Breast Cancer Screening

Jim Shannon Excerpts

Wednesday 16th December 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Sir Edward. First of all, I congratulate the hon. Member for High Peak (Robert Largan) on the way that he set the scene. I thank the hon. Member for West Bromwich East (Nicola Richards) for her contributions, as well as the hon. Member for Westmorland and Lonsdale (Tim Farron), and I also thank him for the leadership that he gives to the all-party parliamentary group on radiotherapy. I am a member of that APPG, but I know that the person who moves it and makes it happen is the hon. Gentleman, along with other colleagues who are trying to make this subject a focus for every one of us.

The statistics for breast cancer are horrifying. The hon. Member for High Peak set them out in his introduction, but I want to repeat them. It is salient and important to focus on the stats, because they are not just stats: they are a person’s life and they affect everybody around them. That is what I want to refer to. The breast cancer stats are clear: 55,000 women and 370 men are diagnosed every year in the UK. We sometimes overlook the fact that men can get breast cancer—not in the same numbers or percentages as ladies, but none the less it can develop in them.

One in seven women in the UK will develop breast cancer, and 35,000 women are living with incurable secondary breast cancer. Almost 1,000 die from breast cancer in the UK every month. Perhaps if they had screening, that would not have happened. That is 1,000 mothers, daughters, sisters—1,000 homes that will never recover from the loss. We must never underestimate the loss and hurt that people feel when someone they love is no longer there. We sometimes focus on the “if only”—we do not know what that “if only” would have done, but it does come into our minds and our questions.

About 600,000 people in the UK are living with or beyond breast cancer. Let us be honest: if it is caught in time and if the surgery and treatment go correctly, people can live for longer. We should perhaps not always focus on the negatives, although this debate is about breast cancer and is an opportunity to highlight the issues that we feel are important. Health is a devolved matter in Northern Ireland, and I understand that the Minister cannot answer for it—I am not asking her to—but I want to make a contribution to this debate because what happens here on the mainland will be replicated in Scotland, Wales and Northern Ireland.

I said that it is not only the person who has breast cancer who suffers. We have to look at the families around them who also suffer—those who feel the pain of their partner or loved one who unfortunately has breast cancer and, in some cases, is still waiting for the treatment or screening that they need.

I am my party’s spokesman, and I have a deep interest in health matters. That is why I attend all health debates whenever I have the opportunity. I cannot get to them all, but I do my best to get to most of them. Back in Northern Ireland, I have had the opportunity over the years to get to know some of my constituents personally. The hon. Member for Westmorland and Lonsdale referred to two names. I never refer to names—they probably would not know who they are when they are referred to in this Chamber, but I do not do that because this is a very personal thing. It is a very physical problem that they have gone through. Some of those people have survived and some have not. As an elected representative and a person with compassion, as we all are in this House, my heart goes out to those who are in need of treatment and need it now.

We cannot neglect—I do not think there is an intention to do so—those with cancer, because time is of the essence and early diagnosis is needed. This is where we are. What I and other Members want is a different set of statistics for next year. We do not want to be referring to the 100,000 and some of the other stats that I will give in a few minutes. We want statistics that show more early diagnosis, more successful outcomes and—please, God—nowhere near 1,000 grieving loved ones. How do we achieve that? That is the key issue of this debate, and why we are here. I believe we all agree on this. It is simple: screening. Early screening, frequent screening, structured screening, simple screening—screening, screening, screening. We need to get that into our minds for how we deal with this. We are here today because we all have the same idea. That is how we get better outcomes.

In the media and the newspapers yesterday and every other day I can recall, we have had stats for cancer treatment. We cannot fail to be annoyed when we see the stats for the people who are waiting for treatment, diagnosis or screening. It has all been put on hold, and we need to look at that urgently. The hon. Member for Westmorland and Lonsdale referred to the Government response to covid-19. The Government responded in an excellent way. They made all the necessary resources available and they gave us hope, up to the stage where we are now, with the vaccine in place. That hope will lead us into next year. Perhaps by this time next year everyone in the United Kingdom of Great Britain and Northern Ireland will have had that vaccine; that would be our hope.

The coronavirus is the biggest crisis that breast cancer care has faced in decades. With every month that passes, more women with breast cancer could be missing the best possible chance of early diagnosis, which is key to preventing death from the disease. The breast screening programme was officially paused in Scotland, Wales and Northern Ireland, and effectively paused in England, in March. Screening has now restarted, although that has happened more quickly in some parts of the country than others.

Breast Cancer Now has estimated that a significant backlog of nearly a million women requiring screening built up across the UK during the first pause, which is a massive number. If a million ladies are waiting to have the screening, that underlines the importance of putting resources into that, to try and give people peace of mind. It is unclear how long it will take to catch up. Around 8,600 of those women could have been living with undetected breast cancer, which is a worry.

When my wife went to get the test, we got the results back quickly, but imagine what it would be like for someone waiting for the screening if they suspected something was wrong but were not sure. Sometimes the screening can diagnose at an early stage something that the individual was not aware of or might not see themselves. Can the Minister be so kind, during her closing remarks, to clarify what the Government mean when they say they have cleared the backlog on breast cancer screening? Does that mean that open invitations to breast screening have been sent, but not that the actual screening has happened? I have every confidence that the Minister’s response will answer those questions and give us the hope and reassurance that we need.

The expected increase in referrals and backlog of women waiting for breast screening will lead naturally to an increase in demand for diagnostic and imaging services in the coming months, threatening to overwhelm a workforce that was already stretched before the pandemic. Combined with a reduction in the number of people that services will be able to see, as a result of infection prevention and control measures, there is grave concern that that may lead to people waiting longer to be diagnosed and receive treatment. Again, we need reassurance.

A recent survey by the British Medical Association revealed that 28% of doctors—the people on the frontline, doing the work—have found non-covid demand higher than before the pandemic. They recognise a serious gap that needs to be filled. Moreover, 58% are concerned about their ability to care for non-covid patients, 44% are worried about the plans to manage the huge backlog of patients and 65% say staffing shortages are their most pressing concern. I understand those concerns, and I look genuinely and respectfully to the Minister for her answers.

The unprecedented pressures put on the NHS by the first wave of the pandemic, which have already had damaging impacts on diagnosis and treatment for breast cancer patients, are now being exacerbated by the second wave and the winter pressures, which we all know are coming to every region in the United Kingdom. Winter pressures come every year, but this year they will be greater because of the waiting lists and the ways we are dealing with that.

While it is great to see Health Education England receive an additional £260 million to train more staff in 2021-22, Cancer Research UK estimates that £140 million to £260 million is needed over the next 35 years to grow the cancer workforce alone. It is not only about responding to the current waiting lists, but how we deal with the growing number of those with cancer over the next few years. An additional £260 million for HEE’s total budget in 2021-22 should go some way to address that, but will not fill the gap.

I conclude by reflecting on the comment by the hon. Member for Westmorland and Lonsdale, because to me it is the key to the issue. The Government responded in an exceptional way to covid-19. They made the resources available. A strategy for something we had never dealt with before was difficult to get together, but they did it in a way we all welcomed—we give credit where it is due—until now we have the vaccine.

However, when it comes to cancer we need a similar policy and strategy, so that we can give peace of mind to all those people who have breast cancer, and have a worrying process to go through. The Government have shown they can do it, and I believe they, and the Minister, can again respond in a way that will show us we can deal with breast cancer. We need a dedicated strategy and long-term investment. I look to the Minister to hear how that can and will be provided, in the light of the additional covid-19 demands. Covid-19 is not over yet. I wish it was, but at least we are going the right way. We can see the light at the end of the tunnel and there is hope for the future, but we need the same hope for those with cancer.

--- Later in debate ---

[Jo Churchill]

I am so sorry, Sir Edward. As I was saying, the challenge is that there is variation in the system. That variation occurs for a plethora of reasons, not only those that are covered by an impact assessment on accessibility via open appointments. It is important to keep an eye on all the data.

I am proud that we have a national breast screening programme that offers every woman between the ages of 50 and 70 an appointment every three years. We will strain every sinew to ensure that nobody waits longer than 36 months. We will not step back from that, even with the challenge of driving the backlog down. The programme reaches millions of women and detects approximately 20,000 cancers each year. I recognise the challenge, but every single individual provider has been asked to produce a recovery plan, which should help us to understand the variation. I recognise that about half a million women are waiting, but there are also 500,000 women who have not replied. They will need to be re-approached and encouraged into the system. It is incumbent on everyone to give women the confidence to come forward.

We have also had to look at making sure that women are asked to come forward in accordance with priority by targeting the women who are most likely to have an occurrence of breast cancer. High-risk women will not have open appointments; they will be called immediately. We will then screen positive women in the pathway, followed by screening results that have not been processed, routine open episodes, those who have previously been invited but not screened, and the delays. It is important that we prioritise, so that we target the women we are most worried about.

I am aware that this year, the national breast screening programme could not maintain the service that it normally provides. In March, as the NHS responded to one of the biggest challenges that has faced our healthcare system in a generation, many local providers made the decision to pause appointments so that arrangements could be put in place to protect staff and patients from covid-19. We were unaware at that point what we were dealing with. Staff and facilities were redeployed to tackle the outbreak of the pandemic, but as soon as it was possible to do so, it was made an absolute priority that they were brought back in to do the job that we need them to do.

I am sure that there is not a single Member in this Chamber, or indeed the House, who does not pay tribute to the hard work of all NHS staff. Cancer staff and their teams have done a particularly incredible job of making sure that people across the cancer family have received treatment. Earlier today, I talked to a young man about the treatment he has had, and I talked to a young woman who experienced chimeric antigen receptor T-cell treatment earlier this year. The redeployment of staff left a shortfall in the breast screening programme, and screening appointments for many women have been delayed. I know that that wait, and the anxiety it drives, is incredibly difficult. For those who are looking for reassurance from their routine screen, or who are waiting to receive an all-clear or an early warning that something is wrong, this is undoubtedly a challenging time. However, I want to be absolutely clear that no woman has been left behind, and no woman ever will be. It is a priority to ensure that services are there. Improvements are being driven by the heroic efforts of staff, who have been working longer days and over weekends. They have gone above and beyond to schedule as many appointments as possible to help to drive down the backlog that was created earlier this year.

The first priority is to screen women aged 53 who have not yet had their first screening appointment; those who have passed their 71st birthday and have not yet received their final breast screen; those at very high risk of breast cancer, as I said; and those who have been identified for further treatment. I am pleased to say that the tremendous efforts of screening staff—the nurses, the radiographers and the whole team—are succeeding and the backlog is steadily reducing. The number of women waiting for screening, having received an invitation prior to the first wave, decreased by 98% between 1 June and 4 November.

Screening has been made a clear priority this winter and NHS commissioners have been instructed, where humanly possible, not to redeploy their staff or their facilities away from screening services. It is a priority, and that is absolutely the right approach. My message to everyone is that breast screening services are running, they are safe, they will continue to run through the winter and they are standing up to the increased capacity that is coming towards them.

When people receive an appointment to attend, I urge them to go. “Do not attends” are so frustrating. Those appointments could be taken by a woman who—although she would not want a diagnosis—might get into the stream quicker.

[Jim Shannon]

I suspect that on some occasions, ladies are not attending because of the fear of catching covid-19 at the hospital. I have spoken to some ladies back home and that was one of their concerns. How can we address that?

[Jo Churchill]

Essentially, by constantly reassuring them that the reason why we can do elective operations, have out-patient clinics open and carry on doing some of the business as usual is because heroic efforts have been made to make sure that there are safe places. I pay tribute to Dame Cally Palmer, who has made sure that rapid diagnostic centres have been stood up to ensure that patients can access care safely. We had 17 at the start of the pandemic, and we now have 45. The cancer alliances have worked extremely hard in all our regions. There is no one silver bullet, but it is important that we do what we can for patients.

If people have any concerns or notice any abnormal changes in their breasts, they should contact their GP. I pay tribute to my hon. Friend the Member for West Bromwich East, and I am pleased that her mum is now in good health. CoppaFeel! is a great charity and its website shows how to do a good check. Breast Cancer Awareness Month still went on—I did wear it pink—although it did not quite have the same profile as usual. It is every woman’s responsibility to make sure that they check their breasts monthly. If they see anything unusual that they are concerned about, such as puckering or discharge from the nipple, GPs are open and there to help women.

One thing that can help is to make sure that people go, but we are here to talk predominantly about screening services. Cancer diagnostics and treatments are back on track. The latest official data for October 2020 suggests that GP referrals are back to almost 85% of pre-pandemic levels, compared with August 2019. I appreciate that that leaves a lag, but we are heading in the right direction.

Urgent referrals were 156% higher in October than in April, which is when they were most affected. That shows that we are not only getting there, but beginning to go beyond. Nearly 88% of cancer patients saw a specialist within two weeks following their referral, and nearly 96% of patients received their treatment within 31 days of a decision to treat. In October, 83.5% of breast cancer patients received their first treatment within 62 days, and breast cancer treatment activity was at 101% of last year’s levels. However, these figures do not hide the fact that there is a backlog and we have to work as hard as we can to address that. The “Help Us Help You” campaign, launched in October, is a key part of this and reinforces that message of seeking help. We will closely monitor the effect of covid restrictions on referral rates to ensure that the number of people coming forward with symptoms remains high, because it is about confidence. Some pathways are more problematic than others, but the important thing is to make sure that we get as many people as possible through the pathway.

I turn to the theme of breast screening for younger women. As the hon. Member for Midlothian (Owen Thompson) has said, this has been found not to be evidenced-based. There is a risk in referring women for unnecessary tests, in over-treatment, and in operating on women who have diseases that mean that that is likely to cause harm. Women with a very high risk of breast cancer, such as those with a family history, may well be offered screening earlier and more frequently. Sometimes, in life, we just have to ask a question, and I recently asked a breast cancer specialist about this. My hon. Friends the Members for Chatham and Aylesford (Tracey Crouch) and for Norwich North (Chloe Smith), and the former Members for Dewsbury and for Eddisbury, all of whom are in the younger age group, are going through treatment—I think one of them is post treatment—and I was their age when I was diagnosed. Just because something looks right, it does not necessarily mean that it is, and we have to act on the evidence. That is where we are at the moment for young women.

We published the people plan in July, and I recognise, as Sir Mike Richards did, that the screening workforce is a challenge and it is important that we drive more individuals into the areas of radiography, mammography, pathology, nursing and cancer specialist nursing. The spending review provided another £260 million to continue to grow the workforce and support those commitments, which were so important in the NHS long-term plan.

Health Education England has also provided £5 million to support training and development programmes through the National Breast Imaging Academy, which aims to improve breast screening recruitment targets and early diagnosis. It has already made significant progress, launching the mammography level 4 apprenticeship; recruiting the first of the NBIA radiology fellows, who will benefit from specialist training in breast radiology; and developing e-learning for health programmes on the breast.

To improve screening uptake, we need to work with cancer alliances, primary care networks and the regional teams to promote the uptake of breast screening and to get to as many people as possible. As I said, the open appointments systems is something that we are looking at, and we hope that the result will be that we get more women through. The national cancer recovery plan was released this week. It is a joint effort from cancer charities, royal colleges, national teams and patient voices, and it was led by the national clinical director for cancer, Professor Peter Johnson. Its whole ethos is to outline the actions that need to be taken to restore demand to at least pre-pandemic levels by raising national public awareness through campaigns; ensuring that there are efficient routes into the NHS for people who are at risk of cancer; improving referral management practice in primary and secondary care; and setting out immediate steps to reduce the number of people who wait more than 62 days from urgent referral, so that patients are seen as quickly and safely as possible. Finally, it ensures sufficient capacity to meet demand through maximising the use of available capacity in both symptomatic and screening pathways, which both feed into the same funnel, optimising the use of the available independent sector capacity, enabling the restoration of other services, and protecting service recovery during winter.

This is an excellent plan, which will work towards the long-term plan ambitions for cancer services to continue during the pandemic. I am fully committed to seeing it through and working with Dame Cally Palmer and all the others to ensure that we can get to a better place. I recognise that, as the hon. Member for Westmorland and Lonsdale said, there have been some remarkable changes to treatments with radiography and other treatments in cancer. We must take those silver linings where we can.

I pay tribute to my hon. Friend the Member for High Peak for coming to me to say that High Peak was special due to its geography, and he did not want the women he serves in his constituency to be disadvantaged in any way by a loss of service. I understand that the decision to put breast screening services into static positions was taken to maximise capacity. I was quite amazed that, pre pandemic, 70% to 80% of screening happened in mobile units. They are particularly helpful in dispersed rural areas, but with some of the challenges of providing covid-secure spaces—some of those units did not even have running water—a decision was made to bring them back to a static site. The static units can stay open longer and at the weekend, making about 1,000 more appointments possible in a three-month period, so a lot more women can be seen.

Although I take on board the point about travel, I am asking women to bear with us—to work with us. These are temporary changes, but they are a vital measure in the recovery of breast cancer screening services, allowing more women to be seen, particularly those who may have missed an appointment this year. I know that longer travel times are difficult. I know that those beautiful hills that my hon. Friend’s constituency is blessed with do not have particularly good bus services either. This is not always an easy proposition, but it was decided that, for now at least, optimising the service to see as many people as possible should take priority over optimising a mobile service.

When my hon. Friend came and met me, I could not give him any assurance, and he has pressed me again today. I assure him that this is a short-term measure. The increase of appointment availability will assist us in in being able to resume mobile screening for High Peak, safety permitting, by July 2021. I have been reassured by the Chesterfield Royal Hospital NHS trust that it is monitoring attendance, that this compromise is temporary, while services recover, and that the usual screening locations will be reinstated in the longer term to ease access. I take this opportunity to stress that the screening services are safe to attend and a range of measures have been put in place to ensure that people go.

I thank my hon. Friend and all other hon. Members who have participated today. I pay tribute to all the incredible staff across the country who are working so hard on the backlog and to make sure that cancer services stand up and catch up over the winter period. Hon. Members have my absolute commitment that we are focused not only on the short-term recovery of screening services, but on their long-term improvement too. Prevention, public health and early diagnosis continue to be a huge priority for me. We will continue to bear down on screening services, making sure we have the right kit in the right place and that we are delivering the different parts of the cancer pathway for men and women to have the best treatment.