Breast Cancer

Steve McCabe Excerpts

Thursday 18th October 2018 Westminster Hall

[Steve McCabe (in the Chair)]

This debate can last for up to three hours, but hon. Members are not obliged to fill the entire time.

[Laura Smith (Crewe and Nantwich) (Lab)]

I beg to move,

That this House has considered the future of breast cancer.

It is a pleasure to serve under your chairmanship, Mr McCabe, and to have been selected to introduce this important debate. I welcome my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and, of course, the Minister. Their presence underlines the importance of this issue. I also welcome everybody in the Public Gallery, many of whom have had personal experience of breast cancer, and all other hon. Members here today. It is important that we demonstrate our commitment to raising the profile of this issue across the party political divide. I am sure we have all been touched by this terrible disease in some way in our own lives.

I pay tribute to the remarkable people up and down the country who raise awareness of breast cancer and fight against it in their everyday lives. I want to take this opportunity to mention Rachael Bland, the BBC Radio 5 Live newsreader and presenter, who sadly passed away on 5 September. She did a remarkable thing by blogging about her experience in “Big C. Little Me.” and bringing down the barriers when it comes to living with breast cancer. Her strength and courage touched many of us, and her family and friends should be incredibly proud of her.

Between 2014 and 2016, an average of 457 women a year developed breast cancer in the South Cheshire clinical commissioning group area, which covers my constituency of Crewe and Nantwich. Sadly, in the same period, an average of 101 women lost their lives to the disease.

Today is World Menopause Day. It may seem odd that I have chosen to start my speech by talking about what might, at first glance, appear to be an unrelated issue, but the reverse is true. Breast cancer is most commonly diagnosed in women between the age of 50 and 65—the age at which women undergo the menopause. Some breast cancer treatments can bring about menopause symptoms, because they reduce oestrogen levels in the body. To make matters worse, women diagnosed with breast cancer usually cannot use hormone replacement therapy, the primary treatment for menopause symptoms, because there is strong evidence that it can increase the risk of breast cancer coming back. Some might ask whether it is really a big enough issue to warrant special attention, but we cannot afford not to pay special attention to it.

It is absolutely vital that we continue the fight to ensure that those diagnosed with breast cancer live, but we must also fight to improve their quality of life. About 70% of women with breast cancer experience severe night sweats and hot flushes, which cause major physical discomfort and anxiety, and affect their confidence. In some cases, they can even lead to serious sleep deprivation. Such problems can persist for many years. The severe and persistent symptoms of menopause are one of the main factors contributing to women discontinuing their treatment. Given that doing so can increase the chance that their breast cancer will come back, we have simply got to take this issue seriously.

What can be done? Professor Fenlon of Swansea University believes that cognitive behavioural therapy can help to ease physical symptoms, and is leading a clinical trial to assess how feasible it would be to train breast cancer nurses to deliver it. If clinical trials deem it to be effective, it has the potential to improve the quality of life of half a million women living with or beyond breast cancer in the UK, so I urge the Government to provide the NHS with resources to make the programme available in all our hospitals.

That brings me to the next issue I want to focus on: the geographical inequality in treatments and related services. It is important that the advances that I hope we are about to make in this area benefit everyone. The main CCG covering my constituents is NHS South Cheshire. I am proud to say that it was recently rated outstanding based on four pan-cancer measures, including waiting times, one-year survival rates and patient experience.

However, the report by the all-party parliamentary group on breast cancer states that there is a postcode lottery for breast cancer outcomes. All hon. Members will agree that it is simply unacceptable that women in some areas are more than twice as likely to die prematurely as women who are treated elsewhere. My CCG is set to merge with three others in the near future, and I want to ensure that my constituents continue to see waiting times fall, survival rates rise and the patient experience improve. I was shocked to read that women in some areas are one third less likely to have attended breast cancer screenings in the past three years than women living in other parts of the country.

Patients have had issues accessing off-patent drugs such as bisphosphonates, which were originally licensed for the treatment of osteoporosis but were discovered to be effective in preventing breast cancer recurrence in some post-menopausal women. When CCGs were asked last year whether they routinely fund bisphosphonates for that purpose, only 42—20%—said that they did. At the time, South Cheshire CCG said it was not doing so. I hope that the situation has improved, given that the National Institute for Health and Care Excellence has recently published updated clinical guidelines that recommend bisphosphonates. I am currently waiting to hear back from South Cheshire CCG. Is there an opportunity for the Government to make some specific interventions in the NHS long-term plan to prevent more cases of secondary breast cancer?

There is currently little incentive for manufacturers to license off-patent drugs for new uses in breast cancer. Breast Cancer Now is calling on the Government to introduce a catalyst fund in the NHS long-term plan to provide that incentive. That would make it quicker and easier for patients routinely to access cheap off-patent drugs. Breast Cancer Now commissioned York Health Economics Consortium to model how many lives we could save if the best outcomes were reached everywhere. It found that more than 1,100 lives could have been saved in 2016 if all CCGs in England had been able to reduce their mortality rates to match the lowest. Geographical inequality is not just an issue of principle; we have the potential to save lives, and if we save only one life, does that not make it worth addressing?

I would be grateful to hear from the Minister about the steps he is taking to facilitate the sharing of best practice between cancer alliances to reduce those variations. What conversations has he had with the Chancellor and his Treasury colleagues to ensure the long-term funding of cancer alliances?

If cancer alliances are properly to invest in the future of services and plan strategically, we must provide them with multi-year budgets. The APPG’s report on geographical inequality highlights that there are still worrying gaps in data collection, including in relation to the number of people living with secondary breast cancer. It is absolutely essential that we improve the cancer dashboard with more detailed performance data. After all, identifying and understanding these inequalities is the first step towards addressing them.