- New Freedom of Information (FOI) data shows just 42 out of 208 Clinical Commissioning Groups (CCGs) across England are routinely funding 43p-a-day drugs to prevent breast cancer spread
- As key NHS performance figures stagnate, leading charity’s new ‘Good Enough? Breast cancer in the UK’ report warns that “a continued lack of leadership across UK will cost thousands more lives if simple opportunities to make further improvements are inexcusably ignored”
- Baroness Delyth Morgan: “In bisphosphonates, we have a simple and cost-effective chance to cut 10% of all UK breast cancer deaths, using drugs already at the NHS’ disposal. That this is not being taken is nothing short of a dereliction of duty.”
- Baroness Morgan: “Funding pressures are unfortunately now affecting the delivery of England’s Cancer Strategy. Amid increasing incidence, the Government and NHS England are failing to address disease prevention and secondary breast cancer – and we need to see urgent action.”
Progress on breast cancer in the UK is “stalling” as a lack of leadership continues to prevent research breakthroughs from reaching patients and see the NHS miss clear opportunities to save lives, a major new report by leading charity Breast Cancer Now has found.
Amid unprecedented financial pressures for the NHS, the charity’s landmark ‘Good Enough? Breast cancer in the UK’ report assesses the most up-to-date UK data to investigate the current state of play for the prevention, diagnosis and treatment of the disease on the NHS in England, Scotland, Wales and Northern Ireland.
The full report outlines 18 key recommendations for immediate action needed across the UK – by October 2018 – to improve the management of breast cancer on the NHS.
We are also asking supporters to email their local politicians to ask the Government to take action and address these uses.
Real progress has been seen on breast cancer in the last 25 years, thanks to NHS investment, academic discovery and increased charity support funded by the public – with more women than ever now surviving the disease. However, today’s report warns that UK survival figures are masking a “worrying plateau in progress” for NHS breast cancer treatment, amid deteriorating performance figures and missed opportunities to translate research developments into patient benefit.
While the number of women dying from breast cancer in the UK has been reduced slightly in recent years, to around 11,500 every year at present, the latest available data shows:
- A declining uptake of screening: In England, the proportion of women taking up their invitation to the NHS Breast Screening Programme fell from 74.8% in 2005/6 to 72.1% in 2015/16
- Falling waiting-time performance: While waiting-time targets for treatment in England have been met over the last year, performance has declined significantly since 2012 – from 97% patients beginning treatment within 62 days of GP referral with suspected breast cancer in Q1 2011/12, to 93.5% in Q1 2017/18 – which is largely considered to be the result of delays in diagnosis due to:
- Shortfalls in NHS diagnostic workforce: Amid continued uncertainty around the impact of Brexit, a diagnostic workforce already at crisis capacity must be urgently addressed, as 21% of breast radiologists in the UK are expected to retire by 2020, and 32% by 2025.
Furthermore, the report highlights critical opportunities that are being missed by the NHS to save more lives from breast cancer: in particular, the possibility to prevent one in ten deaths from the disease through the routine use of bisphosphonates in post-menopausal patients, and to better prevent the disease in women at increased risk due to family history through the routine use of tamoxifen (chemoprevention).
Bisphosphonates are low-cost, widely-available drugs used to strengthen bone in the treatment of osteoporosis and other conditions. But a ground-breaking analysis published in The Lancet over two years ago (July 2015) showed that they can reduce the risk of breast cancer spreading to the bone – where it becomes incurable – within 10 years by 28% (an absolute risk reduction from 8.8% to 6.6%).
They are estimated to cost 43p per day per patient1 (including consultant time and monitoring for possible side-effects2), and could be taken by all post-menopausal women diagnosed with primary breast cancer – estimated to be at least 35,700 women a year across the UK. But despite overwhelming evidence and strong clinical support from leading bodies such as the UK Breast Cancer Group and NHS England’s Breast Cancer Clinical Expert Group, the absence of clear commissioning guidance for this new use means that many patients are missing out.
In November 2016, Breast Cancer Now called on the Health Secretary to clarify which health body was responsible for funding bisphosphonates. While the Department of Health and NHS England say that it is clear that responsibility lies with local Clinical Commissioning Groups (CCGs), many CCGs remain unaware of this responsibility – an issue that leading clinicians and Breast Cancer Now have flagged repeatedly with the Department of Health and NHS England through ongoing correspondence over the last year.
A Freedom of Information (FOI) request conducted by Breast Cancer Now has today revealed that just 42 out of 208 CCGs (20.2%) across England are routinely funding these drugs for post-menopausal patients – with a further 13 CCGs (6.2%) responding that they will soon be doing so.
More progress has been seen in Scotland and Wales, where they are available in two of three cancer networks and two of three cancer centres respectively – but access is still far from routine. While not all patients would benefit – if given routinely to all eligible women in the UK, it is estimated that an extra 1,180 women each year could be prevented from dying from breast cancer – the equivalent of one in ten breast cancer deaths.
Meanwhile, with many women at an increased risk of breast cancer still not being offered the choice of taking tamoxifen to reduce their risk, major hurdles remain in ensuring patient access to off-patent drugs. Without a pharmaceutical advocate to seek a licence and commissioning guidance for the new indication, off-patent drugs shown to be effective in a new use continue to struggle to make it into routine NHS commissioning, which is now hindering NHS progress on breast cancer.
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said:
“While we have seen real strides forward in recent decades, these figures highlight a worrying plateau in NHS progress on breast cancer. Funding pressures are now affecting the delivery of England’s Cancer Strategy – and red-tape continues to prevent major research breakthroughs from reaching NHS patients.
“Amid increasing incidence, the Government and NHS are failing to address disease prevention and secondary breast cancer – and we need to see urgent action. This continued lack of leadership across UK nations will cost thousands more lives if simple opportunities to make further improvements continue to be inexcusably ignored.
“In bisphosphonates, we have a simple and cost-effective chance to cut 10% of all breast cancer deaths in the UK, using drugs already at the NHS’ disposal. Two years since the evidence of their benefit, that the Government and NHS England have not ensured all eligible patients can access these drugs is nothing short of a ‘dereliction of duty’.
“We now call on NHS England to take immediate action to ensure all CCGs are able to prescribe bisphosphonates to all eligible patients. “Crucially, this report outlines 18 clear and deliverable recommendations to ensure that we keep up the pace of progress for NHS patients – and we remain ready and willing to work with all parties to help implement them.”
Juliet FitzPatrick, a 56 year-old sports administrator from Rickmansworth, was diagnosed with primary breast cancer in January 2016. Having heard about the clinical benefit of bisphosphonates in reducing the risk of the disease spreading to the bone via an online patient support group, she asked her clinical team whether she could access the drugs.
She was told that her hospital would like to offer her the treatment but that they were unsure whether they would be able to do so as they weren’t sure about its funding. Following months of uncertainty as to whether she would be prescribed the drugs, she sadly missed the evidenced window of benefit (within the first six months after diagnosis) and is no longer eligible for the treatment.
“After my diagnosis, I felt like my world was crashing down around me. Without the support of my family and friends during my treatment, I’m not sure how I would’ve coped.
“There is always the fear of your breast cancer spreading or coming back. So I was really excited to hear about the discovery that an existing drug could help prevent this.
“While I fitted the criteria, my excitement was short-lived. I was devastated to find out my doctors couldn’t prescribe them to me because they couldn’t sort out who would pay for them. I asked about the drug at every appointment, but they could never say yes and it soon became too late for me to benefit.
“I feel so frustrated. The evidence is there. To be denied a drug which could prevent my cancer spreading, at a cost of just 43p per day, is so disappointing. While it’s too late for me, this needs to be fixed urgently so that all eligible patients can receive this potentially life-saving drug.”
Professor Rob Coleman, Professor of Medical Oncology at the University of Sheffield, said:
"That over 1,000 women a year are being allowed to die unnecessarily from breast cancer is a shameful irresponsibility – particularly when the solution is a safe and inexpensive treatment that within five years would not only save lives but save the NHS precious funds to invest elsewhere.
“The inability of NHS England to action this treatment across the country is totally unacceptable. Both European and North American guidance recommend their use and NICE has provided a supportive evidence review. This is a clear opportunity to improve the management of breast cancer on the NHS and it should be taken with immediate effect.”
Breast Cancer Now’s full report outlines 18 key recommendations for action across the UK by October 2018 to improve NHS breast cancer treatment, including:
Across the UK:
- Action to significantly improve patient access to preventive drugs for breast cancer – bisphosphonates to reduce the risk of breast cancer spreading in post-menopausal patients and tamoxifen to reduce the risk of the disease for women at increased risk due to family history
- Clear and sustainable workforce planning to address the shortfalls across the breast cancer pathway, in particular diagnostic capacity, that are being exacerbated by uncertainty over Brexit
- Progress on reform to the drug appraisal and funding system to ensure patients have timely access to life-extending medicines at prices affordable for the NHS and taxpayer
- NHS England should publish a year two report on progress in implementing the Cancer Strategy, and its plans and funding for the remaining three years
- NHS England should provide clarity about the impact on women with breast symptoms of the move from the two week wait from GP referral to seeing a specialist, to a four-week wait from GP referral to diagnosis
- The Scottish Government should deliver the recommendations outlined in the review of access to new medicines quickly and effectively
- The Welsh Government should upgrade its ambition in relation to improving cancer outcomes and ensure targets in relation to this are measurable and supported by appropriate funding
- The Welsh Government should publish data on the number of women that are being seen by a specialist within two weeks of being referred by a GP for a symptom of breast cancer
In Northern Ireland:
- An updated, integrated strategy for improving cancer outcomes should be developed and implemented, and supported by appropriate funding
- The process for implementing NICE guidance should be reviewed to ensure that medicines that are recommended for use in the NHS are available more quickly.