New All-Party Parliamentary Group on Breast Cancer report finds stark inequalities in NHS screening, early detection and services across England.

  • South West consistently falling short of two-week wait target, with more than 15% of patients waiting over two weeks to see a specialist
  • “Demographic time bomb” facing breast cancer workforce, with over one in five mammography posts vacant in South West
  • Despite national decline, women in South West rank third most likely to attend screening
  • Thangam Debbonaire, MP for Bristol West and co-chair of the APPG on Breast Cancer calls on NHS England and PHE to take immediate action to address variation

More women are waiting longer than the recommended two-week target to see a breast cancer specialist in the South West than anywhere else in the country, 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 – showing 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), 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.

The inquiry found the South West to be falling worryingly short of the recommended referral target – with more than 15% of patients waiting longer than two weeks to see a specialist (15.5%) – over three times more than in the North East (4.4%).

With the report’s publication, Thangam Debonnaire, MP for Bristol West 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 South West, with over one in five 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, over a fifth (22.36%) of mammography posts were vacant in the South West. 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 have a severe impact on the speed at which patients are diagnosed and therefore treated.

But women in South West third most likely to attend breast screening in England

The report revealed that, despite a slight decline (2.4%) in screening attendance over the past ten years, the South West was the third best-performing region in England for the number of women attending breast screening in 2016-17, with 73.7% of women attending within six months of invitation in 2016-17 – surpassing the national target of 70%.[if !supportFootnotes][3][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.

Local variation in South West – with women in Gloucestershire less likely to have their breast cancer diagnosed early than those in Bath and North East Somerset

Despite the South West performing above the national average (71%) for early detection and significantly above the South East (61.6%) – with 71.2% of breast cancers being detected early (at stage 1 or 2) in the region – the report uncovered major variation between local Clinical Commissioning Groups (CCGs) in the South West. For example, in NHS Gloucestershire CCG only 61.9% of breast cancers were detected at stage 1 or 2, compared to 78.7% in neighbouring Bath & North East Somerset CCG.

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 South West

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 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 South West varied from as low as 18 per 100,000 people dying from breast cancer before the age of 75 in South Gloucestershire CCG, to as high as a rate of 25.5 deaths per 100,000 of the population in Swindon 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][5][endif]

Urgent action is needed to address geographical variation

Following the report’s publication, Thangam Debonnaire 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 

Thangam Debbonaire, MP for Bristol West, and co-chair of the All-Party Parliamentary Group on Breast Cancer, said:

“Our report worryingly shows major inequalities in the diagnosis, treatment and care of breast cancer across the country. The workforce shortages and missed waiting-time targets we are seeing in the South West are of real concern, and these must be urgently addressed to ensure all patients receive the best possible care.

“But it’s great to see that the South West is one of the three top-performing regions for breast screening attendance and we now need to ensure this is matched in other areas. The earlier breast cancer is diagnosed, the more likely treatment is to be successful and we’d encourage all women to attend screening where possible.

“Our inquiry unfortunately shows that the services and care being received by breast cancer patients can vary significantly in different parts of the country, and we need NHS England and Public Health England to take action. In particular, we must ensure data is being collected fully across England to help local NHS services develop new initiatives to prevent more breast cancers and detect more cases earlier.” 

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.

“That so many women in the South West are waiting longer to see a specialist to find out whether they have breast cancer is totally unacceptable – and this 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 miss 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 South West and across the country receive fair access to the services, treatment and support they need.”