Breast Cancer Screening: Women Over 70

Question

Asked by

To ask His Majesty’s Government what plans they have to review the NHS policy of ending automatic mammogram invitations for women over 70.

My Lords, an important research study, AgeX, is investigating the effects of routine breast screening in women over 70. It is the biggest trial of its kind ever undertaken and results are expected in 2027. The UK National Screening Committee has been closely involved throughout and will use the findings as they are available. It is vital that all screening policy is based on robust scientific evidence, as screening can also cause harm.

My Lords, I thank the Minister for that, but I am not sure that I want to wait until 2027. The facts are compelling. Early detection of breast cancer significantly boosts survival rates, especially of older people, some of whom might not last until 2027. I disagree with the policy of not sending out invitations for mammogram screenings to the over-70s. We should not leave it to self-referral every three years. Will the Minister say what outreach programmes are being implemented in the meantime to inform women of their right to self-refer? Such programmes should include informational mailings, community health talks, and leveraging technology and social media platforms, with healthcare providers having proactive discussions with seniors about continuous screenings. In the intervening period to the magic date of 2027, can the Minister assure me that all these things are happening?

The noble Lord is quite right to say that women over the age of 71 can go to their GP and request a further screening every three years above that age. The noble Lord touched on a good point that it is imperative that that information is more widely available. I have talked to women of that age group and found that there is no general awareness that that is the case. I believe that all these policies should be managed and rolled out locally. It is for local healthcare systems to make sure that information is available to those most vulnerable in their communities. That is the work we are doing through the 10-year health plan, particularly reaching out to areas of disadvantage and inequality.

My Lord, I agree with the sentiments that have been expressed by the Minister. However, she will be aware that there are significant regional variations in the uptake of breast screening among those who live in poorer disadvantaged communities and among ethnic-minority women. These are women below the age of 70. What are the Government doing to narrow the gap in outcome for these women, and what key performance indicators are the Government using to monitor this?

The noble Baroness will be aware of the launch of the women’s health strategy. Running throughout that is a real understanding that too many women are not aware of the treatment that is available. There might be all sorts of reasons why they are not coming forward for the screening to which they are entitled. The focus on working locally, spreading information, giving reassurance, and coming up with peer models within communities who can go out and convince women that screening is in their interest are all parts of the rich toolkit available to local health communities.

I am over 71, yet I had no idea until this moment that a self-referral programme was in place—and I have just had a friend in her early 70s go into surgery for breast cancer. How is this message being distributed? I fear that, if I contacted my GP, even the GP would have no idea that self-referral was available.

I declare an interest, in that I am in the same age group. All I can say from personal experience is that, when I went for my last screening, I was informed by the local screening team. This speaks to the point that it is patchy and inconsistent; we need to have a fundamental check around the country to ensure that consistency exists. The noble Baroness has made my point perfectly: too many women are not aware of what is available. That is why we are going to address the needs of women going forward.

My Lords, I thank the noble Lord, Lord Palmer, for raising this and my noble friend the Minister for raising awareness about one of the largest age-extension trials. It is true that it will give us results, but I was not aware that the final report would be available in 2027; I was under the impression that it would be by 2032. Can my noble friend confirm that the final report on age extension will be available by 2027? In the meantime, given that international professional guidelines support regular screening for women over 70, could we consider regular screening for women in the community when we establish neighbourhood health centres?

I stress the importance of being mindful of all ongoing research, as there is extensive research going on in all areas of cancer. We also need to be very mindful of the new technologies coming forward. The EDITH programme, looking at the use of AI, could potentially significantly reduce the number of medical practitioners who need to be involved in screening, thus freeing up capacity and making sure that trials can be implemented. I want to reassure my noble friend of the work that is happening and the intention to abide by the timeframes set.

Does the Minister agree that, since it is a given fact that women over 70 can self-refer every three years, there is no need for these layers of bureaucracy and administration in the health service? There is no reason why a GP needs to refer a woman in that age group to their local breast screening unit. I go into the hospital breast-screening unit and say, “Could I please book an appointment?” They say, “Yes, certainly”. No GP comes anywhere near it. Let us cut out the bureaucracy; there is too much of it in the NHS.

To veer away from breast cancer for a moment, one of the most successful programmes I was involved in was working with the local authority and local NHS services to remove the need to see a GP to be referred for lung x-rays. This programme particularly targeted men in disadvantaged areas and, my goodness, it had a huge impact. This is something that needs to be taken seriously. A lot of people, men and women, are averse to going to seek medical help. We need to make available as many opportunities as we possibly can.

My Lords, since there is a strong hereditary element in breast cancer, what action is being taken to make sure that women who have had cancer ensure that their daughters and granddaughters are rightly tested? Will the Minister acknowledge the information being given out via “The Archers” on this matter at the moment?

I wondered when someone was going to mention “The Archers”.My noble friend is referring to BRCA and BRCA2 screening. It is incredibly serious that some people are wary of going through screeningbecause of the possible implications hanging over their children. We all need to work to make that screening more of a possibility. I have to declare that my eldest sister died from breast cancer when she was in her late 50s. It is a dreadful thing to happen to families, and we have to make sure all families who go through this are aware of what they need to do and that the information is as widely available as possible.

My Lords, I thank the Minister for sharing her personal experience; I am sure our thoughts are with her. The Government have rightly said they want a shift from treatment to prevention, and the Minister will know that one element of prevention is testing and early diagnosis. We know that about one-third of breast cancers are diagnosed in women over70, and this increases with age. We have heard that many women are not aware of screening on demand. Apart from the health and emotional consequences, when the Government conducted a cost-benefit analysis of ending routine screening, werethey absolutely certain that any money saved in the short term was not outweighed by the extra cost of treating patients with later-stage cancer, which will be harder to treat and will end up costing the Government more money?

I reassure the noble Lord that all these factors are taken into account. I would warn against complacency. To go back to my personal experience, my sister had regular breast screening and it wasnot picked up because of the type of cancer that she had. I am delighted that the noble Lord, Lord Vallance, is leading the work on looking at how we can better screen women and make sure that the work we do is the most effective and reaches the highest number of women possible.