Breast Cancer Screening (Young Women)

Paul Burstow Excerpts

Tuesday 30th November 2010 Westminster Hall

[The Minister of State, Department of Health (Paul Burstow)]

It is a delight to serve under your chairmanship, Mr Betts, and I congratulate the hon. Member for North West Durham (Pat Glass) on securing this important debate. As others have said, it is important that we do everything possible to increase awareness of breast cancer so that people are more aware of signs and symptoms and are able to present themselves at an earlier time and thus make the chances of survival much greater. I also congratulate the hon. Lady on the work that she does in raising funds and increasing awareness of the issue, as she has done today. I note the personal experience that she draws on.

Around 40,000 women a year are diagnosed with the disease—that is a third of all cancer diagnoses in women. The hon. Lady made a good speech setting out a powerful case that needs proper consideration. It is a shame that she made the point about Ministers trotting out certain lines about coalition funding and so on, as that added nothing to the debate. I was certainly not intending to go down that line because I want to try to give a substantive response to her remarks.

Breast cancer can strike women of all ages, although a person’s risk of developing it rises dramatically after middle age, with cases peaking among women in their early 60s. The prognosis for a person with breast cancer has transformed over the last 40 years. It has gone from a consistently lethal killer, to the second-least deadly form of the disease, if judged by five-year survival rates.

The NHS breast screening programme has played a major part in that success. Since it began in 1988, the programme has made a huge difference to a woman’s chances of surviving breast cancer. Around 83% of all women with breast cancer are still alive five years after diagnosis, and among those whose cancer is detected through screening, that survival rate increases to over 96%. That is a striking demonstration of the power of detecting cancer early on—that point has rightly been made in the debate—and that is why we will make earlier detection a key part of our forthcoming cancer reform strategy.

Experts believe that the current breast screening programme saves 1,400 lives a year among the 50 to 70-year-old age group on which it focuses. That point was made by the hon. Member for Easington (Grahame M. Morris). Therefore, the hon. Lady asks a fair question about whether there is scope to widen the net and whether that would be appropriate. Should we be looking to extend the programme to cover other age groups?

Under the current programme, women aged between 50 and 70 are routinely invited for screening, and women over 70 can request to be screened every three years. The hon. Lady suggested that women as young as 30 should be invited for screening. When it comes to health care, our priority is simple—to have outcomes that compare with the very best in the world. We will achieve that by handing power to front-line professionals and basing decisions on the best available evidence. That is where there is a debate. I am interested and I listened carefully to what the hon. Lady said about the emerging evidence. However, when it comes to extending screening to all women older than 30, as far as I can see, the evidence is not there.

[Pat Glass]

May I just clarify that I am talking about women between the ages of 35 and 47 rather than 30? That is the point at which screening would be most helpful.

[Paul Burstow]

I am grateful to the hon. Lady for that clarification. In 2006, the Institute of Cancer Research published the results of a 15-year study of the benefits of screening women from the age of 40. The study invited about 53,000 women to receive annual breast cancer screening over nine years and then compared them to a control group of women who received standard NHS treatment. The study found that the reduction in deaths due to screening was not statistically significant. I understand that, for the individual, it is 100%; I understand the hon. Lady’s powerful point. She might say that, if such measures save a single life, they are worth doing. However, the study pointed out, as she seemed to guess, that early screening had significant disadvantages. Almost one in four women in the study had at least one false positive, with all the resulting distress, anxiety and unnecessary follow-up, including invasive biopsies. Currently, there are about 7 million women aged between 30 and 49 in England. I accept that she wants to screen from 35 onwards, but if the take-up rate among that population were 75%, we would be screening about 5 million more women a year. Even if the minimum age were 35, it would create the issue of false positives.

[Ian Lavery]

Does the Minister agree that there is still a huge diagnosis problem, involving the time between mammogram and results, based on what is classed as a postcode lottery? We need to look at that and ensure that each patient, regardless of wealth or where they reside, gets her mammogram results within days, not weeks.

[Paul Burstow]

Yes. It is entirely right for the hon. Gentleman to make that point. That is why this Government will publish the first ever NHS outcomes framework, which will focus much more clearly on how we ensure that the system delivers the right outcomes in terms of cancer survival. We will publish that shortly, along with a new cancer reform strategy in due course that will say even more.

The Government’s view at present is that the risks of the change proposed by the hon. Lady outweigh the benefits. However, I want to ensure that the evidence that she has discussed is properly evaluated by officials in the Department. We will consider those points and her representations carefully, and I will write to her after we have had an opportunity to do so. However, the Department’s view and the Government’s view about maintaining the status quo is shared by most countries in Europe, as well as the Council of Europe, which recommends a breast cancer screening age of 50 to 69. The United States recommends screening every two years for women aged between 50 and 74. The position that this country has adopted for a considerable time is based on international practice and the best available evidence. One must be open to changes in evidence; that is important in an evidence-based approach to developing policy.

[Grahame M. Morris]

On best practice and targeting available resources, the figures suggest that in some areas, as many as one third of women within the target group aged 50 to 70 do not attend routine screenings. There are various reasons for that. It might have to do with misconceptions about the nature of the screening test. In some urban areas, it might have to do with the fact that there is a large transient population. In my area, where we also have the problem of people failing to turn up for routine appointments, they may be reluctant or poorly educated, or a number of—

[Grahame M. Morris]

I apologise. The Minister will see the point that I am trying to make.

[Paul Burstow]

I understand fully. Today, the Secretary of State will make a statement in the House setting out this Government’s new commitments on public health and the clear lines that we are drawing on tackling health inequalities. Some of the issues clearly involve a social gradient that we must address, and we will address them in our new cancer reform strategy and public health White Paper.

[Pat Glass]

I appreciate what the Minister says about considering new evidence. Will he also take into account—this relates to the remarks by my hon. Friend the Member for Easington (Grahame M. Morris)—the issues that affect younger women and the cohort that those younger women are likely to come from? It is about obesity, hormone replacement therapy and alcohol. It is younger women from low socio-economic backgrounds who are likely to be hit hardest by those things.

[Paul Burstow]

I am grateful for those points, and I am coming to them, which is why I was smiling—it was not because of the subject, which is very serious.

Let me talk briefly about partial age extensions, which is another issue worth airing. The last cancer reform strategy committed the Government to extending the NHS breast screening programme to women between the ages of 47 and 73. Beyond 73 years of age, patients would still be able to self-refer. That extension will ensure that all women are invited for screening before their 50th birthday. The June revision to the NHS operating framework confirmed that the extension will begin this year—in 2010-11. By the end of March next year, we expect 60% of screening programmes to be screening that wider age group, and we obviously want to go as far and as fast as we can.

Our updated cancer reform strategy will focus on outcomes and on improving cancer survival rates. Although the one-year and five-year survival rates have improved in recent years, we still lag behind other European nations. If we could match the five-year survival rates of the best countries in Europe, we could save up to 10,000 lives every year in England. As has been said, therefore, early diagnosis is essential. In September, I announced funding for a new £9 million campaign to get people to recognise and, importantly, to act earlier on the signs and symptoms of cancer. We are talking not so much about a campaign as a series of 59 local campaigns, which will focus on the three big killers: breast cancer, bowel cancer and lung cancer. The campaigns will raise public awareness of symptoms and encourage people to talk to their GP at the earliest possible opportunity. We will target those populations that the hon. Member for Easington talked about, which are often harder to reach.

Our approach will also encourage GPs and others in primary care to act appropriately. The tragedy of these cancers is that they are preventable. As has been said, lifestyle—eating too much, drinking too much and not getting enough exercise—plays a big part. That is why the coalition is determined that public health will become a far more important part of overall public policy and practice nationally and locally. We will make sure that we treat and prevent cancer in that context. That is why we will, as I said, publish a White Paper later today to set out how we will provide the right leadership and the strategy to improve people’s lifestyles and to reduce their risk of getting cancer in the first place.

[Natascha Engel]

Will the Minister briefly outline his opinion regarding national funding for the hereditary breast cancer helpline? It is a national service and it needs national funding, but the Department of Health has said that it is more appropriate to fund it locally. This incredibly important service provides information and advice and helps women up and down the country. What does the Minister think needs to be done about it?

[Paul Burstow]

I am grateful to the hon. Lady, and I certainly pay tribute to the work that the helpline does, but it is important to stress that NHS organisations and commissions are responsible for such funding, so it is perfectly possible for them to collaborate to make the resources available.

The hon. Lady rightly refers to inherited cancers. It is perhaps important to stress that about 5% of women will contract breast cancer simply because it runs in the family. National Institute for Health and Clinical Excellence guidance published in 2004 recommends that women with a moderate or higher risk of familial breast cancer should receive annual screening. However, across the NHS, delivery is patchy, and we have heard examples of that patchiness in the debate. Women deserve better than that; they deserve a consistent service wherever they happen to live. For that reason, the NHS breast screening programme will soon take responsibility for ensuring that familial screening is regularly and routinely carried out.

In conclusion, I very much respect the points that the hon. Member for North West Durham has made, the passion with which she delivered them and the commitment that she clearly has to improving our ability to detect these cancers early and prevent them. We must do everything we can to improve survival rates and to improve the quality of life for those living with cancer. We will do that by focusing resources on what works and where the evidence demonstrates the risks are outweighed by the benefits. In this instance, the evidence at the moment is clear: extending annual breast cancer screening to all women over the age of 35 would not improve their chances of surviving the disease. However, it would mean that we would need to ensure that we did not place women in a situation where they felt unnecessary anxiety as a result of false positives. We will always act on best evidence, which is why I make the undertaking to take away the evidence that the hon. Lady referred to. At this time the evidence does not lead us to conclude that there is a case for change. But we will keep it under review.

I thank the hon. Lady for raising these matters today. The Government are determined to achieve the best possible outcomes for people with cancer through our public health strategy and our cancer strategy. We are committed to ensuring that the resources are there to avoid the postcode lottery that some hon. Members described, an inheritance that we are determined to deal with.