Breast Cancer: Younger Women

Wera Hobhouse Excerpts

Tuesday 12th November 2024 Westminster Hall

[Martin Vickers (in the Chair)]

I will call Vera Hobhouse to move the motion, and I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in 30-minute debates.

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered breast cancer in younger women.

It is a pleasure to serve with you in the Chair, Mr Vickers. I thank the Minister for being here to respond.

Every woman deserves a fair chance against breast cancer, no matter her age. It is the most common type of cancer in the UK. Most women who are diagnosed are over 50, and it is therefore a disease often associated with older women, but young women are at risk, too. Breast cancer in younger women is often caught later when it is more advanced. That is because there is no routine screening and too often symptoms get dismissed as something less serious. That must change. Awareness and early detection are crucial, no matter your age.

The issue arose for me during a constituency surgery when my Bath constituent Lucy shared her story, which resonated with me because my nephew’s mother died many years ago of breast cancer aged 35. In 2021 Lucy, who was 38, had two young children and was diagnosed with primary breast cancer. She underwent a mastectomy, chemotherapy and radiotherapy before being given the all-clear. In 2024, when she was 41, a self-initiated MRI scan tragically came back showing that her cancer had returned, leading to a diagnosis of secondary breast cancer, which is currently incurable. In both cases she found it a struggle to be diagnosed.

The first time, despite her mother having had breast cancer and Lucy presenting with a lump, at least three different doctors told her that it was likely to be hormones and nothing to worry about. It was not until she requested the biopsy, which ultimately came back showing it was cancer, that the diagnosis was made. The second time she repeatedly voiced concerns about a symptom that she was experiencing, but she was repeatedly assured that it was just a side effect of the treatment. Still concerned, she approached the GP, who did some initial tests but ultimately suggested that her worries were anxiety-driven. After that appointment she came out and sobbed in her car.

Searching for peace of mind, Lucy then paid privately for a breast MRI, which tragically revealed that the cancer had returned, but by then it was too late. In both cases—first by requesting the biopsy and secondly by initiating an MRI—it was up to Lucy to fight for a diagnosis.

[Helen Grant (Maidstone and Malling) (Con)]

I congratulate the hon. Lady on securing this important debate. Because of the age restrictions in accessing NHS mammograms and the importance of early diagnosis, which she highlights, does she agree that self-awareness and self-examination in young women is critical in the battle to beat breast cancer?

[Wera Hobhouse]

The hon. Lady is absolutely right that we need to continue to raise awareness, but I am pointing out that even when young women are aware and go to a doctor, the doctor says, “Don’t worry about it.” However, I agree that we need to continue to make sure that women examine their breasts and are aware of the risks of breast cancer, even when they are young.

[Jim Shannon (Strangford) (DUP)]

I spoke to the hon. Lady yesterday. This is a massive issue for me and my constituents back home, and they bring it to my attention all the time. It was great to attend the Breast Cancer Now “Wear It Pink” event last month to raise awareness of the most common cancer in the UK. Studies have suggested that breast cancer among younger women has a more aggressive pathophysiology, correlating to poorer outcomes compared with those for breast tumours in older patients. Does the hon. Lady agree that consideration must be given to lowering the age requirement for breast screening to ensure quicker intervention for younger women?

[Wera Hobhouse]

I will come to that later in my speech, but I absolutely agree with the hon. Gentleman. We are here to make the case for earlier screening programmes for younger women, because it is becoming such an issue—the rates are increasing. It is because of Lucy’s struggle to get a diagnosis that she felt the need to speak up on behalf of the countless young people who would not question decisions made by medical professionals.

[Clive Jones (Wokingham) (LD)]

I congratulate my hon. Friend on securing this important debate. After I survived breast cancer, one of my many emotional conversations with my daughters was about having the BRCA gene. Currently, there is a postcode lottery for the availability of counselling with proper genetic guidance for those who are identified as having the gene. Does my hon. Friend agree that NHS England should ensure equitable access to information and counselling services, and that fixing the system should be a feature of the Government’s future cancer strategy?

[Wera Hobhouse]

I am sorry to hear that my hon. Friend went through a cancer diagnosis, and I am glad that he recovered. Breast cancer in men is not as well known; people do not necessarily recognise that men can develop breast cancer. Once a diagnosis is made, it is quite traumatic for the whole family. Counselling services need to be adequate, and I agree that there should not be a postcode lottery.

The description of Lucy’s story is in no way meant as an attack on the NHS. Since she was diagnosed, Lucy has received the top-class care for which the NHS is renowned, but she is not alone in having her age used against her. There are countless similar stories of women of a similar age or younger who have found it difficult to receive an initial diagnosis, with concerns often dismissed too early by doctors as hormones, anxiety or tiredness. This is by no means the doctors’ fault; they are forced to make difficult decisions about who to prioritise because of the impossible time and budget constraints that are imposed on them. That does not, however, make it acceptable.

There is a long-standing myth that breast cancer only affects older women, but there has been a global surge in cancers among the under-50s over the past three decades—sadly, the issue is not limited to breast cancer. Last year, a study found that cancer cases in under-50s worldwide are up nearly 80% in the last 30 years. More than a million under-50s are dying of cancer each year, and that figure is projected to rise by 21% by 2030.

I draw attention to the “Jess’s Law” petition, which has more than 350,000 signatures, to improve the awareness and diagnosis of cancer in young adults. It points out the struggles young adults face in getting diagnosed, even though adults aged 25 to 49 contribute around a tenth of all new cancer cases. According to Cancer Research UK, cancer rates in 25 to 39-year-olds in the UK increased by 24% between 1995 and 2019. In 2019 alone, almost 35,000 people in that age bracket were diagnosed with cancer.

The trend is especially alarming in breast cancer. Diagnoses of breast cancer have increased steadily in women under 50 over the past two decades, but in recent years the increase has been even more stark. In 2013, breast cancer cases in women under 50 topped 10,000 for the first time. To the alarm of experts, breast cancer diagnoses in women under 50 have risen by more than 2% annually over the past five years, so the trend is clearly an increase. That is deeply concerning, especially since women under 50 are nearly 40% more likely to die from breast cancer than are women over 50.

It is truly alarming that in the UK, breast cancer accounts for 43% of all cancers diagnosed in women aged 25 to 49. Despite that, we continue to wait until women are 50 or older to begin routine screening. Why are we delaying early detection when the rates of breast cancer in younger women are rising year on year? Cervical cancer screening is available to women from the age of 25, but of the top 10 cancers detected in those aged 25 to 49 in the UK, breast cancer outweighs cervical cancer by more than five times, so that discrepancy simply does not make sense. If we can screen for other cancers earlier, we should do the same for breast cancer. We all know that early detection saves lives, so we must ensure that all women, regardless of their age, have the opportunity to access lifesaving screenings.

Young women are more likely to develop aggressive forms of the disease. Breast cancer is the most common cancer in women, and it remains one of the leading causes of death in women under 50 in the UK. Unfortunately, as Lucy’s story shows, younger women often face more challenges to diagnosis. They are more likely to be diagnosed at a later stage of the disease, with larger tumours and greater lymph node involvement. Cancer in younger women is also more likely to be biologically aggressive: sub-types such as triple negative breast cancer are harder to treat and have poorer outcomes. As a result, younger women have significantly worse prognoses, with a higher risk of recurrence and death than older women. We cannot ignore that stark reality.

Premature death from breast cancer among women in their 40s accounts for the same years of life lost as those in their 50s, and substantially more than those diagnosed in their 60s. That is crucial. A death of a woman in her 40s or 50s represents not just a loss of life, but a tragic loss of potential life years.

Researchers also found an increase in the diagnosis of stages 1 and 4 tumours, which suggests that if stage 1 tumours are missed in younger women, they tend not to be found until they reach stage 4, at which point the cancer is incurable. Early detection can make all the difference. During the previous Parliament, a petition calling for funding to extend breast cancer screening to women from the age of 40 got more than 12,000 signatures. That widespread public support reflects the growing concerns about early detection.

The Government’s response was deeply disappointing. They continue to use the Marmot review as their main reference point, citing the lower risk of young women developing breast cancer and the fact that women below 50 tend to have denser breasts, reducing the accuracy of a mammogram. It is true that the risk of younger women developing breast cancer is lower, but statistics show that rates of breast cancer in women aged 25 to 49 are rising fast, and that upward trend demands urgent attention.

Although mammograms can be less effective in women with denser breast tissue, that should not limit our approach to early detection. We should continue to use modern digital mammography, but the Government should expand the use of automated breast ultrasounds. Ultrasounds are especially effective in detecting abnormalities in dense tissue that might be missed on a mammogram. The technology is not invasive; it is quick and radiation-free, and it is often used for secondary screening for women with dense breasts. Automated breast ultrasounds can detect up to 30% more cancers in women with dense breasts than mammograms alone. By embracing both mammography and ultrasound, we can significantly improve detection rates, ensuring early and more accurate diagnosis.

Last week, in the light of Sir Chris Hoy’s bravery in sharing his story about his struggle with prostate cancer, the Health Secretary asked the NHS to look at the case for lowering the screening age for prostate cancer, particularly for people with a family history of the disease. That is an important and welcome step, but we must look at extending that approach to breast cancer too. Both diseases share a significant genetic link, and a family history often increases the risk. Aligning the screening policies for prostate and breast cancers in recognition of the shared genetic risks would provide a better safety net for those affected.

Various parts of the NHS are competing for investment, but it is clear that short-term investment in this area will save money in the long term, with fewer women needing extensive long-term treatment if breast cancer is caught early. According to Breast Cancer Now, breast cancer will cost the UK economy almost £3 billion in 2024, and the annual cost could rise to £3.6 billion by 2034.

I call on the Department of Health and Social Care to review the national breast cancer screening programme to identify where changes can be made to increase capacity in the system, to ensure that, where appropriate, a woman’s initial screening appointment can happen at a lower age. I also call on the Government to investigate the merits of early optional ultrasound for women aged 30 to 49. Finally, we must educate healthcare professionals and increase resources so that younger women who seek help are always taken seriously and investigated thoroughly, and never dismissed.

It is about not just policy change, but giving people the best possible chance to fight back against cancer and live healthier, longer lives. I hope that the Minister has heard Lucy’s story and will actively look at changing the way we screen for breast cancer for good.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the hon. Member for Bath (Wera Hobhouse) for bringing this debate to the House, as well as other hon. Members for their interventions. I also pay tribute to the hon. Lady for championing the story of her constituent Lucy and others, such as Jessica Parsons, who have done so much to raise awareness. We have a powerful role as Members of Parliament, and I commend the hon. Lady for doing an excellent job.

The hon. Lady is absolutely right that awareness raising is key to catching cancer early, and the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly. The NHS is going through the worst crisis in its history, and this Government will turn it around so that cancer patients are diagnosed and treated on time. The investments we are making now in breast cancer treatment and research are part of our plan to make the NHS fit for the future.

Although women of any age can get breast cancer, it is much more likely to occur over the age of 50. That is why our screening programme sends women their first invitation at 50. However, I will take this opportunity to emphasise that the take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to change that. I make a plea to all hon. Members to help the Government achieve greater take-up of breast cancer screening in women over 50. Women need to come forward for screening.

Taken as a whole, the evidence does not support regular mammograms for women below the age of 50. Decisions on screening, including the age at which to offer it, are made by experts on the UK National Screening Committee, and those decisions are kept under review so that they continue to be based on the best available research. Ultrasound can be used as a diagnostic tool, but it is not appropriate for screening. Mammograms provide a fuller picture of the breast, and are better able to spot early signs of cancer. As the hon. Lady said, mammograms used for screening are less reliable for younger women given their denser breast tissue. Change in the screening age could mean a greater risk of false negatives, where cancer is missed, and there would also be a greater risk of false positives, which may lead to invasive testing when there is no need for it. Our approach is in line with that of most European countries, which screen women between the ages of 50 and 69.

For younger women who have a greater risk because of their family history, we offer screening using mammogram or an MRI scan. As I have said, the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly, and to consult their GP straight away if they have any concerns.

[Wera Hobhouse]

Lucy did that and was dismissed. Today’s debate is particularly important for awareness raising among the medical profession to ensure that women, particularly those who know about a family history of breast cancer—some do not—are not dismissed and are taken seriously.