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House of Lords Hansard
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19 November 2018
Volume 794

Question

Asked by

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To ask Her Majesty’s Government how many facilities which conduct mammograms offer breast cushions in order to relieve the pain of breast scans.

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I beg leave to ask the Question in my name on the Order Paper. In doing so, I declare an interest as the vice-chair of the All-Party Group on Breast Cancer.

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My Lords, the use of cushions in mammography has not been formally evaluated. Therefore, information on centres that might offer them is not collated, although we know that some hospitals use cushions non-routinely after surgery or radiography. Use of cushions had been trialled but was discontinued because of interference with the reading of the mammogram. However, I have asked the advisory committee on breast cancer screening to advise on this issue.

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I thank the Minister for that concerned reply. Many women suffer intense pain during mammograms and are therefore put off returning for examination. The use of breast pads is not conclusive, but they do not seem to interfere much with the results of the mammogram. We also do not track how women react to mammograms. We do not hear the voices of women to say how they feel. Therefore, they do not inform good practice. Could the Minister say whether these issues will be addressed during any investigation or advice that he may be seeking?

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I am grateful to the noble Baroness for the Question and the spur to ask the advisory committee to look at this issue. She is quite right about the experience. It can be painful. As she pointed out, it is the experience of pain that puts some women off taking up their appointments. Around half a million each year do not take up the appointments they are invited to. That is obviously a problem if we want a comprehensive screening programme. I will make sure that the advisory committee not just considers the evidence for use of them, but looks at how we can get qualitative evidence from women to inform their use across the country.

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My Lords, can the Minister encourage the NHS to do some proper research with the women who do not turn up for a mammogram when invited to do so and bear in mind that there is more than one reason why? In my case it is the very sharp edge of the plate that sticks under your armpit. It is really extremely painful. Will he agree that such discomfort should not discourage women from attending mammograms, which are so very important for saving thousands of lives, including my own?

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Absolutely. I completely agree with the noble Baroness. Indeed, breast cancer screening saves 1,300 women’s lives every year. It is an essential part of our health system. On why women do not turn up, Professor Sir Mike Richards is reviewing all the cancer screening programmes at the moment. I will specifically put that question to him to ask him to investigate it.

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My Lords, we are told that pain or fear of pain is one of the main reasons why women decline screening. I ask the Minister: what initiatives have been investing to address the decline in breast screening uptake and to help ensure equality of access to screening?

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In addition to investigating some of the reasons through the review, a primary way in which we are encouraging women to take part in screening is through public health advertising and marketing campaigns. They have been demonstrated to have an impact. Public Health England had such a campaign on breast cancer screening this year; there will be a further campaign on cervical screening next year.

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My Lords, given that the quality of an image is dependent on the closest possible contact with the screen, and as the only radiographer in this House, can I ask the Minister how this can be achieved if we start to put cushions under people to make just a few minutes’ examination more comfortable?

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The noble Baroness is of course right. It is precisely because of interference with the image that the trial was discontinued and the evidence not collated. Such cushions are used for women across the country who are particularly sensitive or after surgery, but I have asked the committee to consider whether there are ways in which they can be used more systematically to relieve discomfort without interfering with the crucial image that needs to be captured.

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My Lords, will the Minister undertake to ask Sir Mike Richards to look at the need for large paddles for ladies who have large breasts and who may currently need to have two separate images taken on the same side, with the two images then put together, which does not always give a good picture? Not all breast screening services can supply larger paddles to have larger films.

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I am more than happy to do so. If the review is not the correct forum for consideration of such an issue, I will refer it to the advisory committee instead.

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My Lords, does my noble friend agree that, with mammography and all other forms of screening, the quality and availability of radiographers are important? Will he report to the House on the current status of radiographers in the country?

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I am happy to tell my noble friend that we are in the process of recruiting many more radiographers for the NHS, with a plan to recruit nearly 1,900 by 2021.

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My Lords, it is important that women have scans throughout their lives. They receive a reminder to go for a scan, but those reminders stop at the age of 70. The incidence of breast cancer continues after 70. Will the Minister reinstate reminders for people over that age?

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A trial is going on the moment, the AgeX trial, which is looking at the clinical effectiveness of breast cancer screening for women aged 71 to 73. However, that is a randomised control trial, so not all women are being invited.

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What steps are the Government taking to make everybody aware of the availability of breast cushions? I suspect that a lot of people do not even know of their existence, so it is time that we knew.

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That is precisely what I have asked to committee to advise on.

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I have a suspicion that were this a procedure which men had regularly to go through on a sensitive part of their body there might have been some urgency and investment to mitigate the discomfort. I welcome the assurance given by the Minister about the research that will be undertaken, but will he assure us also that resources will be made available if that research shows that such cushions or other mitigating equipment are needed to ensure that all women who need mammograms can get them?

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There is absolutely no doubt that women are much braver and have a much higher pain threshold than men. I suspect that it is not so much about the availability of the devices, because I am sure that almost every hospital has them, as about how they should be deployed in such a way as not to interfere with the screening. That is what I will be asking for advice on.