NHS: Breast Screening Programme

Question

Asked by

To ask His Majesty’s Government what assessment they have made of the take-up of the NHS breast screening programme.

Breast cancer survival rates have improved by 41% since the mid-1970s and 86% of women survive their cancer beyond five years. I pay tribute to NHS staff and to my noble friend Lady Morgan for making such a contribution to these improvements. Take-up of breast screening is just below 70%, and NHS England has developed a national uptake improvement plan, including expanding access to screening, reducing inequalities, improving IT systems and ensuring that communications are inclusive and accessible to all.

I thank my noble friend for that very kind and generous Answer. As we know, screening uptake has been in decline for more than 10 years now. There is no NHS region that has met its 70% minimum standards since 2019-20. Importantly, uptake for women on their first invite is really worrying. Will the Minister commit to keep feet to the fire on this issue, and work closely with the department and NHS England to press down on any potential complacency because breast cancer outcomes have improved so much? Screening is a simple way to stop women dying of breast cancer, and it is not rocket science. Please can we do all we can to improve uptake?

My noble friend makes a very clear and definite point about the link between breast screening and outcomes. I certainly can give her the assurance that we will continue to seek to drive up rates of breast cancer screening. It is important to say that the reason for the take-up not improving as one might have hoped since Covid is multifactored and complex, as I am sure she understands. We all know that research shows that women are more likely to attend breast screening if it is in a unit that is easy to get to, if it is convenient, and if we can help women to get over the problems of fear of the test, awkwardness or embarrassment. I give my noble friend the assurance that the NHS is working on understanding all that, and all that will be in collaboration with charities and key stakeholders.

I also begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. Can the Minister reassure me that the Government will look again at the ceasing of breast cancer screening after the age of 70, when the incidence of disease occurring in that age group is still high, and would be higher were it not for the success of earlier breast cancer screening? This cohort of women should not be ignored.

If a woman in the age group to which the noble Baroness refers has concerns, she may request follow-up and investigation. But it is the case that we follow the scientific advice, which is that going beyond that age as a matter of course will not give the rewards that we would hope. I can certainly reassure any woman in that age group that she will be seen should she have concerns, and she should present herself as soon as possible.

My Lords, artificial intelligence has been very efficient in helping to interpret breast imaging, reducing false positives and false negatives, and significantly reducing the workload of the second reader. We know that early detection is key to reducing mortality, and I understand that AI can be used to identify patients with high risk so that they can be screened more frequently and proactively. What work is being done to use AI to identify high-risk individuals, so they can be screened more frequently?

It is important to ensure that the service is there for those who are at greater risk. The noble Baroness is right to refer to the growing interest in and potential use of AI, which is indeed very exciting. The National Screening Committee is very aware of this point. The committee is working with the National Institute for Health and Care Research and NHS England, and has designed a research project to see whether AI can be safely used to read mammograms in the breast screening programme, and whether that is acceptable both to women and to clinicians. That work will continue.

My Lords, I join others in commending the work that Breast Cancer Now has done in improving outcomes for women through breast screening and improving breast cancer outcomes. However, the problem remains when it comes to wider issues about care of patients with cancers. We know that early diagnosis achieves the best results for all cancers, yet we are woefully low in the percentage of people who are picked up with early cancers. There is another more serious issue, which is unwarranted variations in the care of all cancer patients. Unwarranted variation is when care that is clearly demonstrated to be effective in reducing death rates is not given to cancer patients. That has to be absolutely unacceptable. Eliminating unwarranted variation in cancer care ought to be one of the performance measures that integrated care boards are measured on—I hope that the noble Lord, Lord Darzi, is listening.

I am sure that the noble Lord, Lord Darzi, is listening, but if he is not I will ensure that the noble Lord’s comments are drawn to his attention. I can say to your Lordships’ House that this Government intend to transform the NHS from a late-diagnosis, late-treatment health service to one that catches illness earlier and also prevents it in the first place. It is that shift that will make the greatest change. I have been interested to see that, across all the screening programmes, something like 15 million people are invited for screening and 10 million take it up. That still leaves us with 5 million people to work on. It is important to note that the 10 million take-up figure for screening saves a considerable number of lives. We need to continue to drive up the take-up on screening, across the various cancers and not just breast cancer. As noble Lords will know, there are programmes in respect of cervical and bowel cancer, and there will be a lung cancer screening programme as well.

My Lords, I begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. We are very lucky to have her in your Lordships’ House. We know that the NHS wants to shift the emphasis from cure to prevention and screening, which, whether for breast cancer or other conditions, is a vital part of prevention. The previous Conservative Government took action to drive up breast cancer screening, with new breast cancer screening units and our community diagnostic centre programme. What steps will the Government take to further increase the uptake of breast cancer screening?

The measures that the noble Lord refers to did indeed assist, but as I mentioned earlier we have a stubborn problem in returning to pre-Covid rates. The improvement plan that exists sets out the priorities and the interventions, but also the monitoring of what is working and what is not. The kinds of things that are being tested and introduced now include, for example, new IT systems to enable communication with women in 30 different languages, and new IT systems that mean people know when their appointment is and are reminded of it. All these things sound quite straightforward, but they have not been in place across the country and it is important that they are. I mentioned the importance of addressing fears and embarrassment, improving information and reassurance to women, as well as more convenient times and booking systems. It is very important that we make better use of mobile screening units, so that screening is near to where women are.

My Lords, undoubtedly breast screening is vital—I know that from a personal perspective—but I ask my noble friend whether consideration could be given to lowering the breast cancer screening age to 40, to include for diagnosis those with triple-negative breast cancer, because many in the younger cohort are diagnosed with it.

As my noble friend will be aware, we keep a very close eye on the science and the advice, and we will continue to follow that. I emphasise, and it was raised in an earlier question as well, that the NHS has been proactively writing to those women at very high risk of breast cancer who may not have been referred. I give an assurance that women who are at greater risk are not forgotten.