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Breast Screening

Volume 817: debated on Tuesday 14 December 2021


Tabled by

To ask Her Majesty’s Government what plans they have to ensure screening of the estimated 1.2 million women in England who missed breast screening during the COVID-19 pandemic; and what assessment they have made of the extent to which health disparities may have been exacerbated due to the reduction in screening attendance.

My Lords, I beg leave to ask the Question standing in the name of my noble friend Lady Morgan on the Order Paper.

Recovery of screening has been an ongoing priority and all NHS breast screening providers are now operational. We allocated £22 million towards mobile breast screening units and £50 million towards increased regional capacity, and have collaborated across cancer alliances, primary care networks and NHS England and NHS Improvement regional teams to promote uptake. We know inequalities in screening exist, exacerbated by changes to service provision during the Covid-19 pandemic. Inequalities remain key in restoration planning, and guidance was recently published on reducing inequalities in breast screening.

My Lords, I thank the Minister for his reply. He appears to be aware that it is in fact minorities and socially deprived women who have been hardest hit by the shortfall in screening take-up due to Covid. I understand from his response that the Government are issuing guidance. What action will that guidance envisage to ensure that these minorities and deprived women receive screening for breast cancer?

The noble Baroness raises a very important point; we need to tackle inequalities not just in this area but across all healthcare. One of the things we have been looking at is research into why women in certain areas do not come forward. That is why we have invested in mobile breast screening units, so that we can take screening services closer to those people who are reluctant to come forward.

My Lords, we heard the Minister’s Answer about the money that has been pledged, but the elective delivery plan promised by the end of November has not been published. Can he say when it will be published and how it will help to find and treat the just under 10,000 fewer than usual women who would have been diagnosed with breast cancer between March 2020 and October 2021?

The plan will be published in due course. When we look at the backlog for the breast screening programme, we see that all 77 NHS breast screening providers are now operational and screening women. Some have caught up, and others are not predicted to recover by the end of March 2022. That is why NHS England and NHS Improvement have comprehensive plans, including spending and investment.

My Lords, as I can testify, breast cancer screening is vital. Allied to this is the need for funding for secondary breast cancer. I know that an audit has been launched here in England, but there are no such audits for secondary breast cancer in Northern Ireland and Scotland. Will the Minister use his good offices with those appropriate Ministers to ensure that such audits are established and that this House can be furnished with ongoing reports of the audit here in England, and the results thereof, to ensure that funding can be deployed into oncology, nursing and care support?

I thank the noble Baroness for raising the importance of co-ordination and sharing information across the devolved Administrations. I have meetings scheduled with health Ministers from the devolved Administrations, and I will make sure that my office puts this on the agenda.

My Lords, following on from the question of the noble Baroness, Lady Ritchie, will the Minister tell us how the stage of presentation of breast cancer has altered over the past two years? How many women presenting with stage 3 and stage 4 cancers had never been screened?

I thank the noble Baroness for giving me advance notice of the question, and so giving me the chance to get some information. Data on cancer stages is currently published only annually, and NHS Digital is publishing the data from 2019 on Thursday 16 December. The latest data from 2018 shows that nearly 86% of breast cancers were diagnosed at stages 1 and 2, meaning that about 15% were diagnosed at stages 3 and 4, but this was pre-pandemic. I will make sure that I get the updated data as soon as possible.

My Lords, in October, when we last had a Question on this issue, the Minister was asked about the need to ensure that innovative new treatments such as Trodelvy reach patients as quickly as possible. I gather that this issue is still not resolved. As yet, there is no agreement between the drug company Gilead and the NHS, which means that access to this transformational treatment is extremely ad hoc and unfair. Will the Minister please help to expedite this issue with NICE, the MHRA and the manufacturer?

As the noble Baroness will acknowledge, the MHRA and NICE are independent, but I can, of course, raise the issue with them.

My Lords, can my noble friend confirm that the incidence of breast cancer increases with age? If I am right in that, what plans do the Government have to help older women?

The statistics we have show that four out of five breast cancers tend to develop in women over 50. Therefore, screening is really for women between 50 and 71, which will catch most of them. The 2012 review of breast cancer screening, the Marmot review, estimated that inviting women between the ages of 50 and 70 reduces mortality in the population invited by 20%. It also found concerns about screening women outside those ages and overdiagnosis.

My Lords, this issue, like many across the NHS, is exacerbated by what the Financial Times today referred to as a workforce crisis. When will the Government take urgent action to stem the large and increasing outflow of trained medical personnel that is proving so debilitating to the provision of health services across the board?

In previous debates this week I have outlined what we are doing to increase recruitment. On the specific issue in the mammography workforce, Health Education England is providing £5 million to support a new training and development programme through the National Breast Imaging Academy. That itself will increase recruitment, improve screening targets and increase early diagnosis of cancer.

My Lords, while we wait for the routine screening programme to get back to normal, is there a fast-track mechanism for women who believe they have themselves detected a lump or a worrying change in their breast tissue to be screened and seen by a specialist?

The method for booking screenings has now changed, so people can book online on demand, rather than waiting for a referral.

Does the Minister agree that it is beyond doubt now that screening is beneficial? Can he assure us that no credence is given to those arguing that screening leads to overtreatment? Can we say that that is scotched?

My Lords, the noble Baroness, Lady Masham of Ilton, wishes to speak virtually, and I think this is a convenient point for me to call her.

My Lords, as GPs are having to work in vaccination centres, would it be possible for people who think they have or may have cancer—breast cancer or other cancers—to go straight to secondary care for investigations? GPs cannot do everything at the same time. Does the Minister agree with me that it is important to have a speedy diagnosis for cancer?

I think all noble Lords would agree with the noble Baroness that it is important we have speedy diagnosis. On the specific question, I will check and get back to her.

My Lords, will the Minister accept that, at the same time as aid and assistance to the developing world is being cut in the health sector, we are increasing the recruitment of doctors and nurses, not least from Africa, while Africa is experiencing a real issue with the distribution of the Covid vaccine? Is there not something terribly wrong there?

I thank the noble Lord for raising the issue; I know he has been a strong champion of Africa over the years. The fact is that, when it comes to recruitment, we adopt ethical guidelines in line with the World Health Organization. I will give him one example. Recently, I had a discussion with the Kenyan Ministry of Health about sending Kenyan nurses. I asked whether we were depriving them of their nurses, and was told “No; we train far more nurses than our health system can absorb, and therefore we see this as a powerful way to increase earnings for our country.”

My Lords, further to the question asked by my noble and gallant friend, Lord Stirrup, the Minister’s answer related to what was happening in the recruitment of new staff. Can he say something about what the Government are doing to retain existing staff?

I have previously announced government investment in retention programmes and looking at getting back those who have retired and increasing training places in medical schools and elsewhere.

My Lords, going back to the question from the noble Baroness, Lady Fookes, could the Minister remind the House exactly what is the rationale for not including women over 70 in the screening programme, given that, as he has conceded, vulnerability to breast cancer increases with age?

The Marmot review found that screening women outside the ages of 50 to 70 could lead to overdiagnosis and to referring women for unnecessary tests and overtreatment. But women in other categories with a very high risk of breast cancer—those with a family history, for example—are often screened earlier and more frequently. Women are not automatically invited for breast cancer screening if over 71, but they can request screening themselves.