Breast Cancer Screening (Women Under 40)

I beg to move,

That leave be given to bring in a Bill to entitle women aged under 40 and with a family history of breast cancer to breast cancer screening services; and for connected purposes.

May I begin by putting on record my thanks to the charity Breast Cancer Now, which has given me such a great amount of support in preparing the Bill? I thank my hon. Friend the Member for North Warwickshire (Craig Tracey) and the all-party group on breast cancer for their support. I thank all cross-party MPs who are backing the Bill. Even the Whip on duty, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), is a two-time survivor of breast cancer. The issue affects so many in this House and I am grateful for such great support for the Bill.

I was moved to introduce the Bill thanks to an incredible young lady called Nicola Morgan-Dingley. Nicola was one of the most inspiring young women I have ever met. She was a healthy 36 year old non-smoking, marathon-running wife and mum when she was diagnosed with triple negative breast cancer, or as she called it on her blog, “the killer boob”. She came to see me not just about her own care, but about the care of all the other young women across the country. She had a passion, a calmness and a sense of spirituality that I have rarely seen in anyone. It was impossible not to want to help her.

I raised Nicola’s campaign with the Prime Minister at Prime Minister’s questions, and Nicola and I went off together to see the Health Secretary about her campaign to ensure that young women get the early screening and early detection that could save their lives. As we sat on the Terrace after that meeting, and Nicola enjoyed a glass of wine and we put the world to rights, I would never have guessed that just two weeks later, at the age of 38, Nicola would lose her battle with cancer. I am here today as a tribute to Nicola, to carry on her campaign with what I am calling Nicola’s law.

The good news is that we are winning the war on cancer—more women are surviving the disease than ever before—but breast cancer remains the leading cause of death in women under 50 in England and Wales, with more than 920 losing their lives to the disease in 2017. Breast cancer is the UK’s most common cancer, with around 55,000 women and 350 men—it does not just affect women—diagnosed each year in the UK, and it is estimated that 5% to 15% of cases are linked to a family history of the disease.

We all know that the sooner a cancer is identified, the sooner treatment can begin and the greater the patient’s chance of surviving, so early detection is surely a vital part of any national strategy to reduce breast cancer deaths. Professor Gareth Evans recently undertook a major UK trial funded by Breast Cancer Now, which provided the strongest evidence yet that women aged 35 to 39 who are at moderate or high risk of developing breast cancer could benefit from annual screening, and that screening those women annually could pick up tumours earlier. The study found that when tumours were picked up through screening, most were smaller and less likely to have spread to lymph nodes than those in women who were not screened. Importantly, as my hon. Friend the Member for Lewes (Maria Caulfield) has pointed out, such screenings are an opportunity also to screen for ovarian cancer, which is often linked to the same gene.

We know that women with a family history of breast cancer have a higher risk of developing breast cancer themselves and are more likely to get breast cancer at a younger age. The degree of extra risk varies according to whether breast cancer was diagnosed among someone’s first-degree relatives, such as their parents, siblings or children; their second-degree relatives, such as their grandparents, aunts or uncles, or half-siblings; or multiple family members. Breast cancer risk is also inherited from the father’s side of the family. Familial breast cancer tends to be more aggressive than non-familial breast cancer. Prognosis also appears to be partly heritable: women whose mothers died of breast cancer are more likely to die from it, even adjusting for tumour characteristics. We know that women who have breast cancer in their family are more likely to develop it and more likely to develop its most aggressive forms, and we know that detecting breast cancer early gives women the best possible chance of survival.

Based on a thorough assessment of the available evidence, the National Institute for Health and Care Excellence—NICE, as we all know it—recommends that women with a confirmed family history of breast cancer should be offered annual mammograms from age 40, and that women at the highest risk may be offered MRI scans from age 30. That one word—“may”—literally means life or death to some women, because not all young women are offered that screening. Despite all the evidence, young women are not getting screened. Not all women with a family history of breast cancer get access to the extra breast screening currently recommended by NICE. Screening can save lives, so why is that happening?

NICE guidelines are not implemented uniformly across the country. We need to tackle that. There is a lack of clarity about the provision of family history clinics. Only some women at the greatest risk receive family history screening though the national breast screening programme. Other women at high risk, and those at moderate risk, may—again, “may”—receive family history screening through local family history services instead. However, some might not receive it at all, and it is those young women that the Bill aims to help.

The inconsistent provision of screening is risking lives. Some young women, because of where they live and the treatments available to them, will have their breast cancer spotted early and treated; some will not. Some will survive; others will not. Imagine having to bury your wife, your daughter or your granddaughter because early screening was not available in their town or area.

In reality, neither I nor the Secretary of State, NICE or the Minister knows the scale of the hole in provision. If the Minister does know, I would be interested to hear it, but everything I am told indicates that there is a lack of national oversight of family history screening for women at all levels of risk, which may result in women not being able to access screening in some areas. We just do not know where or why.

This issue may be exacerbated by the fact that some family history clinics, which assess and support women with a family history of breast cancer, may be at risk of closure. Those clinics are not supported by national funding, and there is lack of clarity about the current governance arrangements for the provision of those services. As a result, some clinical commissioning groups may choose to stop funding family history clinics in their area. I am sure the Minister agrees that that cannot be allowed to happen.

The Bill is intended to strengthen oversight of family history services for women with a family history of breast cancer by introducing a duty on the Secretary of State for Health to ensure the rigorous and transparent implementation of current NICE family history guidelines. The purpose is to ensure that every woman in the country with a family history of breast cancer is able to access services with a proven life-saving benefit, to which they should be entitled regardless of where they live. The Bill would also require NHS England to provide clarity about the current governance arrangements for the provision of services for women with a family history of breast cancer, including the obligations CCGs have for funding family history clinics.

Thanks to Nicola, I have met or corresponded with the people she called her “warriors”. I have been astounded by how they support one another through difficult times, in person, online and in chatrooms, and I was humbled to see so many of them at Nicola’s funeral, still supporting her and one another. They are watching on today, and they want action, so I beg the Minister to support the Bill, to help to deliver Nicola’s law and to help save the lives of thousands of young women in the future.

That Andrew Griffiths, Steve Brine, Fiona Bruce, Maria Caulfield, Marion Fellows, Carolyn Harris, Anna Soubry, Craig Tracey and Anne-Marie Trevelyan present the Bill.

Andrew Griffiths accordingly presented the Bill.