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Breast Cancer: Women Over 73

Volume 795: debated on Tuesday 15 January 2019


Asked by

To ask Her Majesty's Government what plans they have to extend the reminder for breast cancer checks to women over 73 years old.

My Lords, routine breast screening is currently offered to women aged 50 to 70 on the basis of evidence. There is currently no evidence to suggest that inviting women over 73 for routine screening provides more benefits than harms. However, women over 70 are invited to self-refer for a mammogram every three years if they wish. They are informed of this when they attend their last routine breast screening appointment.

I thank the Minister for that Answer. The risk of breast cancer increases with age. A third of all breast cancers and a quarter of all breast deaths occur in women over 70—I have these figures from Breast Cancer Care, of which I am a patron. Older women need to know and report their symptoms. They need to be reminded, because as you get older your memory fades. Why are the reminders stopped at 70? Although there is now a trial, it stops at the age of 73. What about those of us over 73?

My Lords, the noble Baroness makes a very interesting point but the NHS breast screening policy is based on strong peer-reviewed evidence. The decision to offer routine screening to women between the ages of 50 and 70 followed support from the Marmot review, which estimated that inviting women between the ages of 50 and 70 reduces mortality from breast cancer in the population invited by 20% and saves an estimated 1,300 lives a year. It also stated that evidence to support screening outside the 50 to 70 age group was not strong enough to allow older women to be invited for screening routinely.

My Lords, does the Minister agree that although the evidence from the study leading to the introduction of screening between the ages of 50 and 73 was strong, the evidence for screening beyond 73 exists only in observational studies carried out in the United States and Australia? Would it therefore not be wise to ask NICE to conduct the same type of study it carried out before and assess the cost-benefit analysis, which includes the health benefits, relating to women over 73 who are offered regular mammography?

On the NICE review, NHS England has asked Sir Mike Richards to lead a review of the current cancer screening programmes and diagnostic capacity. He will make initial recommendations by Easter this year and the review should be finalised in the summer of 2019. The review aims to further improve the delivery of the screening programmes, increase uptake and learn lessons from the review and recent issues. I cannot say any more until the review has completed its work.

My Lords, has the department carried out any research—and if not, will it do so—into the number of women, like me, who were diagnosed with breast cancer on the final routine mammogram for which they were called? If the number is substantial, surely that indicates that the age range for the routine screening service should be extended, particularly in the light of the fact that we are all getting older.

My Lords, I can only refer the noble Baroness to the answer that I gave previously, but I am delighted that her issue was picked up and dealt with effectively in routine screening—I am pleased to hear that. However, as I said, once we know the results of the AgeX trial we can consider any other issues that may emerge.

My Lords, for the second time in a week, the noble Baroness has denied evidence that exists. The evidence from New York—a recent study—clearly shows that screening of women over 75 is valuable. Moreover, most of those cancers—about 85%—are invasive. The problem, of course, is that all cancers are more common in older people. Is it worth while paying for mammography, or is it better to pay for the surgery afterwards?

My Lords, I agree entirely with the noble Lord, Lord Winston. It is always better to do preventive care. I am a passionate believer in that, and so is the department. As I said, however, the reality is that peer reviews in this country demonstrate different evidence. At the moment, we can only look at peer-based evidence and reviews undertaken by clinicians and researchers.

Absolutely not, my Lords. Screening has to be evidence based, there are very clear criteria, and where there is a need, we will endeavour to do it. It is not about inequality or accessibility. If any lady, whatever her age, including women over the age of 73, feels that she has an issue when she is examining herself and there are abnormalities in the breast, she can refer herself to a GP or self-refer for screening. Women are openly and freely able to do it every three years and can be seen more often if the need arises.

My Lords, will the Minister please return to that question? My noble friend asked what value the state and the NHS are putting on the lives of older women, because they are not included in the screening programme. Surely that is a question that she and her colleagues need to ask themselves.

My Lords, we place the same value on everyone’s life. No one life is more important than the next. I have already answered the noble Baroness on that. We will endeavour to do everything possible to save lives where we can and where evidence demands it.