All-Party Parliamentary Group on Breast Cancer report finds stark inequalities in NHS services across England – with almost a third of mammography posts vacant in East Midlands.

  • East Midlands falling short of two-week wait target, with more than 10% of patients waiting longer than two weeks to see a specialist
  • Women in East Midlands most likely in country to attend routine mammograms, despite overall ten-year decline in breast screening uptake
  • Although Rushcliffe was the top-performing CCG in country for early detection, the East Midlands lags behind other regions
  • Leading MPs call on NHS England and Public Health England to take immediate action to address variation

Shortages in the breast cancer workforce in the East Midlands have reached a critical level with almost a third of mammography posts vacant, according to a new report by the All-Party Parliamentary Group on Breast Cancer (APPGBC) – and supported by charity Breast Cancer Now.

The landmark report, A Mixed Picture: An Inquiry into Geographical Inequalities and Breast Cancer’ uncovers the true extent of the ‘postcode lottery’ in breast cancer diagnosis, treatment and care across England, with women in worst-affected areas found to be more than twice as likely to die from breast cancer under the age of 75 than those elsewhere in the country.

Following a year-long inquiry (October 2016 - November 2017), which gathered evidence from NHS leaders, clinicians, patients and charities, the report found that while more women are surviving breast cancer than ever before, stark geographical inequalities exist across England in screening, early detection and access to treatment and services.

With the report’s publication, leading MPs have today called for NHS England and Public Health England to intervene to address the geographical variation in breast cancer services across England.

Shortages in breast cancer workforce hit the East Midlands – with almost a third of posts vacant

The inquiry heard serious concerns from NHS leaders about the “demographic time bomb” facing the breast cancer workforce. Current vacancy rates, coupled with a mammographic workforce approaching retirement, are affecting the health service’s ability to cope with increasing breast cancer incidence among an ageing population.

Worryingly, almost a third (28.99%) of mammography posts were unfilled in the East Midlands. This exceeds the England average of 19.4%, and is a stark contrast to the North East and Yorkshire & the Humber, where just 8.63% of posts were vacant. These shortages can severely impact the speed at which patients are diagnosed and therefore treated.

The East Midlands was found to be falling worryingly short of the recommended referral target – with more than 10% of patients waiting longer than two weeks to see a specialist, making it one of the worst-performing regions in the country for waiting times.

Screening attendance inconsistent across the country – but women in East Midlands most likely in England to attend routine mammograms

The report revealed that the East Midlands was the top-performing region in England for  women attending breast screening in 2016-17, with 75.2% of women invited to screening attending within six months – surpassing the national target of 70%. Despite being the highest region for uptake – outperforming the capital by almost 20% – the report showed that screening attendance in the East Midlands has fallen by 3.1% over the last ten years, mirroring the concerning countrywide decline.

Women between the ages of 50 and 70 are invited for routine mammograms every three years as part of the NHS Breast Screening Programme. A major independent review in 2012 showed that NHS breast screening prevents 1,300 deaths from breast cancer each year, with around a third of all breast cancers in the UK – roughly 16,000 cases a year – diagnosed through the Programme.

Despite Rushcliffe CCG leading the way in England for the early detection of breast cancer, the East Midlands behind other regions

Rushcliffe was the highest-performing CCG for early detection in England, with 88% of breast cancers being detected at earlier, more treatable stages (stage 1 and 2) – compared to just 61.9% in Gloucestershire. Despite this, the East Midlands was below the national average (71%) for early detection.

The earlier breast cancer is detected and diagnosed, the greater the chances of survival. 90% of breast cancer patients diagnosed at stage 1 survive for five years, compared to just 15% diagnosed at stage 4, when the cancer has spread to other parts of the body and has become incurable.

Variation in mortality rates – with women in Newark & Sherwood more likely die from breast cancer under the age of 75 than anywhere else in country

Around 42,000 women are diagnosed with breast cancer in England each year. Today’s report highlights that where a woman lives, her ethnicity and demographic characteristics can significantly affect her outcome, with some women in the most extreme cases more than twice as likely to die from breast cancer under the age of 75 as those living elsewhere.

Mortality rates in the East Midlands varied from as low as 15.4 per 100,000 people dying from breast cancer before the age of 75 in Hardwick CCG – one of the lowest rates in the country – to 31.9 per 100,000 in Newark & Sherwood CCG – the highest nationwide. The average rate for England as a whole was 19.8 people per 100,000 of the population dying before the age of 75 as a result of breast cancer.

Following the report’s publication, the All-Party Parliamentary Group on Breast Cancer is now calling on NHS England and Public Health England to urgently address the stark geographical variation in breast cancer services by:

  • improving the consistency, transparency and accountability of breast cancer services through new NHS structures (called Cancer Alliances)
  • addressing the “demographic time-bomb” in the breast cancer workforce, ensuring clear plans are published to address critical shortages in both diagnostics and nursing
  • ensuring data is finally collected effectively across the country to drive service improvements, to support the development of tailored local prevention, awareness and screening initiatives

Thangam Debonnaire MP, Craig Tracey MP and Dr Philippa Whitford MP, co-chairs of the All-Party Parliamentary Group on Breast Cancer, said:

“Our report highlights a concerning postcode lottery in the diagnosis, treatment and care of women with breast cancer in different parts of the country.

“The current shortages in the breast cancer workforce in the East Midlands, and missed waiting time targets for patients, are incredibly alarming and must be urgently addressed. The number of women being diagnosed with breast cancer is steadily increasing and it’s vital that local NHS services are fully resourced to meet this rising demand. 

“That said, it’s fantastic that the East Midlands is the best in the country for breast screening attendance. Routine screening prevents deaths from breast cancer and we need to do more to encourage more women across the country to attend.

“Our inquiry shows the urgent need for the NHS to ensure the worst-performing areas are brought in line with the best, where local innovation is already driving real progress. We call on NHS England and Public Health England to work with the Cancer Alliances in the East Midlands to ensure all cancer patients receive the best possible care.”

Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, which supported the inquiry, said:

“While overall, more women are surviving the disease than ever before, this crucial report highlights geographical variation in NHS breast cancer services on a worrying scale.

“With patients and healthcare professionals alike already feeling the impact of the workforce shortages in the East Midlands, this alarming report must now act as a wake-up call. All women with breast cancer deserve the best possible chance of surviving and living well, no matter where they live, their age or the colour of their skin.

“This report shows too many women are missing out on the best breast cancer care this country has to offer. We need immediate action from NHS England and Public Health England to ensure all women in the East Midlands and across the country receive fair access to the care, treatment and support they need.”