarks on an area that is critical to achieving that ambition and that is often referred to as the biggest breast cancer risk that women are not aware of—namely, breast density.

During my work with the APPG, issues surrounding breast density have become clear, particularly the increased risk and the masking of cancers in mammography. Mammograms are obviously the main method of national screening and, while considered the gold standard, evidence shows that they are not as effective for women with dense breasts. Before I move on, it is important to understand the implications of breast density. It is not uncommon, with 40% of women aged over 40 having dense breast tissue. Although it is completely normal to have, it is also a well-established predictor of developing breast cancer. Women with the highest density are between four and six times more likely to develop the disease than those with less dense breasts.

The challenge is that tumours show up as white on a mammogram, but so does the dense tissue, meaning that the cancer is missed in more than 50% of cases. To illustrate the significance of that, it is useful to recount a couple of examples given to me by patients that highlight the importance of the issue and the differences in approach by country. One lady living in the UK underwent mammogram screening from 2004 to 2012, receiving a clean bill of health each time. Shortly after her fourth mammogram, she found a lump, which was later found to be 7 cm in size and had been missed for over 10 years due to her breast tissue being 75% dense. She underwent a mastectomy and, as a result of her illness, was forced to give up her business. Six years later, she continues to undergo breast construction surgery. Compare that experience with that of another patient I met who lives in France. In 2016, her first ever mammogram was clear. However, as she was also diagnosed as having dense tissue, she was immediately referred for an ultrasound scan, which revealed an 8 mm invasive tumour. As a result of the early detection, she received minimal treatment and an extremely positive outcome. Sadly, the first experience is not unusual, with 3,500 breast cancers going undetected each year in the UK alone.

I am aware that there is a global movement to educate not only women, but also health professionals about the implications of density, with a view to ultimately saving lives by promoting earlier diagnosis, so that tumours can be found when they are small. In the USA, 30 states have passed legislation to provide women with some level of information on breast density, detailing the increased risk they face and how effective mammograms are likely to be for them. Having raised it with the Minister previously, I know that he has a great deal of interest in this area, and it is pleasing that some action is already being taken in the UK, with the Government commissioning research from the University of Warwick. However, clear evidence shows that high breast density eclipses family history as a risk factor for actually developing breast cancer.

What are the solutions? In an ideal world, the answer would be to change screening guidelines and offer further screening to those women at risk. For changes on this scale, I appreciate that we need to await the outcome of the research so that long-term decisions can be reached, but a relatively straightforward solution can be achieved right now. We should not ignore the breast cancer experts in the UK, who are already educating about breast density, as there is a definite need to promote awareness not only to women, but health professionals, including GPs, who are the usual first port of call for women concerned about their health. The simple task of educating about breast density can potentially promote more positive health outcomes, lead to less harsh treatments, reduce mastectomies, avoid secondary cancers and, ultimately, save lives.

In conclusion, I have learned an awful lot about breast density over the past two years, and I would like to think that more people will be informed about its potential impact as a result of today’s debate. However, the following questions remain. Do the women in your family or among your friends know the risk from breast density? Does your mother, wife, sister or daughter know that a clear mammogram may not actually be clear? Those potentially life-saving pieces of information should be available to every single woman to ensure that the Government’s excellent ambition to deliver world class cancer outcomes and even better cancer survival rates can be achieved.