Part of: Ill Health and Disability, Cancer

Related to: Digestive Cancers - Bowel (Colorectal) Cancer and Upper Gastrointestinal (GI) Cancer ,Lung Cancer, Cervical Cancer, Skin Cancer (Melanoma), Prostate Cancer,[[Aging Population]], Births and Fertility, Mental Health and Illness, [[Health Checks]], Major Causes of Mortality, Smoking,End of Life Care

Key Facts:

  • Breast cancer is the most common type of cancer in the UK.
  • In 2012,149 women were known to have breast cancer in Bath and North East Somerset.
  • There has been an overall increase in the number of women with breast cancer in B&NES, the South West and England.
  • Incidence rate of breast cancer in B&NES in 2012 was 162.86 per 100,000 of the directly age-standardised (DSR) female population, 173 per 100,000 in the South West, and 163.77 per 100,000 in England.
  • Mortality from breast cancer has been deceasing in B&NES, the South West and England.
  • Breast screening rates for 53-70 year old women (less than 3 years since last test) as of March 2013 were lower in B&NES (74.1%) than in the South West (79.0%) and England (76.4%).
  • Breast screening rates for 53-70 year old women (less than 3 years since last test) have decreased slightly since March 2011, in B&NES, the South West and England.

Types of breast cancer 1

Breast cancer is the most common type of cancer in the UK. Most women who get it (8 out of 10) are over 50, but younger women, and in rare cases, men, can also get breast cancer.

There are several different types of breast cancer, which can develop in different parts of the breast. Breast cancer is often divided into non-invasive and invasive types.

Non-invasive breast cancer is also known as cancer or carcinoma in situ. This cancer is found in the ducts of the breast and hasn't developed the ability to spread outside the breast. This form of cancer rarely shows as a lump in the breast that can be felt, and is usually found on a mammogram.

Invasive cancer has the ability to spread outside the breast, although this doesn't necessarily mean it has spread.The most common form of breast cancer is invasive ductal breast cancer, which develops in the cells that line the breast ducts. Invasive ductal breast cancer accounts for about 80% of all breast cancer cases and is sometimes called "no special type".

Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Paget's disease of the breast.

It's possible for breast cancer to spread to other parts of the body, usually through the lymph nodes (small glands that filter bacteria from the body) or the bloodstream. If this happens, it's known as "secondary" or "metastatic" breast cancer.

What does the data say?

In 2012,149 women were known to have breast cancer in Bath and North East Somerset, 5,009 in the South West and 42,489 in the England. 2

There has been an overall increase in the number of women with breast cancer since 1995,  when there were 133 women in B&NES, 3,463 in the South West and  30,839 in England. 3

The incidence rate of breast cancer per 100,000 of the directly age-standardised (DSR) female population, has also increased overall since 1995 in the South West and England, but it has remained fairly stable overall in B&NES: 4

  • B&NES - 165.00 per 100,000 in 1995 and 162.86 per 100,000 in 2012
  • South West - 142.63 per 100,000 in 1995 and 173 per 100,000 in 2012
  • England – 138.38 per 100,000 in 1995 and 163.77 per 100,000 in 2012

Mortality 5

 

Mortality from breast cancer has been deceasing overall since 1995 in Bath and North East Somerset, the South West and England.

 

Numbers of women who have died:

  • B&NES -  in 1995 and 33 in 2013
  • South West - in 1995 and 1,112 in 2013
  • England – in 1995 and 9,545 in 2013

Morality rates per 100,000 of the directly age-standardised (DSR) female population:

  • B&NES -  42.42 per 100,000 in 1995 and 34.73 per 100,000 in 2013
  • South West - 54.83

    per 100,000 in 1995 and 35.16 per 100,000 in 2013
  • England – 52.93 per 100,000 in 1995 and 35.31 per 100,000 in 2013

Figure 1: Directly age standardised mortality rates for breast cancer per 100,000 of the female population  - B&NES, South West and England (1995-2013) 6

Are we meeting the needs?

Breast screening 7

Mammographic screening (where X-ray images of the breast are taken) is the best available method of detecting an early breast lesion.

Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.

As the risk of breast cancer increases with age, all women who are 50-70 years old are invited for breast cancer screening every three years.

Women over 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit.

The NHS is in the process of extending the programme as a trial, offering screening to some women aged 47-73.

Bath and North East Somerset, South West and England

Breast screening rates for 53-70 year old women (less than 3 years since last test) as of March 2013 were lower in B&NES (74.1%) than in the South West (79.0%) and England (76.4%).8

Breast screening rates for 53-70 year old women (less than 3 years since last test) have decreased slightly since March 2011, in B&NES, the South West and England, when they were 75.4%, 79.5%, and 77.2% respectively. 9

B&NES had the second lowest coverage amongst South West Primary Care Trusts in 2010/11. There was also wide variation at practice level. 10

However, the B&NES breast screening programme in 2010/11 was meeting all of its national targets, so that women are being invited for screening, are receiving their results, and were being offered a follow up appointment and attended this within the recommended timescales. 11

What can we realistically change?

Bath and North East Somerset Clinical Commissioning Groups Commissioning Intentions for the cancer programme for 2013/14 12

The Bath and North East Somerset Clinical Commissioning Groups have developed a draft paper outlining their Intentions for the cancer programme for 2013/14; to be used in conjunction with the Cancer Mortality Report for Bath and North East Somerset (July 2012). This paper is a guide to prioritising commissioning of cancer services in the Bath and North East Somerset area. It is key objective is to improve cancer outcomes (including premature mortality and 1 and 5 year survival) through a targeted approach to cancer inequalities.

The changes to Bath and North East Somerset’s Breast Screening Programme it outlines are:

  • National guidance requires incorporation of Very High Risk (Familial) Breast Cancer Screening into the NHS Breast screening programme, resulting in increased assessment, treatment and surveillance.
  • Agreement has been reached that the data and the call-recall systems will be integrated into the Avon Breast screening service, whilst women (very high risk) will continue to be managed at the breast clinics where previously they have been managed (ie BANES women at RUH).

National Institute for Health and Clinical Excellence (NICE) guidance