All-Party Parliamentary Group on Breast Cancer report finds stark inequalities in NHS services across England.

  • “Demographic time-bomb” facing breast cancer workforce – with over a quarter of mammography posts vacant in Greater London, however the capital continues to meet the two-week wait target
  • Women in Greater London least likely in England to attend routine mammograms, despite overall ten-year increase in breast screening uptake in the region
  • But local programme in Tower Hamlets improves screening uptake by 13.6% in just five years, paving the way for other areas – with Tower Hamlets CCG also having the lowest premature mortality rate in England
  • Leading MPs call on NHS England and PHE to take immediate action to address variation

Shortages in the breast cancer workforce in Greater London have reached a critical level with more than a quarter of mammography posts vacant, 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, with women in worst-affected areas found to be more than twice as likely to die from breast cancer under the age of 75 than those elsewhere in the country.

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.

With the report’s publication, leading MPs have 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 Greater London – with over a quarter of 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, more than a quarter (25.74%) of mammography posts were unfilled in Greater London. These shortages can have a severe impact on the speed at which patients are diagnosed and therefore treated. But despite staffing pressures, 94.7% of Greater London patients were seen by a specialist within the recommended two weeks, compared to just 84.5% in the South West and 88.1% in the East Midlands.

Women in London least likely to attend screening, as the capital fails to meet national target yet again – but local initiative in Tower Hamlets leads the way in reversing trend

The report revealed that Greater London had the lowest breast screening attendance rates in England in 2016-17, with just 64% of women invited to screening attending within six months – falling short of the national target of 70%. However, despite the worryingly low uptake levels, London was the only region to seen an increase (6.1%) in attendance over the last ten years, bucking the nationwide trend.

In 2005/6 Tower Hamlets had one of the lowest uptake rates and poorest survival outcomes in the country, but following several local innovations, the CCG saw a 13.6% increase in screening attendance in just three years. The APPG on Breast Cancer is now calling on other regions to learn from and adopt similar interventions – such as offering a second specific appointment time for those who don’t take up their first invitation, text message reminders and pre-appointment phone calls – to those that proved effective in increasing uptake in Tower Hamlets.

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.

Inconsistencies in early detection across England, with London lagging behind other regions

Overall, just two thirds of breast cancer cases in Greater London were detected at early, more treatable stages (stage 1 and 2), as the capital fell below the England average (71%) for early detection. The report uncovered notable variation within the region, with just 69.4% of breast cancers being detected early in Newham CCG compared to 81.4% in Redbridge 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).

Tower Hamlets has lowest breast cancer mortality rates in England for those under 75

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 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.

Nationwide, Tower Hamlets CCG reported the lowest premature mortality rates, with 13.3 per 100,000 people dying from breast cancer before the age of 75 – however, those living in Central London (Westminster) CCG were almost twice as likely to die from breast cancer under 75, with a rate of 26.3 deaths per 100,000 of the population. 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.

Following the report’s publication, the All-Party Parliamentary Group on Breast Cancer 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 (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 Debonnaire MP, Craig Tracey MP and Dr Philippa Whitford MP, co-chairs of the All-Party Parliamentary Group on Breast Cancer, said:

“Our report uncovers widespread differences in the diagnosis, treatment and care of women with breast cancer, depending on where they live.

“It’s encouraging that more Londoners are attending screening than a decade ago, but the capital is still failing to meet the national targets. This, coupled with the demographic time bomb facing the diagnostic and imaging workforce, is incredibly alarming and must be urgently addressed. More women are developing breast cancer than ever before and we need to ensure local NHS services are fully resourced to meet this demand.

“The recent initiative in Tower Hamlets showed real promise in encouraging more women to attend screening to help detect the disease earlier, and we hope other parts of the country will now be able to learn from its success. 

“While such variation in services exists across England, we’re falling short of the Government’s ambition of world-class outcomes for all cancer patients. We call on NHS England and Public Health England to work with the Greater London Cancer Alliance to ensure they receive the support they need to meet this challenge.”

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.

“With healthcare professionals currently taking the strain to help diagnose more patients in Greater London despite staff shortages, this alarming 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 are missing 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 Greater London and across the country receive fair access to the services, treatment and support they need.”