All-Party Parliamentary Group on Breast Cancer report finds stark inequalities in NHS services across England – with more than a quarter of mammography posts vacant in the West Midlands.

  • While the West Midlands is still meeting national targets for screening attendance, the number of women attending mammograms in the region has fallen sharply over last decade
  • West Midlands above the national average for the early detection of breast cancer, but some areas are outperforming others – with Birmingham Cross City CCG leading the way
  • Craig Tracey, MP for North Warwickshire and co-chair of the APPG on Breast Cancer calls on NHS England and PHE to take immediate action to address variation

Shortages in the breast cancer workforce in the West Midlands have reached a critical level with more than a quarter of mammography posts vacant, according to a new report by the All-Party Parliamentary Group on Breast Cancer (APPGBC) – and supported by leading 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 overall outcomes for breast cancer are improving, stark geographical inequalities exist across England in screening, early detection and access to treatment and services.

With the report’s publication, Craig Tracey, MP for North Warwickshire and co-chair of the APPGBC has 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 West Midlands, with over 25% 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, more than a quarter (25.5%) of mammography posts were unfilled in the West 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. But despite staffing pressures, 92.7% of West Midlands patients were seen by a specialist within the recommended two weeks, compared to just 84.5% in the South West and 88.1% in the East Midlands.

Screening attendance inconsistent across England – with uptake in West Midlands falling 5.1% in the last decade

The report revealed that in the West Midlands in 2016-17, 71.2% of women invited to screening attended within six months, surpassing the national target of 70%. However, the report worryingly shows that, despite meeting the national target, screening uptake in the West Midlands has fallen sharply by 5.1% in the last ten years, reflecting the concerning countrywide decline.[if !supportFootnotes][iii][endif]

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 local variation in early detection, West Midlands is performing better than other regions in England

Despite some variation between CCGs, overall the West Midlands performed above the national average (71%) for early detection, with 73.6% of breast cancers detected at early, more treatable stages (stage 1 and 2). In Birmingham Cross City CCG – the highest-performer in the region for early detection – 30% more breast cancers were diagnosed at early stages than elsewhere in England.

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 more likely to die from breast cancer under the age of 75 in some parts of the West Midlands

 Around 42,000 women are diagnosed with breast cancer in England each year. But today’s report highlights that where a woman lives, her ethnicity and demographic characteristics can significantly affect her outcome, with 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 West Midlands varied from as low as 18.9 per 100,000 people dying from breast cancer before the age of 75 in Wolverhampton CCG, to as high as 30.0 people per 100,000 in Redditch & Bromsgrove CCG. 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.[if !supportFootnotes][v][endif]

Urgent action is needed to address geographical variation

Following the report’s publication, Craig Tracey MP and the All-Party Parliamentary Group on Breast Cancer is 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

Craig Tracey, MP for North Warwickshire and co-chair of the All-Party Parliamentary Group on Breast Cancer, said:

“Our report uncovers widespread differences in the diagnosis, treatment and care of women with breast cancer, based on where they live.

“In particular, the shortages in the breast cancer workforce in the West Midlands are incredibly alarming and must be urgently addressed. The number of women being diagnosed with breast cancer is steadily increasing and local NHS services must be fully resourced to meet this demand.

“It’s really encouraging that the West Midlands as a whole is meeting national screening targets and is above the national average for early detection. But this report unearths wide variation across the country and we must ensure the worst-performing CCGs in the region are brought in line with the best, where local innovation is already driving real progress.

“While such variation across the region exists, we’re falling short of the Government’s ambition of world-class outcomes for all cancer patients. We call on NHS England and Public Health England to work with the West Midlands Cancer Alliance to ensure they receive the support they need to meet this challenge.”

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 healthcare professionals currently taking the strain to help diagnose more patients in the West Midlands despite staff shortages, 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 urge NHS England and Public Health England to take immediate action to ensure all women in the West Midlands and across the country receive fair access to the services, treatment and support they need.”