Written evidence submitted by Breast Cancer Now (CBP0080)

 

Executive summary

Breast cancer diagnosis and treatment

Breast reconstruction

 

About Breast Cancer Now

We’re Breast Cancer Now, the charity that’s steered by world-class research and powered by life-changing care. We’re here for anyone affected by breast cancer, the whole way through, providing support for today and hope for the future.

 

1.       Size of the backlog

Breast Cancer Diagnosis and Treatment

1.1.             In the 15 months since March 2020, there were a total of 540,090 referrals on the 2 Week Wait urgent GP referrals for suspected breast cancer route. Compared to a pre-pandemic baseline period* (2019/20), there were 19,330 fewer referrals (559,420). See Table 1 for overview:

Table 1 – 2WW urgent GP referral for suspected breast cancer 2019/20 and 2020/21 comparison

Month

19/20

20/21

Difference

Mar

40,693

32,702

-7,991

Apr

38,983

16,906

-22,077

May

37,873

22,413

-15,460

Jun

36,272

31,034

-5,238

Jul

39,950

34,987

-4,963

Aug

32,519

31,978

-541

Sep

33,733

37,933

4,200

Oct

39,353

40,654

1,301

Nov

36,749

44,099

7,350

Dec

35,009

41,823

6,814

Jan

36,471

37,811

1,340

Feb

34,266

37,692

3,426

Mar*

40,693

47,640

6,947

Apr*

38,983

42,568

3,585

May*

37,873

39,850

1,977

*The baseline period uses repeating months to allow  like-for-like monthly comparisons before and during the pandemic.

1.2.             We estimate that, if 2019/20 is a pre-pandemic baseline operating at 100%, in 2021/22 referrals would need to be over 100% to work through the backlog seen during 2020/21. If levels were increased to 10% above pre-pandemic levels, it would take 15 months to clear this backlog. See Table 2 for overview:

Table 2 – 2WW Referrals at 110% capacity to clear backlog

Month

19/20 100%

10% extra

Total

Mar

40,693

44,762

44,762

Apr

38,983

42,881

87,644

May

37,873

41,660

129,304

Jun

36,272

39,899

169,203

Jul

39,950

43,945

213,148

Aug

32,519

35,771

248,919

Sep

33,733

37,106

286,025

Oct

39,353

43,288

329,314

Nov

36,749

40,424

369,738

Dec

35,009

38,510

408,247

Jan

36,471

40,118

448,366

Feb

34,266

37,693

486,058

Mar

40,693

44,762

530,820

Apr

38,983

42,881

573,702

May

37,873

41,660

615,362**

**The total needs to exceed the 2019/20 figure of 559,420 + “backlog” of 19,330 referrals (giving a figure of 578,750).

1.3.             Also, in the 15 months since March 2020, a total of 50,721 people started treatment on the 31-day wait from diagnosis to first definitive treatment for breast cancer which covers those diagnosed via both referrals and screening. Compared to a pre-pandemic baseline period* (2019/20), 10,162 fewer people started treatment (60,883). See Table 3 for overview:

Table 3 – 31-day wait from diagnosis to first definitive treatment for breast cancer 2019/20 and 2020/21 comparison

Month

19/20

20/21

Difference

Mar

3,894

4,990

1,096

Apr

4,050

3,108

-942

May

4,230

1,930

-2,300

Jun

4,038

2,126

-1,912

Jul

4,419

2,665

-1,754

Aug

4,120

2,587

-1,533

Sep

4,047

3,375

-672

Oct

4,333

3,483

-850

Nov

3,995

3,722

-273

Dec

3,772

4,012

240

Jan

4,194

3,491

-703

Feb

3,617

3,467

-150

Mar*

3,894

4,061

167

Apr*

4,050

3,835

-215

May*

4,230

3,869

-361

 

1.4.             We estimate that if levels were increased to 10% above pre-pandemic levels, it would take 16 months to clear this treatment backlog. See Table 4:

Table 4 – 31-day Referrals at 110% capacity to clear backlog

Month

19/20

10% extra

Total

Mar

3894

4283

4283

Apr

4050

4455

8738

May

4230

4653

13391

Jun

4038

4442

17833

Jul

4419

4861

22694

Aug

4120

4532

27226

Sep

4047

4452

31678

Oct

4333

4766

36444

Nov

3995

4395

40839

Dec

3772

4149

44988

Jan

4194

4613

49601

Feb

3617

3979

53580

Mar

3894

4283

57863

Apr

4050

4455

62318

May

4230

4653

66971

June

4038

4442

71,413***

***The total needs to exceed the 2019/20 figure of 60,883 + “backlog” of 10,162 referrals (giving a figure of 71,045).

1.5.             We also estimate that around 1 million fewer women in England had breast screening between March 2020 and December 2020 due to the programme being effectively paused in March 2020 and running at reduced capacity on re-starting due to infection prevention and social distancing measures. We are currently updating this estimate and will provide a revised figure to the Committee at the end of the month.

Breast Reconstruction

1.6.             Breast reconstruction is a vital part of treatment and recovery from breast cancer for those women that chose it. We estimate that over 1000 women will have missed out on immediate reconstruction during the first wave of the pandemic, and around another 500 will have had their delayed reconstruction delayed further[1].

 

1.7.             These numbers will be continuing to grow as a result of units operating under capacity and the fact that breast reconstruction is considered the lowest priority (priority 4) in the clinical guide to surgical prioritisation during the pandemic[2].

2.       NHS capacity to deal with the backlog

Breast Cancer Diagnosis and Treatment

2.1.             It is vital that women are diagnosed and start treatment as early as possible to ensure their treatment has the best chance of being successful. In the worst cases, some women could die as a result of delayed diagnoses.

 

2.2.             According to our estimations, the NHS would need to work consistently at 110% for the next 15/16 months to clear the backlogs in referrals and people starting treatment. It is unclear how the NHS will meet the ambitions set in NHS England’s ‘2021/22 Priorities and Operational Planning Guidance’ to both recover the breast screening programme and address the shortfall in the number of people starting treatment for cancer by the end of March 2022.

 

2.3.             The required resources are not in place to address this backlog, specifically with regards to the right number of staff. The Royal College of Radiologists (RCR) latest Clinical Radiology UK Workforce Census 2020 Report highlighted that:

2.4.             The backlogs create a demand for diagnosis and imaging services that threatens to overwhelm a workforce that was already stretched before the pandemic.

Breast Reconstruction

2.5.             Before the pandemic, breast reconstruction services were already under strain, with waits of 1 to 2 years for delayed reconstruction in many hospitals. The pandemic has further exacerbated this pressure as a result of breast reconstruction being suspended during the peak of the first wave.

 

2.6.             It is clear that the NHS has limited capacity to deal with the backlog of women waiting for breast reconstruction. It is vital that NHS England works with Breast Cancer Now, the Association of Breast Surgery and British Association of Plastic, Reconstructive and Aesthetic Surgeons to develop a clear plan to address the issues with breast reconstruction.

 

2.7.             A survey we carried out in July 2020[3] showed that of those respondents that experienced changes to their reconstructive surgery nearly half (48%) told us they were unhappy with their body image. 59% were concerned that they would need more operations as they were unable to have reconstruction at the same time as their mastectomy.

3.       Financial investment needed

Breast Cancer Diagnosis and Treatment

3.1.             We welcome the Government’s previous £1 billion investment to tackle the elective backlog, £50 million to recover the breast screening programme, £325 million for new investments in diagnostics equipment, and an additional £260 million for Health Education England in 2021-22 to support the training and retention of our vital NHS workforce.

 

3.2.             However, if we are to ensure the recovery of the breast screening backlogs and that all patients with symptoms of breast cancer have access to the timely investigation they need- both now and in the future - the diagnostic workforce must be properly and sustainably resourced and sufficiently supported.

 

3.3.             We need the Government to tackle the enormity of the crisis facing the cancer workforce by developing a robust, long-term, and fully-resourced plan – which must include investment in expanding and retaining the breast imaging and diagnostic workforce.

 

3.4.             Moreover, any long-term, fully resourced plan for the cancer workforce needs to be backed by regular, published modelling of the workforce, including long-term projections and by speciality.

 

3.5.             Whilst we welcome the new duty on the Health and Care Bill on the Secretary of State to publish a report describing the system in place for assessing and meeting the workforce needs of the health service in England, we urgently need the Government to go further and send a stronger signal of its commitment to invest in the NHS staff that people affected by cancer rely on, both now and in the future.

 

3.6.             With the current workforce crisis, we must take this important legislative opportunity to improve the way NHS workforce planning is carried out. Alongside an additional duty, there should also be a specific provision to ensure a long-term NHS workforce plan is put in place and regularly reviewed and that the Secretary of State sets out the necessary funding required to deliver it. Without this, we fear the Government will be unable to meet its commitment to deliver world class care for patients and build back better from the pandemic.

Breast Reconstruction

3.7.             While we welcome the Government’s previous investments to tackle the elective backlog, it is unclear how much of it will benefit women waiting breast reconstruction surgery. It is vital that NHS England works with Breast Cancer Now, the Association of Breast Surgery and British Association of Plastic, Reconstructive and Aesthetic Surgeons to develop a clear plan to address the issues with breast reconstruction.

 

Sept 2021


[1] Estimate based on data on the number of women having immediate and delayed reconstruction from the National Mastectomy and Breast Reconstruction Audit 2011 and updated to 2020.

[2] Clinical guide to surgical prioritisation during the coronavirus pandemic, Federation of Surgical Specialty Associations, updated April 2021.

[3] Breast Cancer Now’s survey was open from 9 July – 6 August and promoted via the charity’s networks and social media channels.  2124 people with breast cancer responded to the survey, 1545 with primary breast cancer and 472 with secondary breast cancer. The remainder chose to describe their breast cancer themselves.