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Metastatic and Secondary Breast Cancer

Volume 831: debated on Monday 19 June 2023


Asked by

To ask His Majesty’s Government what assessment they have made of level of compliance of NHS Trusts in submitting data on metastatic and secondary breast cancer to the National Cancer Registration and Analysis Service as mandated from 1 January 2013.

My Lords, the cancer outcomes and services dataset is collected by the National Disease Registration Service. It captures data about the patient at the time they are diagnosed for each tumour. Compliance with the data standard is improving, as reflected in the increasing number of instances of disease progression and recurrence submitted to the dataset. The National Disease Registration Service continues to support all trusts to improve the quality and completeness of their data submissions.

My Lords, I thank the Minister for his Answer, but I will probe a little further. A clinical audit for metastatic secondary breast cancer was commissioned by NHS England in May 2021. What is the progress of this clinical audit? Given the compelling importance of working across the jurisdictions of the UK, what is the incidence of metastatic and secondary breast cancer data held by cancer registries in England, Scotland, Wales, and Northern Ireland, notwithstanding devolution responsibilities?

I am most grateful to the noble Baroness, and I pay tribute to her long-standing work on this subject. Data is very important, as it allows us to look at best practice in the various areas of the United Kingdom and how we can learn from that. It is all about the quality of data.

The Royal College of Surgeons began scoping for the audit commissioned by NHS England in October 2022. Key stakeholders will be consulted over the scoping period to determine the audit’s quality improvement goals. The scoping period concludes in September 2023 and a state of the nation report will be published in September 2024.

The noble Baroness will welcome that Cancer Focus Northern Ireland announced a £60,000 commitment to fund a two-year research audit into secondary breast cancer in Northern Ireland in February 2023. We look forward to the findings of this audit to see where we can improve our services here in England.

The Government and the NHS are committed to delivering the elective recovery plan, published in February 2022, and we are making good progress. The Government will publish a major conditions strategy, setting out a strong and coherent policy agenda that sets out a shift to integrated, whole-person care, including for cancers. The major conditions strategy will apply a geographical lens to each condition and address regional disparities in health outcomes in an interim report to be published this summer.

My Lords, the Minister referred to the major conditions strategy, but behind that lies the decision to scrap the 10-year NHS England cancer plan. Is it really wise to move priority away from cancer, given the poor outcomes in this country?

The noble Lord is right to mention the 10-year cancer plan because we are doubling down and we are committed to improving cancer outcomes in this country. We have made significant progress.

My Lords, I draw the House’s attention to my registered interests. It is one thing to collect data, but it is quite another to ensure that those data are appropriately curated and are available to drive improvements in clinical practice and provide the opportunity to accelerate the innovation agenda for the NHS through research and development. Is the Minister content that His Majesty’s Government are making sufficient progress regarding curation and access of NHS data to drive those important priorities?

I am aware that the data is made available to the research community. However, as I said in a previous answer, it is reliant on good-quality data and working with the research community. If the noble Lord knows of any specific examples, I am very happy to take that away and look into it specifically.

My Lords, recent industrial action has caused great worry and distress for many cancer patients and their families. I press my noble friend the Minister specifically on what efforts he and the department are taking to alleviate the impact of the strikes and refocus the energy on reducing cancer treatment waiting times affected by the industrial action.

My noble friend raises a very important point. Despite a very challenging environment, where ongoing industrial action has been planned, the number of patients waiting more than 78 weeks for care has decreased from 124,000 in September 2021 to just under 11,500 at the end of April 2023. There has been significant progress in reducing the cancer backlog, which was down by 4,500 patients at the end of April 2023 compared with the same period last year.

The level of disruption has, none the less, been significant. The main impact has been on cancer surgery, in addition to some out-patient appointments. The recent nursing and junior doctor strikes came after previous industrial action, meaning that the accumulative impact will continue for some time. The department and NHS England are monitoring the impact and, where possible, taking action to mitigate the impact on patients.

My Lords, the most recently published cancer registration statistics are for 2020—published in autumn 2022—which note severe disruption to data collection as a result of Covid. Data is still slow to come in. Is the data of the children of those who have had breast or ovarian cancer with either the BRCA 1 or 2 gene or the relevant ones for ovarian cancer being collected? They are at extremely high risk of developing cancer. Once that has been identified, they can get access to regular testing. If the Minister cannot answer that now, could he write to me with the answer to make sure that that is fed into the system?

I am grateful to the noble Baroness for raising that very important point; she is absolutely right. I cannot answer that specifically, but I can certainly take it back to the department and write to her.

My Lords, going back to the Question, it is encouraging that breast cancer outcomes have improved tremendously and that 85% five-year survival is what is now expected. However, this is not the case for two groups of patients: those with metastatic disease and those who are triple negative to oestrogen, progesterone and HER2 receptors. Can the Minister confirm that innovative modern drugs, including immunotherapy, should be available to these groups of patients throughout England?

The noble Lord is exactly right. I can confirm that if there any drugs that should be made available, they will be. As I said previously, if there are any specific drugs the noble Lord has in mind, I ask him to please let me know and I will take it back to the department and make sure that they are available, if appropriate.

My Lords, I did not quite understand the Minister’s answer to the question about ladies with breast cancer, and their children. Surely, the answer is quite simple: those children should be screened for those genes. If they do not have those particular mutations, they are not at any greater risk than anybody else. That is not a very difficult intervention to ensure, is it?

I bow down to the noble Lord’s expertise on this. What I said is that I did not have the answer at the Dispatch Box and that I would take the question away and report back to the department so that the noble Baroness can get a fulsome answer.

My Lords, the number of breast screenings fell below acceptable levels in the years ending March 2021 and March 2022, when uptake at first invitation fell to under 50% across England for the first time. While this might be expected given the impact of the pandemic, what assessment have the Government made of the backlog and its implications, and what remedial steps are they taking to increase screening rates and decrease the cancer risk for women?

The noble Baroness is absolutely right. The Government are increasing the available sites for screening. In terms of specific details, I will come back to her in writing. We have expanded facilities across the United Kingdom to make sure that screening sites are readily available in local communities.

My Lords, in an earlier response, the Minister referred to the success of the NHS in addressing issues of diversity. Why is it, then, that if you are a black or an Asian woman, you are more likely to die of breast cancer than if you are white?

I am sorry to hear that. I do not have the exact response to that question, but the noble Lord is right to raise it. It is deeply troubling, and I will come back to him with the answer to that.

My Lords, the Minister may be aware of the unexplained increase in what is known as early onset cancer among people in their 40s, 30s and 20s, and that in the G20 the fastest-growing cancer rates are among 25 to 29 year-olds. That is subject to ongoing research, but the thesis being put forward by experts at the moment is that it is related to dietary changes over recent decades, particularly with regard to processed and ultra-processed foods. Should the Government be waiting for this research, or should they not be acting when we know that there are so many benefits—including those increasingly understood in the area of cancer—to tackling the terrible British diet?

The noble Baroness raises a very good point and I largely agree with her. It is a well-known fact that processed foods can lead to obesity, and we have an obesity issue, not just in the United Kingdom but throughout the western world, which is connected to cancer. Unfortunately, as the noble Baroness said, it is travelling down the age groups to the 20s and 30s, which is directly due to diet. I will certainly feed that through to the department, but we will wait for the report. The Government look into all research, but it is a fact that diet has a significant link to health and well-being, full stop, but particularly to cancers.