How NHS England’s cancer plan can deliver progress for breast cancer

In response, Breast Cancer Now came together with 60 other leading cancer charities as One Cancer Voice (OCV). Together, we're calling for the government’s upcoming cancer plan for England to address the rising number of cancer cases and to put forward 6 tests that the plan must meet:

1. Prevention: Deliver successful policies to prevent cancer, including tackling some of the biggest risk factors 
2. Access: Pledge to meet all cancer wait times by the end of this parliament 
3. Earlier diagnosis: Outline a new earlier diagnosis target, alongside improvements to screening programmes and support for primary care so that fewer cancers are diagnosed at a later stage
4. Treatment: Ensure every patient receives the best possible treatment and address inequalities
5. Research and development: Improve patient access to relevant cancer clinical trials and make the NHS the world leading platform for cancer research and development
6. Living with and beyond cancer: Improve the quality of life for every person living with cancer, by delivering care and support that meets the needs of people with breast cancer and tackles inequalities

If the National Cancer Plan is to truly deliver, it must drive progress across these tests. At Breast Cancer Now, we’re clear that the plan must deliver radical improvements in detection, treatment and support. We’ve been working with government, NHS England and people affected by breast cancer to develop practical solutions which would deliver real change for people with breast cancer. 

Some women are at an increased risk of breast cancer due to carrying an altered gene, or because they have a significant family history of cancer. These women should have access to additional support, including extra screening and risk-reducing treatments. But we know that right now, they’re not always able to get the care they need.

In the new cancer plan, we want to see that treatment and support for women at increased risk is available consistently across England. And that the teams providing this care have the resources they need to meet demand. It’s also important that the plan includes steps to improve data collection and encourage more research into calculating and reducing breast cancer risk.

Screening finds the highest proportion of breast cancer cases at an early stage, but access and uptake of breast cancer screening isn't equal. The cancer plan should include specific actions to address the most common barriers preventing people from getting screened and reduce the inequalities in uptake.

Making screening services more flexible, convenient, and adaptable to people’s needs must be the central focus of this work. This will require upgraded technology, digital and data systems, which is why the plan must deliver the full digital transformation of screening promised over 5 years ago.

As well as improving access to breast screening, the cancer plan should also set out how the programme will prepare for the future. This should make it possible to quickly and safely rollout new innovations in screening, like risk-stratification, different imaging tools, and A.I.

Most of the delays that breast cancer patients experience are waits to be seen by a specialist and get a full diagnosis, as shown by waiting time data. However, current measurements of performance hide these delays within top line figures, making it harder to identify the causes behind long wait times.

We want to see more transparency in waiting times performance statistics, so that it’s easier to identify why people are missing the targets. More importantly, to fix the underlying issue, the cancer plan should commit to recruiting across the entire diagnostic workforce to meet the high demand for breast cancer services.

Recent changes to treatment evaluations mean that some people with incurable secondary breast cancer can’t get access to life-extending the treatments. In the case of Enhertu for HER2-low secondary breast cancer, people in England are unable to access a treatment that’s available in 25 other European countries, including Scotland.

We want the cancer plan to promise to review and reform the current drug appraisal system to ensure women with secondary breast cancer aren't denied access to treatments that can extend their lives. You can find out more about the issue in our current campaign, More Time To Live.

Getting treatment quickly is also a big challenge. High demand and limited capacity has meant long waits for systemic anti-cancer therapy (SACT) and some types of breast surgery, particularly reconstruction. The core issue here is gaps in the breast cancer workforce, which is why the cancer plan needs to provide updated, long-term workforce planning that meets the growing demand.

To improve breast cancer treatment and survival, we need cutting-edge research. But it's often hard for people to get involved in studies. And research can be hindered by poor data collection. We want to see the cancer plan include actions to make it easier for people to enrol in clinical trials. We also want it to commit to integrating breast cancer datasets to enable research and help services evaluate and improve their performance.

We think that there are around 61,000 people in the UK with secondary breast cancer. But we still don't have accurate, up-to-date data in England, despite data collection being mandatory since 2013. Without reliable data on secondary breast cancer patients, services struggle to understand their local patient population’s needs or plan to meet them.

We want to see the cancer plan establish a taskforce dedicated to solving this problem so that everyone with secondary breast cancer is counted, and services are prepared to treat them.

The cancer plan must also include steps to make sure all secondary breast cancer patients can have their needs assessed and have access to mental health and wellbeing support on an ongoing basis.

Clinical nurse specialists (CNSs) are a vital source of support, but many secondary breast cancer patients are forced to navigate their illness without a CNS. The cancer plan should commit to recruiting enough CNSs so that everyone with secondary breast cancer has access to one.

 As work on the National Cancer Plan progresses, we’ll be continuing to push for changes which deliver for people with breast cancer. The plan is a unique opportunity to transform outcomes and experiences for the better. It’s crucial that the government takes it.