Breast Cancer Screening

Owen Thompson Excerpts

Wednesday 16th December 2020 Westminster Hall

[Owen Thompson (Midlothian) (SNP)]

It is always a pleasure to serve under your chairmanship, Sir Edward. I thank the hon. Member for High Peak (Robert Largan) for securing this important debate. It is also important to thank all the NHS staff who are working so hard to keep services running during this difficult time, and the cancer charities working to keep funds coming in and awareness high, and to support those living with a cancer diagnosis. High-profile breast cancer awareness events such as the “wear it pink” photocalls that we are all so used to were lost to the virus this year, so there is a lot of ground to make up to keep the UK’s fourth biggest killer high on the political agenda.

Thanks to a combination of advances in the medical sciences, treatments, early diagnosis and screening, breast cancer survival has doubled in the last 40 years, but the necessity of disrupting routine screenings has created a danger of progress taking a significant step backwards. There are immense challenges, now, for the NHS, in meeting an influx of demand, when we are clearly still in the teeth of the pandemic. As members of the Royal College of Radiologists report, challenges are made all the tougher by the extra infection control methods needed at screening centres, limited availability of space because of distancing, and, at times, staff and equipment shortages because of redeployment.

As other hon. Members have said, Breast Cancer Now estimates that nearly 1 million women in the UK missed potentially life-saving mammograms because of covid-19. There was also a marked fall in the number of urgent breast cancer referrals from GPs during the pandemic. That was due to a range of factors, including reluctance to take up the scheduled appointments, worry about catching the virus, or a lack of awareness that while routine screenings were paused the majority of cancer treatment services continued throughout. According to Macmillan Cancer Support, 100 fewer women started treatment for breast cancer each working day in May and June 2020, compared with a year ago. It estimates that there are 50,000 missing cancer diagnoses across the UK because of covid-19 disruption.

Those are serious causes for concern. Cancer patients cannot be allowed to be collateral damage as we struggle to fight the pandemic. All of us have a role to play in encouraging take-up of opportunities for screening, self-checks and getting out the message that the NHS is there for people if they are worried about cancer. Covid continues to dominate the headlines, but the NHS has never stopped prioritising cancer cases.

Governments also have a role in communicating about cancer services, and making sure that there is investment in facilities and staff in the NHS cancer workforce. As the RCR reports, the clinical radiology workforce was already under strain before the pandemic. One in four English trusts has at least one vacant consultant breast radiologist post, and the UK has fewer CT and MRI scanners than the majority of comparable OECD countries. Decisions about the NHS are made by the devolved Government in Scotland. Thankfully, the Scottish Government are working to minimise disruption in the face of the covid-19 challenges. They have invested an additional £10 million to support cancer treatment throughout the pandemic and beyond, in addition to purchasing six additional MRI scanners and three additional CT scanners to aid cancer diagnosis, at a cost of £5.6 million.

There is much to be done, but I welcome the fact that there has been an 89.6% increase in consultant oncologists in Scotland under the current SNP Administration and a 54.4% increase in consultant radiologists. Early detection will also be improved by more GPs. Scotland has 76 GPs per 100,000 population, compared with the UK average of just 60. There are also two new early cancer diagnostic centres, which will be opened in the spring of next year.

I have a great deal of sympathy for the request to extend screening to younger men and women in the petition that we are debating today. It is always heartbreaking to hear of cases that are not diagnosed early enough, leading to long battles to fight the disease and a greater chance of lives being lost too early. We know the risk is related to age and is highest in women over 50—they account for 80% of cases—but that is cold comfort to the 10,000 women under 50 and the 370 men in the UK who receive the dreaded diagnosis each year. Catching this disease early is essential to saving more lives. I would back screening for all in a heartbeat if it was justified clinically, but it is just one tool in the toolbox and it is not always the best one to use.

There are harms as well as benefits to getting mammograms, and decisions on routine screening programmes are all about getting the balance right. The four nations of the UK all take advice on screening from medical experts at the UK National Screening Committee and the Scottish Government concur with the points made in the UK Government’s response to the petition.

If there is one thing that the pandemic should have taught politicians—perhaps even the Chancellor of the Duchy of Lancaster—it is that we should be listening to experts. Their views are so important. It is the scientists and clinicians who are guiding us through the pandemic and providing hope for a solution through their incredible efforts to find treatments and vaccines. So, too, should we trust evidence on screening. The Marmot review of the benefits and harms of breast cancer screening identified overdiagnosis as one of the dangers, stating:

“The consequences of overdiagnosis matter, women are turned into patients unnecessarily, surgery and other forms of cancer treatment are undertaken, and quality of life and psychological well being are adversely affected.”

Only 1% of cases involve men. There is a need for us to focus on messaging and spread the awareness that breast cancer is possible for both sexes, although at a far lower risk for men. Perhaps we all need to do that bit more to highlight that point, to make sure that men self-check and seek treatment where necessary.

Although there is largely consensus on the science, there is perhaps more divergence on these isles about the resources needed. Warm words about tackling cancer are easy, but they need to be backed up by sustained and substantial further investment. Ahead of November’s comprehensive spending review, the SNP called on the Government to increase funding for NHS England to match per capita spending in Scotland. That would have amounted to a £35 billion increase by 2023-24. The £3 billion offered for the next year is only a third of what we have been calling for on a yearly basis. After a decade of austerity, the sum is not even enough to cover the cost of outstanding hospital repairs in England, let alone recover from the coronavirus and deliver decent cancer care moving forwards.

I urge the UK Government to do all they can—to “build back better”, to borrow their phrase—and to properly and genuinely invest in the NHS to save lives.