The All-Party Parliamentary Group on Breast Cancer (APPGBC) has today (Wednesday 26 October) launched an inquiry into geographical inequalities in breast cancer services across England.
More people are developing breast cancer than ever before – with 42,000 women and around 300 men being diagnosed every year in England – and almost 10,000 patients still lose their lives to the disease each year.
While breast cancer patients should receive the same high level of treatment and care across England, unfortunately this is often not the case.
Many patients receive varying levels of care depending on where in the country they live, and inequalities continue to exist throughout the patient pathway from early diagnosis through to treatment and survival.
The following examples* show some of the variation in performance at Clinical Commissioning Group (CCG) level:
- The proportion of women aged 50 to 70 screened for breast cancer in the last three years (up to 31st March 2014) varies between 50.8% in some parts of the country and 81.5% in others.
- The proportion of breast cancers diagnosed at an early stage (stage 1 & 2, when it is the most treatable) varies from 36.3% to 88.0%
- The mortality rate from breast cancer for women aged under 75 varies between 13.3 per 100,000 women, up to 31.9 per 100,000 women.
Recent years have also seen dramatic changes to the way that health services are structured, funded and commissioned, including through the introduction of CCGs and the subsequent split in commissioning of the breast cancer pathway between NHS England and CCGs.
This has had a major impact on the way that services are provided and potentially on the treatment and outcomes experienced by NHS patients.
Led by Co-Chairs Sharon Hodgson MP, Craig Tracey MP and Dr Philippa Whitford MP, as well as Vice Chairs Jo Churchill MP and Baroness Massey of Darwen, the inquiry will seek to establish the extent of these variations and explore the impact that they are having on patients.
The group will collect evidence in three key categories – early diagnosis, outcomes and structures – investigating factors such as patient access to Clinical Nurse Specialists by local area and areas where two-week waiting times to see a specialist are consistently not being met, and the impact these may be having on patients in those areas.
The wide-ranging inquiry will also collect evidence of differences in screening uptake figures and staging data, as well as variation in mortality and survival across the country.
With the publication of a report, due in 2017, the APPGBC will make recommendations intended to reduce geographical inequalities and ensure that any new structures and developments in the health service, such as the soon to be rolled out Cancer Alliances, consider the experiences of breast cancer patients.
Jo Churchill MP, vice chair of the APPGBC, said:
“Ensuring good access to services is essential wherever a cancer sufferer lives. Breast cancer affects too many of us. Understanding the disease, prompt treatment and consistent patient pathways help outcomes – and by that I mean survival! Geography shouldn’t matter.”
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said:
“It is totally unacceptable that some breast cancer patients are experiencing treatment and care that’s not to the same high standard as in other areas of the country.
“All patients need to receive the same high quality of cancer treatment, regardless of where they live, and continued postcode lotteries in cancer care must be urgently addressed.
“As such, we are delighted that the APPGBC is taking action on this important issue and we look forward to participating in this much-needed inquiry.”
The inquiry has been launched today (26 October 2016) and the APPGBC will shortly publish a public call for evidence. The group wants to hear from clinicians, local health bodies and other experts who can share their experiences in providing cancer care in their area and monitoring performance, and can furthermore suggest reasons for any variation. Anyone who has taken action to address inequalities is particularly encouraged to give evidence.
The group also want to hear from patients about their experiences, good or bad. It may be that they were slow to be diagnosed with breast cancer, had difficulties contacting their Clinical Nurse Specialist or, on the positive side, benefitted from a treatment or service that was available at their local hospital but not elsewhere.
Although the inquiry will focus on breast cancer services and care in England, the APPGBC is very keen to learn from examples of good practice in Scotland, Wales and Northern Ireland, and so encourages people from the Devolved Nations to respond to the call for written evidence.
*Data obtained from NHS RightCare – further breast cancer-specific data can be downloaded from NHS England.