New All-Party Parliamentary Group on Breast Cancer report finds stark inequalities in NHS services in England, with women in worst-affected areas more than twice as likely to die from breast cancer under the age of 75.

Tuesday 27 February 2018      Campaigns and policy
Lauren, a breast cancer patient
  • "Demographic time-bomb" in breast cancer workforce impacting patient outcomes, as 13% consultant breast radiologist posts are vacant – with pressures hitting North East in particular
  • The number of women attending breast screening in England reaches decade low, with the proportion being screened as low as 55.4% in some areas, compared to 82.3% in others
  • Just 61.9% of breast cancers are being detected early (stage 1 and 2) in some areas, compared to 88% in top-performing areas

A landmark new report published today by the All-Party Parliamentary Group on Breast Cancer (APPGBC) – and supported by leading charity Breast Cancer Now – has uncovered the scale of the postcode lottery in breast cancer diagnosis, treatment and care in England.

The report, A Mixed Picture: An Inquiry into Geographical Inequalities and Breast Cancer, shows that, depending on where they live in England, some women are more than twice as likely to die from breast cancer under the age of 75.

Following a year-long inquiry (October 2016 - November 2017) by the APPGBC, 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.

The APPGBC heard concerns that while new NHS structures were designed to promote local innovation and flexibility – seeing notable successes in certain areas – significant variation could become entrenched in the system, with major impacts on patients’ experiences and outcomes depending on where they live, their ethnicity or other demographic characteristics.

Leading MPs have today called for NHS England and Public Health England to address the geographical variation in breast cancer services across England and ensure all women are given an equal chance of surviving and living well with breast cancer.

The number of women attending screening appointments is inconsistent across the country

Breast screening attendance has declined in all areas of the country except London over the past decade, with significant disparities across England. For example, the proportion of eligible women screened in the past three years in Leicestershire surpassed 80% last year – while Blackpool held a countrywide-low of just 55.4%[1].

With screening uptake across England now at its lowest rate in a decade, the report also uncovers the deep-rooted nature of this variation: over the past ten years, the East Midlands has consistently been the best-performing region (75.2% uptake in 16/17), while London – despite recent efforts to address this decline – still has not once hit the national target of 70%, with uptake of just 64% in 2016/17[2].

All women aged 50-70 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 being diagnosed through the Programme.

Women are having their breast cancer diagnosed much later in some areas than others, which could reduce their chance of survival

While nationally, more breast cancers are being diagnosed at an early stage, and more CCGs are recording data on stage at diagnosis, there are stark differences in the proportion of breast cancer cases being diagnosed at an early stage between CCGs. For example, the variation ranges from 61.9% breast cancers being diagnosed early (stage 1 and 2) in NHS Gloucestershire CCG to 88.0% breast cancers in NHS Rushcliffe CCG[3].

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.

Women are more likely to die prematurely from breast cancer in some areas of the country

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.

While national survival rates have continued to improve, at CCG level mortality rates varied from as high as 31.9 per 100,000 people dying from breast cancer before the age of 75 in Newark and Sherwood CCG, to a nationwide-low of 13.3 per 100,000 in Tower Hamlets CCG[4].

The APPGBC report also found significant variation by ethnicity and demography:

  • Breast cancer is less common among women living in more deprived areas, but mortality rates are higher – potentially as a result of later diagnoses due to lower screening uptake or raising symptoms with a GP at a later stage
  • Breast cancer is less common in Black and Asian women compared to White women, but their survival rates are lower.

Major gaps in the breast cancer workforce

The inquiry heard serious concerns from NHS leaders across the country 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.

As many as 13% of breast radiologist posts in the UK are currently vacant, with a further 21% of breast radiologists due to retire in next five years[7] – with pressures hitting the North East in particular, where 33% of radiologists are due to retire[8].

These shortages can have an impact on the speed at which patients are diagnosed – with speedy diagnosis being essential in either ensuring treatment can start quickly or reassuring patients nothing is amiss.

While nearly all women (99%) in some areas will see a specialist within 2 weeks of being referred by their GP, in other areas as many as 29% will have to wait longer than a fortnight[9].

The APPGBC has asked to see clear plans about how critical shortages will be addressed in both diagnostics and nursing.

Following the report’s publication, the APPGBC 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 (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 inquiry has uncovered a concerning postcode lottery in screening uptake, early diagnosis and access to breast cancer services across England. This variation in NHS services can have a devastating impact on patients’ lives and must be addressed.

“In particular, the demographic time bomb facing the breast cancer workforce poses a worrying threat to the significant progress made in recent decades. Local workforce planning, coupled with sufficient national action and funding is now needed urgently.

“We are already seeing innovative local approaches across England, but we now urgently need to bring the worst performing areas in line with the best. While such inequalities exist, we cannot hope to meet the Government’s ambition of world-class outcomes for all NHS cancer patients. We urgently call on NHS England and Public Health England to intervene.”

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.

“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 alarming report shows many women are missing out on the best breast cancer care this country has to offer, and this is totally unacceptable. We urge NHS England and Public Health England to take immediate action to help prevent more breast cancers, detect the disease earlier and ensure all women receive fair access to the care, treatment and support they need.”

How can you help?

In just a few minutes, you can email your MP and ask them to write to your local Cancer Alliance to call on them to take action. 

Just a moment of your time could make all the difference. The more MPs that contact their Cancer Alliance, the more likely we are to see this problem tackled so that women can know they are receiving the best possible treatment and care wherever they live. Take action now. Thank you. 


For further information, you may be interested to read about the inquiry’s findings regarding shortages in the breast cancer workforce in the East MidlandsWest Midlands, North WestSouth West and Greater London.

[1] Breast Screening Programme England, 2016-17, NHS Digital, January 2018 (Report pages 15 – 16)

[2] Breast Screening Programme England, 2016-17, NHS Digital, January 2018 (Report pages 15 – 16)

[3] Breast cancers detected at an early stage (1 or 2) (2013). Cancer Tumours Focus Pack Tool, NHS England Analytical Service. Available at http://tools.england.nhs.uk/cfv2016/cancer/atlas.html

[4] Mortality from breast cancer: under 75 directly age-standardised rates (DSR) per 100,000 European Standard Population (2011-13). Cancer Tumours Focus Pack Tool, NHS England Analytical Service. Available athttp://tools.england.nhs.uk/cfv2016/cancer/atlas.html (Report page 14)

[5] Percentage of breast cancers detected at an early stage (1 or 2) (2013). Cancer Tumours Focus Pack Tool, NHS England Analytical Service. Available at http://tools.england.nhs.uk/cfv2016/cancer/atlas.html (Report page 13 – 14)

[6] Mortality from breast cancer: under 75 directly age-standardised rates (DSR) per 100,000 European Standard Population (2011-13). Cancer Tumours Focus Pack Tool, NHS England Analytical Service. Available athttp://tools.england.nhs.uk/cfv2016/cancer/atlas.html (Report page 14)

[7] Workforce Survey 2014/15, conducted by RCR, BSBR, PHE and NHSBSP. Cited by Dr Hilary Dobson, Oral evidence session 1, March 2017 (Report page 27)

[8] Workforce Survey 2014/15, conducted by RCR, BSBR, PHE and NHSBSP. Cited by Dr Hilary Dobson, Oral evidence session 1, March 2017 (Report page 27)

[9] Cancer waiting times 2015-16, NHS England. Available here (Report page 29)