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

  • “Demographic time bomb” facing breast cancer workforce in England – with over one in five mammography posts vacant in North West
  • APPG on Breast Cancer calls for regions across England to learn from local innovation at The Christie, where nurse-led clinics have improved care for patients with incurable breast cancer
  • Screening attendance declines sharply over last decade as North West fails to meet national screening targets
  • North West above national average for early detection, but some areas are outperforming others – with Bolton CCG leading the way
  • Leading MPs call on NHS England and PHE to take immediate action to address variation

Shortages in the breast cancer workforce in the North West have reached a critical level with over one in five 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 the North West, with more than 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 one in five (20.18%) of mammography posts were vacant in the North West. These shortages can severely impact the speed at which patients are diagnosed and therefore treated. But despite staffing pressures, 93.5% of patients in the North West were seen by a specialist within the recommended two weeks, compared to just 84.5% in the South West.

Screening attendance inconsistent across England – with women in North West among least likely to attend mammograms as region fails to meet national target

The report revealed that the North West failed to meet the national target for screening uptake (70%) in 2016-2017, with just 68.87% of eligible women attending breast screening within six months of invitation. In addition, the report revealed that screening uptake in the region has fallen sharply by 5.7% in the last ten years, reflecting the concerning countrywide decline.

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.

Despite local variation, North West is performing better than other regions in early detection

Despite some variation between CCGs, overall the North West performed above the national average (71%) for early detection, with 74.2% of breast cancers detected at early, more treatable stages (stage 1 and 2). In Bolton CCG – the highest-performer in the region for early detection – 81.9% of breast cancers were detected at early stages, compared to 70.7% in Wigan Borough CCG, and just 61.6% in the South East.

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 North 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 some 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 North West varied from as low as 17 per 100,000 people dying from breast cancer before the age of 75 in St Helens CCG, to as high as 28.1 people per 100,000 in Southport & Formby CCG – over 65% more and well above the national average. 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.

Local innovation improving patient experience and outcomes in Manchester

The inquiry heard that a new initiative at The Christie Hospital in Manchester to establish nurse-led clinics for all patients diagnosed with incurable secondary breast cancer had significantly improved patients’ experiences and care. The clinics were introduced as part of the hospital’s Secondary Service Pledge for Breast Cancer, in collaboration with Breast Cancer Now and Breast Cancer Care.

Newly diagnosed patients are now invited to an appointment with a clinical nurse specialist to discuss any questions or concerns they may have, enabling any specific needs to be identified and ensuring patients receive tailored advice and support. The APPG on Breast Cancer is calling for other regions to learn from and adopt local initiatives like this to help improve care and service for their patients.

Urgent action is needed to address geographical variation

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, based on where they live.

“In particular, the current shortages in the breast cancer workforce in the North West, along with missed screening targets, are incredibly alarming and must be addressed. The number of women developing breast cancer is steadily increasing and local NHS services must be fully resourced to meet this demand.

“It’s really encouraging that the North West is the surpassing the national average for early detection and for patient waiting times. But this report unearths wide variation across the country and we must ensure the worst-performing CCGs in the region are brought in line with the best, where local innovation is already driving real progress.

“We call on NHS England and Public Health England to work with the Cancer Alliances in the North West to ensure all cancer patients receive the best possible care.” 

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 patients and healthcare professionals alike already feeling the impact of the workforce shortages in the North West, 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.

“More must be done to develop tailored local initiatives so that more women know the signs and symptoms, understand the important role of attending screening in detecting breast cancer earlier and know who to turn to if they are worried. 

“This report shows too many women are missing out on the best breast cancer care this country has to offer. We urge NHS England, Public Health England and Health Education England to ensure all women in the North West and across the country receive fair access to the care, treatment and support they need.”