Lobular Breast Cancer

[Valerie Vaz in the Chair]

14:30:00

I beg to move, That this House has considered the treatment of lobular breast cancer. It is a pleasure to see you in the Chair, Ms Vaz. I secured this debate in memory of my constituent, who was also my close friend, Heather Cripps. I welcome Heather’s husband David and her sister Jenny to the Public Gallery. I will come to Heather’s story shortly, but I also want to welcome to the Public Gallery my mother-in-law Cressida, who survived lobular breast cancer 22 years ago, as well as several others whose lives have been touched by lobular breast cancer. Many of them have provided me with briefings in preparation for the debate, for which I am grateful. I met Heather in 2016 when, as someone who had pretty much never run for a bus before, I was roped into a free 5 km parkrun at 9 am on Saturday mornings in Dulwich park. Heather was a serious runner, and running was a huge part of her life. She took pity on me and decided that her inexperienced local MP needed a friend to run with, and she became that friend. We worked out that we lived close to each other, and it was not long before I was picking her up to go to the parkrun, and we would run together most weeks. Heather was a dedicated public servant, spending her whole life working in the Home Office. It is a testament to her professionalism that she never spoke with me about the content of her work. What she did speak about as we ran was her family, her husband David and two precious daughters. Heather was an amazing mum. She spent so much of her time thinking about what her girls would enjoy, planning birthday parties and holidays and, earlier this year, plotting a trip to Wales to culminate in the surprise collection of a new puppy. In 2020, at the height of the covid-19 pandemic, Heather started to get terrible back pain. For several months this was treated as a musculoskeletal issue. She was given pain medication, but it got worse and worse. Eventually, she was diagnosed with stage 4 invasive lobular breast cancer. The back pain was the result of the cancer having spread to her spine. For three years, chemotherapy held the cancer at bay but, when Heather came to Parliament almost exactly a year ago to campaign on lobular breast cancer, she mentioned to me that she once again had back pain, which she thought could be the cancer recurring.

The hon. Lady brings forward a very personal story. In this House, we know that personal stories are always the hardest to tell, but the ones that have more impact. I commend the hon. Lady for what she is doing today. We would all say that, but we mean it.

I thank the hon. Gentleman—who is my hon. Friend—very much indeed for that intervention. Heather died in St Christopher’s hospice near her home on 30 August. She was 48 years old. Shortly before she died, Heather’s daughter, who was due to start secondary school in September, visited her mummy in the hospice, so that she could see her in her school uniform. In that unbearable heartbreaking detail is why we must do better on lobular breast cancer: better on awareness of symptoms and better at research into treatments. The heartbreak of Heather’s story and the impact on her family and friends is sadly replicated for too many women and their loved ones throughout the UK. Lobular breast cancer is the second most common type of breast cancer, accounting for 15% of all breast cancers, and 22 women a day are diagnosed with lobular breast cancer in the UK. It behaves differently from other forms of the disease, mostly strikingly because it does not cause lumps, and it is often completely invisible on a mammogram.

I thank my hon. Friend for securing this debate on such an important topic, and for so movingly sharing the story of her friend Heather. I want to raise the case of my constituent from Dalgety Bay. Just days before her surgery for lobular breast cancer, a mammogram was still unable to pick it up, exactly as my hon. Friend describes. It could not pick up the existence of her cancer at all. Does my hon. Friend agree that this is a perfect example of why we so badly need more research and better diagnosis and treatment of lobular breast cancer for women across the UK?

I thank my hon. Friend for bringing the story of her constituent to this debate. This is exactly the reason why we need to find better means of diagnosis and treatment for lobular breast cancer. I will come talk about some of those means shortly. Currently, there are no treatments specific to lobular breast cancer. This must change. The issues have been well documented by Dr Susan Michaelis, founder of the Lobular Moon Shot Project. Susan was 50 when she noticed a small, pale, 1 mm mark on her left breast in 2012. She had no lump and both a mammogram and an ultrasound were reassuring. Six months later, the small mark had become redder and Susan had a biopsy that confirmed she had invasive lobular breast cancer. Susan’s cancer had spread to her neck, the back of her head, the eye area and her ribs. She is now on her sixth line of treatment. Dr Michaelis is a qualified air accident investigator. She focuses on how accidents can be prevented by learning from past mistakes, and has used these skills to look at how treatments have failed her. In doing so, she has identified the need for a new approach.

I congratulate the hon. Lady on securing this really important debate. Does she agree that specific forms of cancer like lobular breast cancer require specific funding, research and treatment, and that a one-size-fits-all approach is going to fail millions of women? I declare an interest in asking this question in that last year I was diagnosed with lobular breast cancer. I am cancer-free now, thank God, as a result of the help of the Royal Marsden hospital. Tragically, that is not the case for many, many women in this country.

I thank the hon. Lady very much for that intervention and for sharing her personal story. I pay tribute to Dr Michaelis for her research and campaigning on lobular cancer. I hope that all Members have received their Dr Susan Michaelis rose this week, named in her honour, and will plant it as a reminder of the urgency of her work. There are so many other stories. Katie Swinburne was 47 when she was diagnosed with invasive lobular cancer in her left breast, leading to a double mastectomy, radiotherapy and 10 years of targeted chemotherapy. She writes: “It is very hard to accept that none of my treatment is specific to lobular breast cancer and no one can tell me if it is working or has been effective…I find myself living in fear of recurrence. I deserved to have an early diagnosis. I did not get this. I deserve a specific treatment; I do not have this. I have three young children; they deserve to have a mum. I deserve effective follow up; I do not get this. I need you to change this for me, my husband, my family, all the women with a lobular diagnosis and all the women who will be diagnosed in the future.” Emma Hunwick writes: “I was a happy, healthy and relatively fit 49-year-old professional woman when I noticed a tiny pull in my right nipple. No lump, no other obvious external changes. An annual medical and referral just 12 days later resulted in a clear mammogram and a clear second 3D mammogram. An ultrasound then reported an area of 2 cm of concern. I rapidly went from ‘caught early’ to borderline stage 2 breast cancer. After my mastectomy I was informed that I was in fact stage 3c invasive lobular breast cancer…I am now at high risk with predicted survival outcomes at 10 and 15 years of approximately 45% and 30% respectively...I need to know that the vital scientific research into lobular breast cancer is being done now. Not next year or in 10 years but starting now, so that I might survive longer and continue to work with less worry about whether the standard monitoring tests that missed my first cancer, will miss a recurrence.” Kirstin Spencer’s story is also typical. Diagnosed in 2018, she and had a double mastectomy, but was warned that, especially in the first two years afterwards, the disease could recur in areas such as the scar tissue, chest wall and surrounding skin. She was told that vigilance and well-managed medical follow-up were everything. Within a year of her diagnosis, she developed red-flag symptoms that were repeatedly dismissed by her breast specialist. She was refused follow-up treatment and sent for psychological counselling. By the time that a new GP listened to her concerns, substantial recurrence was confirmed, with extensive metastatic disease. My mother-in-law Cressida’s story is very different from Heather’s, and we are all so grateful to the doctors who treated her and for the subsequent 22 years of health that she has had and continues to enjoy. Cressida did not have any grandchildren when she was diagnosed, but a prompt diagnosis meant that she has been able to be closely involved in the lives of eight subsequent grandchildren, as a much-loved granny. But Cressida’s outcome was about luck rather than design, so much so that it was only very recently, when reviewing her medical notes, that she found out that the type of cancer she had was lobular. Breast cancer survival rates are directly impacted by the stage of diagnosis. Late diagnosis, which is all too common for lobular breast cancer, leads to far worse outcomes. To improve this situation, we need much better awareness of the full range of breast cancer symptoms, including the very small skin changes that are typical of lobular cancer. Not all cancers cause lumps. A clear mammogram does not provide absolute reassurance, because lobular cancer typically does not show on a mammogram. We need lobular-specific research and treatments. Staff at Manchester Breast Centre have stated that they are able to do the research to understand the complete pathology of lobular breast cancer—research that has never been done—to pave the way for bespoke treatments to be developed. This will take five years and cost £20 million—moonshot funding that will be recouped many times over in the tax revenue paid by women like Heather, who would be able to continue working, and in the NHS costs that will be saved. Hundreds of MPs in the last Parliament and this one have listened to the stories of constituents affected by lobular breast cancer and pledged their support for the Lobular Moon Shot Project. Lobular cancer is the sixth most common cancer in women. It is more common than ovarian, brain, central nervous system, non-Hodgkin lymphoma, pancreatic and kidney cancers. I know that the Minister cares deeply about women’s health equality and I put it to her that lobular cancer is a women’s health equality issue.

I thank my hon. Friend for raising this very important issue. I was diagnosed with, treated for and cured of breast cancer this year, in a very timely way. I was very grateful to be told that it was one of the best cancers to have, because there is so much research into it and treatment for it. It is unimaginable that someone could be treated for a different type of breast cancer for which the research and treatment are not available. I am sure my hon. Friend will agree that this situation needs to be addressed immediately, because we cannot have these inequalities. Lobular cancer should be on a par with other breast cancers in terms of treatment.

I thank my hon. Friend for that intervention. She makes the point extremely well. How can it be that there are so few targeted programmes to improve the diagnosis and treatment of a cancer that affects 15% of breast cancer patients? How can it be that such poor information is provided to women that does not empower them to seek help when the symptoms of lobular cancer recur? How can it be that women are lured into a false sense of security when they receive a clear mammogram, or are fobbed off when they raise concerns? We need to do better for women affected by lobular breast cancer, in memory of Heather and many more women like her who will not live to see their children grow up. We need to do better for women like Dr Susan Michaelis, who are living today with their lobular cancer being held just about at bay by generic breast cancer treatments, but who live with the constant anxiety that one day the treatment will stop working. We need to do better for the 22 women today and the 22 women tomorrow—the 22 women every single day—who are diagnosed with lobular cancer. I have a number of asks to make of the Minister. Will she commit to investigate why there are so few targeted programmes to improve diagnosis, research and treatment of a cancer that affects 15% of breast cancer patients? Will she confirm that lobular cancer will remain a priority in the Government’s women’s health strategy? Will she take steps to address the lack of information given to women about mammograms, so that every woman is reminded to remain vigilant for non-lump changes in their breasts, including very small changes? Will she take steps to improve the education of primary care doctors on the symptoms of lobular breast cancer, so that women are not provided with false reassurance, but promptly referred for diagnostic tests? For patients treated for ductal breast cancer, the first five years are critical, but for lobular breast cancer the risk will remain for 10 years and sometimes beyond, yet lobular patients are typically released from surveillance care after only five years. Will the Minister take steps to ensure that there is a specific follow-up pathway for lobular breast cancer? Will she support Manchester Breast Centre’s call for Lobular Moon Shot funding—£20 million over five years—to enable the basic pathology of lobular cancer to be fully understood as the foundation for developing bespoke treatments? Will she look at the fairness of the distribution of research funding to ensure that this funding can be identified without further delay? I know the heartbreak that Heather's death has caused for all who knew and loved her, and most especially for her family. We can act to ensure that, in future, women like Heather who are diagnosed with lobular cancer can live to see their children grow up, and it is imperative that we do so.

14:46:00

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing this debate, and for her very moving speech. I have to make a declaration of interest: I am a governor at the Royal Berkshire hospital in Reading and I have a family member who has shares in a medical company. I would like to start by giving my sincerest thanks to Dr Susan Michaelis: first, for her rose, which I have to say I first thought was a delivery of parliamentary stationery to my office—but it was not; and for her passion and diligence in running the Lobular Moon Shot Project. I am proud to have pledged my support to the campaign, which will hopefully change the lives of millions. I will relentlessly champion the need for improving cancer research in this House, because cancer research is so important for securing earlier diagnosis and delivering more effective treatment. However, the existing system has numerous challenges that need to be overcome. Funding is certainly one of the research barriers, but there are wider concerns that the existing pressures on our cancer and wider health service are acting as a barrier to research. The Government have committed to developing a national cancer plan. This could be a real turning point, because cancer services are simply not delivering for their patients. The Government are determining what the cancer plan will look like, and they are fortunate that Cancer Research UK has already produced a comprehensive report titled “Leading on Cancer”, which sets out some of the key recommendations that they should consider on all matters of a cancer plan. I will highlight some of their points regarding research, which I suspect would significantly improve the chances of making the Lobular Moon Shot Project a reality. Cancer Research UK makes it clear that the Government’s cancer plan needs to cover workforce planning, and physical and digital infrastructure. That would give NHS services the capacity to carry out clinical research and would reverse the current trend whereby clinical research is seen as a “nice to have”, rather than as something that is deeply integrated into cancer outcomes. Cancer Research UK’s report also makes it clear that long-term planning is important in giving healthcare systems notice of innovations coming down the track so that the adoption and implementation of those new treatments can be planned for appropriately. The Government will need to support staff with the right kind of training, and provide the right equipment to deliver innovations. They must not fall into the trap of talking only to themselves. The Department for Science, Innovation and Technology needs to work as one to ensure that cancer research is given the priority it needs. The Cancer Research UK report addresses those points in far more detail. I urge the Minister to read it if she has not done so already, and I would be incredibly grateful if she would meet me and Cancer Research UK to discuss its findings. I pay tribute to the cancer centre at my local hospital, the Royal Berkshire. The King Edward ward provides constituents with chemotherapy, and the Adelaide ward provides care for oncology patients. Its staff are among the very best in the NHS. Can the Government assure me that when they publish their plans for the rebuild of the Royal Berkshire hospital—following the new hospital building programme review, which I fear is already dragging on quite a bit—they will include appropriate digital and physical infrastructure to fully realise and implement new technologies in future years?

14:52:00

It is an honour to serve under your chairmanship, Ms Vaz. I thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for securing this debate, and I concur with my hon. Friend the Member for City of Durham (Mary Kelly Foy) about health outcomes for those diagnosed with cancer. One of my most difficult days was when my wife was diagnosed with cancer. She has now thankfully recovered but, looking back at her cancer and her diagnosis, the fact that it was caught early and was seen as a cancer with greater success outcomes shows the disparity of outcomes—particularly for those with lobular breast cancer, as my hon. Friend the Member for Dulwich and West Norwood described. I pay tribute to the Lobular Moon Shot Project, which aims to give lobular cancer the attention and funding it needs, so that it can be better understood. Lobular breast cancer is the second most common form of breast cancer and, as has been said, accounts for about 15% of all breast cancers, yet there is still not enough research being undertaken. My hon. Friend mentioned my constituent Emma, who is in the Public Gallery. Emma recently attended my constituency surgery and told me of her experiences with lobular breast cancer. Because of the way it presents, it was not picked up by a mammogram, and it took an MRI—facilitated through a routine private healthcare check—for it to be diagnosed. As has been said, it was initially thought to be a stage 2 cancer, but it was in fact stage 3. Following her diagnosis, she underwent a double mastectomy, followed by chemotherapy for six months, and then 15 sessions of radiotherapy. In Emma’s case, her cancer is likely to return, which leaves her with a very uncertain future for years ahead. On the current data collection framework on lobular breast cancer, there is a lack of documented research about outcomes for and recurrences of lobular breast cancer. Indeed, there is currently just one trial available in the UK for lobular breast cancer patients. This leaves women like Emma unprepared for the potential impacts that the cancer will have on them further down the line. Given this position, I would be grateful if the Minister could address not only the points raised by my hon. Friend the Member for Dulwich and West Norwood in her asks, but her comments on what can be done to secure more regular MRIs—as was shown in Emma’s case, having more regular MRIs is the only thing that will pick this up—and to ensure that there is greater data collection and transparency on the effects of lobular breast cancer.

14:54:00

It is a pleasure to serve under your chairship, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for her story on behalf of her dear friend and for leading the debate. We have been very privileged to hear contributions from courageous hon. Ladies to my right and to my left, who have told their own personal stories, which contribute to this debate. It probably also humbles us to have those contributions. Every person who has come here today to make a contribution will have an example of someone they love who has been affected. Westminster Hall is a great place, as the Chamber would be, to raise awareness and to discuss these matters. I am sure that many will not be fully aware of this insidious brand of cancer, or of its specifics. I am personally grateful to be able to give one example, but also to discuss these issues. As my party’s health spokesperson, these issues are incredibly important to me. Indeed, they are important to us all; we are all here for the same purpose and it is vital for us all to be here. I know that we will all have had some journey experiencing cancer within our family or close to home. Not long ago, I met in my office a constituent of mine who was diagnosed with lobular breast cancer. I think that, whenever we meet someone who has come through that journey and thankfully is on the other side and alive today, we thank God, as the hon. Member for Maidstone and Malling (Helen Grant) did. Ultimately—I say this respectfully to everyone here —that is where the power lies for healing: with our God. The hon. Lady explained that there is not enough research into the specifics of this cancer, let alone more access to medication that lessens the impacts of the suffering. Perhaps the Minister will have an opportunity, through civil servants, to check what research and development there is on this specific lobular cancer to help save more lives, make lives better and give people hope for the future. Ultimately, in this House, we are tasked to give hope—not because of our words, because our words are not important—to those out there who face this reality of what the future will hold for them. Invasive lobular breast cancer is the second most common type of breast cancer. It is also known as invasive lobular carcinoma. Around 15 in every 100 breast cancers are invasive lobular breast cancer. The most recent figures show that, in 2016, 6,765 people were diagnosed with lobular breast cancer in England, including 6,754 women and 11 men. There may be those who think that it is not a disease that can affect men; but although it is a very low number, it still does. My hon. Friend the Member for Wokingham (Clive Jones) is one of those survivors. I think we should thank God that he is here today as well. It is important to note that, although it is less common for men to get this form of cancer, they are still able to get it and it can impact them just the same. There were 7,566 cases of female breast cancer diagnosed during 2018 and 2022 in Northern Ireland. On average, there were 1,513 cases per year. I want to put the figures and stats on record because they illustrate clearly how critical, dangerous and invasive this cancer can be. In Northern Ireland, the breast cancer incidence rate was 156.7 cases per 100,000 females. The odds of developing female breast cancer before the age of 85 was one in eight. It is clear that there is a major concern in Northern Ireland and throughout this great United Kingdom. This specific type of cancer often goes undetected, as it spreads in straight lines, as opposed to lumps. Furthermore, although the cancer grows slowly compared with other cancers, the tumours can be large by the time they are detected. In addition, some 3.75 million people will be diagnosed with this cancer in the next 10 years, which is why it is important to discuss it, so I thank the hon. Member for Dulwich and West Norwood for securing this debate.

I associate myself with what we have heard in this very powerful debate. I commend the hon. Member for Dulwich and West Norwood (Helen Hayes), and I commend the family who are sitting in the Gallery. Cancer is a thief in many homes, and I commend them for their bravery. Does my hon. Friend the Member for Strangford (Jim Shannon) agree that, across the UK, we need more investment, more research and more clinical trials, and that it is for this Government to step into the breach and do just that?

My hon. Friend is right. We are fortunate that Labour has set aside £26.3 billion for the NHS. We have to recognise that commitment, and I hope the Minister will be able to tell us that money will be set aside for the very invasive disease to which my hon. Friend refers. ILC currently has no specific treatment and, for those who have been diagnosed, it behaves very differently from the more common type of breast cancer. As we look ahead to the next 10 years, it has been great to learn more about the Lobular Moon Shot Project, which has been supported by this Government, the last Government and hundreds of Members. Everyone in this room supports it, everyone in the Gallery supports it, and everyone outside this room supports it too. The project was set up in 2023, which is fairly recent. At my age, the years go incredibly fast, but 2023 feels like yesterday. The project seeks to lobby the Government to secure the research funding needed to understand the biology of lobular breast cancer. The project has stated that a major research package is estimated to cost some £20 million over five years, but it has not been prioritised as it should have been. I reiterate what the hon. Member for Dulwich and West Norwood said, and I ask that the research is prioritised. The Minister may not be able to tell us about everything that is happening, but we need to hear that commitment. Some fantastic charities undertake amazing work to support those living with breast cancer, and I have met them both in Westminster and at home in my office, and their work is instrumental in helping people to cope with the physical, mental and emotional side of dealing with a cancer diagnosis. One person will have the cancer, but their family and friends are also affected, as the hon. Lady said. With this type of cancer, there is a risk of recurrence or spread. Up to 30% of early-stage primary patients will experience spread to their organs, which can be a number of years after the initial diagnosis. This highlights again the need for greater research and funding to ensure early detection and to prevent the cancer’s spread. The shadow Minister spoke in a debate this morning about research undertaken between Birmingham University, Newcastle University and Queen’s University Belfast. He was talking about rare autoimmune rheumatic diseases, but Queen’s University Belfast has partnerships with other organisations to try to find cures for cancer. Many universities across this great United Kingdom of Great Britain and Northern Ireland are carrying out research, and the Government’s approach to that is vital. I have gone on a bit longer than I had hoped, but there is more work to be done on researching most cancers. Breast cancer, and specifically lobular breast cancer, impacts the lives of thousands of people every year. It is time to do more as a collective. Today, collectively, Members on both sides of the Chamber are committed to trying to find a cure and trying to find hope for those who have cancer, and who will hopefully survive it, and for their families as well, by undertaking the important research into this awful disease. We are also committed to making men and women across the country aware of the warning signs. I look to the Minister and her Labour Government, which is my Government—whether you are a Labour person or not, it is our Government and they are trying to do the best they can, and I think they deserve support for their commitment to do so—with sincerity and honesty, perhaps beseechingly, to ensure that the devolved nations are not left behind in terms of a strategy. I look forward to action from the Minister and to her replying to all the requests.

15:05:00

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for raising this vital issue. Breast cancer is the leading cause of cancer death for women worldwide, and many, if not all, Members will know somebody who has faced the frightening prospect of breast cancer treatment, which is unfortunately all too common and impacts the lives of millions, whether directly or indirectly. What is fortunate is the progress in detection and treatment, which has provided many patients with positive outlooks and a healthy future life with their loved ones. Sadly, this prospect is often not afforded to the 15% of breast cancer sufferers diagnosed with invasive lobular cancer. Survival prospects for those with ILC can be relatively good, but only for those who are diagnosed early, before the cancer has spread. I repeat the calls of other Members and Breast Cancer Now to publish the findings of the UK national cancer screening review into breast cancer risk stratification. If improvements are made so that we can detect more elusive forms of breast cancer, tens of thousands of lives could be saved. However, improved detection is not enough by itself. Women diagnosed with ILC face another issue: the treatments they are provided are not tailored or specific to their cancer. In short, they are treated for a disease they do not have. One of those women, as has been mentioned, is Dr Susan Michaelis, who lives in my constituency of Horsham, where I met her earlier this year. Susan is an incredible woman who has campaigned tirelessly on invasive lobular cancer treatment and research. She was diagnosed with lobular cancer in 2013, but the treatment she then received was designed for ductal cancer, which is the most common form of breast cancer. As a result, Susan’s condition evolved and became resistant to the treatments now available. Someone less determined might have given up looking for answers, but instead Susan went out and started the Lobular Moon Shot Project and, yes, I have already planted my Susan Michaelis rose. She met research experts to build an idea of the cost of research into the basic biology of invasive lobular cancer in the hope of improving outcomes for those yet to be diagnosed. The Institute of Cancer Research has deemed that £20 million is enough to make significant progress, and Rob Clarke of the Manchester Breast Centre will head up that work in conjunction with world leading experts. That is all agreed. Since then, Susan and the Lobular Moon Shot Project have lobbied MPs and Government Departments. Hundreds of MPs have supported the application for funding. In the last Parliament, the number was 247; there have already been almost 200 in the current term, and I am sure that many more will join the call. The team at the project should be commended for all their hard work and amazing, ceaseless energy. Given the Government’s recent announcements about taking a firm business approach to funding within Departments, research into lobular cancer makes for a strong business case as well. Breast Cancer Now research shows that the cost of breast cancer to the UK economy is £2.6 billion. That is set to rise to £3.6 billion by 2034. Ongoing cancer treatment is expensive, with each patient requiring approximately £10,000 a year, whereas the £20 million research request equates to £240 per lobular cancer patient over the next 10 years. Early detection and better treatment can reduce the overall time the NHS needs to support patients. Put simply, research into lobular cancer saves both lives and money. If the human arguments are not enough for the Government to commit to this vital research, then let us talk about the money. The previous Government included lobular cancer research in their women’s health strategy for England 2024 and acknowledged that there was an urgent, unmet clinical need. I ask the new Secretary of State to renew that commitment and to fund the Lobular Moon Shot Project’s call for research, which will enable the NHS to offer specific treatment to lobular cancer patients and end the one-size-fits-all approach. Dr Susan Michaelis and the lobular ladies hope that they will be the last generation to go through the experience of insufficient treatment and poor outcomes, and I hope that this Government can make that a reality.

15:10:00

It is a pleasure to serve with you in the Chair, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for bringing this really important debate to the Chamber and for her excellent speech, which told the story of her friend Heather and the stories of Katy, Emma, Kirstin and Cressida, who have suffered a pernicious type of disease that we are currently unable to treat effectively 100% of the time. I thank my hon. Friend the Member for Wokingham (Clive Jones), the hon. Member for Bexleyheath and Crayford (Daniel Francis), the hon. Member for Strangford (Jim Shannon), and my hon. Friend the Member for Horsham (John Milne) for their speeches, which were all excellent. I also thank the hon. Members for Maidstone and Malling (Helen Grant) and for City of Durham (Mary Kelly Foy) for sharing their own stories, which were very helpful to the discussion. I thank Dr Susan Michaelis for the bare-root rose—when we received it in the MPs’ offices, we were all a bit stumped by what the enormous box might be for—and, more importantly, for her tireless campaigning to secure funding for research into lobular breast cancer. The speeches today have been excellent and detailed, and I wish to avoid repetition. As we have heard, 22 people a day in the UK—mostly women—and 1,000 women globally are diagnosed with invasive lobular breast cancer. It is the second most common type of breast cancer, so it is really important that we support the Lobular Moon Shot Project. Liberal Democrats will fully support that project, which is run with the Manchester Breast Centre. Some £20 million over five years to better understand the diagnosis and treatment of this disease is not really a significant investment for the Government, but it would have an enormous and meaningful impact for those people—mostly women, but, as I said, there are some men—who are affected by it every single day. Research funding is such an important part of investment in the early detection and treatment of cancer—particularly for lobular breast cancer—which is better for everyone, including the patients who have been diagnosed. Receiving a diagnosis of any type of cancer is a really difficult moment for any individual and their family, but receiving a diagnosis of a cancer for which there is not a clear treatment pathway is even more concerning. It is really important that we try to address the problem that these women face. It is better for them and for the NHS, because, as we all know, early treatment tends to be more successful and quicker. Because of that, it is also better for the taxpayer. It is entirely consistent with the recently announced Government strategy of rewiring the NHS to focus resources on early prevention, detection and treatment to ensure that people are kept healthy, rather than treated when they are sick. As other speakers have pointed out, this disease is the sixth most common cancer in women, and it needs to be treated as a distinct disease. We must ensure that women who face this diagnosis are given the treatment for the disease that they have, not for one that they do not have. It is really important that that is built into the Government’s new cancer strategy, which they have committed to work on. The last Government did not have a 10-year cancer plan, although they did include lobular breast cancer in their women’s health strategy, so I was really pleased to see that in a debate led by my hon. Friend the Member for Wokingham, this Government committed to a national cancer strategy. That is a really important step forward, and we are really pleased that the Government felt able to make that step. I hope that for people who have been diagnosed with lobular breast cancer and, indeed, any other type of cancer that the Government are able to deliver on the strategy as soon as possible. One of my key concerns is the dreadful waiting times for scans and for results from MRI scans, which are the best way of detecting lobular breast cancer, and other types of CT scan. In my constituency of North Shropshire, which is part of the Shropshire, Telford and Wrekin integrated care board, we have some of the worst records in the country for scan interpretation. As a result, I have been contacted by constituents who have had devastating outcomes, where scan results have been delivered to them, only for them to find out that they have been on the wrong type of treatment in the meantime, sometimes for many months. We need to avoid that happening in the future. The leadership team has shown that it can address the problem, and I am pleased to report that it is beginning to do so in Shropshire. I hope that the cancer strategy will identify where there are shortages of radiologists and of the machinery needed to carry out those scans and to ensure that we hit the 62-day waiting-time target for people who need to start urgent cancer treatment. Part of the capital expenditure plan announced by the Government is critical to that, and I look forward to hearing the details from the Minister. The Liberal Democrats also want the Government to pass a cancer survival research Act that requires the Government to co-ordinate and ensure funding for less survivable and less common types of cancer, and for types of cancer that are not currently treated as distinct or treated appropriately. We want the time it takes for new treatments to reach patients to be halved, which would mean expanding the capacity of the Medicines and Healthcare products Regulatory Agency. That would ensure that patients with cancers that do not respond to current standard treatments can access new treatments much more quickly as they come online. I echo the request of the hon. Member for Dulwich and West Norwood and the other hon. Members who have spoken so powerfully today. The Lobular Moon Shot Project would change the lives of 8,500 women in the UK every year. In developing the national cancer strategy, I hope the Minister will consider some of the proposals that we have put forward collectively today, which are aimed at improving detection, treatment and survival rates for people with invasive lobular cancer and all other types of cancer.

15:16:00

It is a pleasure and an honour to serve under your stewardship, Ms Vaz, and even more of an honour to be part of this debate. I pay tribute to the hon. Member for Dulwich and West Norwood (Helen Hayes). Not only was her speech emotional, but it was powerful. Cressida, I am sure, is incredibly proud and Heather would be even more proud. That is because the hon. Lady has really done the subject justice today, not only by securing this debate but by bringing the whole room together and highlighting the most salient points. Often in these debates, there is a lot to cover, and the hon. Lady has done it with aplomb. I also thank my hon. Friend the Member for Maidstone and Malling (Helen Grant) and the hon. Member for City of Durham (Mary Kelly Foy) for speaking up about their personal experiences. That is tough to do, and it is a testament to their constituents that they have put on record, in public, the trials and tribulations they have been through. It is important that people feel they can advocate in this space and lead by example in doing so. That leads me on to the hon. Member for Bexleyheath and Crayford (Daniel Francis), who talked about his wife. He is an example of how important it is to have a powerful advocate. Partners and families do exactly that: they advocate for patients who are going through treatment. The fact that he is doing that here as well is incredibly powerful. The hon. Member for Strangford (Jim Shannon) and I are starting to have regular conversations about health in Westminster Hall debates, with an hour and a half this morning and another hour and a half this afternoon. His passion for health topics is probably only superseded by the volumes of Hansard content he accounts for. He talked about networks, and in research it is important to make sure that we are bringing together the best brains from across the field for the biggest possible research pools. That is much needed. I congratulate the hon. Member for Horsham (John Milne) on highlighting hope. The danger is that we spend too much time talking about difficulties, when over the past couple of decades, breast cancer actually provides a good story of how far advances have been made and survival rates improved. It is important that we point that out, so that not all is doom and gloom. There are fantastic survival rates for breast cancer, for example. The hon. Gentleman paid tribute to Dr Susan Michaelis, as did the hon. Member for Wokingham (Clive Jones). As MPs, we are lobbied a lot, so to have got so many MPs signed up and to have secured debates here repeatedly, month on month and year on year, is an incredible testament to the character of Dr Michaelis. The Lib Dem spokesperson, the hon. Member for North Shropshire (Helen Morgan), rightly highlighted access. When it comes to making sure we get diagnoses, access is key. The last Government rolled out community diagnostic centres—almost 170 of them. When it comes to diseases such as breast cancer, I hope that new MRI and CT scanners will become available, allowing us to have better screening pathways, because that is what often limits a screening programme. That access is now being widened so dramatically, with the Government confirming this morning that they are continuing with it, is a sign of great cross-party working, which we all know the NHS needs. Much has been said about lobular breast cancer in this debate, and for me it matters because of the way it presents. One can take the doctor out of medicine but not the medicine out of the doctor, so I will use this opportunity to ensure that people are aware that they should regularly check their breasts. They should look for lumps but also for skin changes, or what we call peau d’orange—it looks a little like orange peel—on the breast. They should also look for slight changes, a little bit of discharge or blood. Lumps, bumps and discharge do not mean an individual has cancer; it simply means they need to be assessed. One of the great things about the set-up in this country is that it is quick and accessible—a good success story—but we need to ensure that people feel comfortable and able to come forward. Cases have been highlighted where clinicians did not seem to trust women. It is important that clinicians trust women’s instincts. Women know their own breasts, and when they are aware of changes, they must be taken seriously. We have a chance through clinical pathways to do that, which is important. We heard that 22 women a day in the UK are diagnosed with lobular breast cancer. As someone who has given that diagnosis, my next piece of advice for anyone unfortunate enough to receive a diagnosis of breast cancer is to ask whether it is lobular or ductal. That is often forgotten. As a clinician, I have never been asked that question, but it would help to change the narrative of expectations about what treatments may be available, and promote understanding. If a patient speaks to someone else with breast cancer, they might wonder why their treatment is different. It is important to educate people, not in a condescending way, but to appreciate the general difference. Treatments are becoming so specialised and nuanced that all will not be the same, and that can be quite disconcerting. I pay tribute to those who are battling lobular cancer, the cancer survivors and the campaigners from Lobular Breast Cancer UK for their tireless work in raising the issue. Of course, the ultimate goal is to have a cure for lobular breast cancer. Advances in medical research and treatment options are moving us closer to that goal. In 2022, the Government invested £29 million into the Institute for Cancer Research and the Royal Marsden biomedical research centre to support research into cancer, including lobular breast cancer. That included a £1.3 million project to determine whether abbreviated forms of breast MRI can detect breast cancers missed in screening. That links to the point about having more MRI scanners, which might well enable better research to determine the way to pick these things up and improve the ability to deliver. I am pleased the previous Government supported, through the National Institute for Health and Care Research clinical research network, 10 further lobular breast cancer-related studies. I am also reassured by the Lobular Moon Shot Project, which we have heard a lot about. I pay tribute to the former Member for Horsham, Sir Jeremy Quin, who did a lot to raise that issue. I am pleased to see the new hon. Member for Horsham standing in his shoes to raise it now. It would be useful to know if the £20 million for the five-year study is being looked at by the Government. It was raised several times with the previous Government, but an election got in the way and power changed hands. It would be interesting to see if the proposals have been reviewed and merit the Government taking them forward. A key measure that has been missed to some extent is guidelines. Lobular Breast Cancer UK is to launch a campaign calling for national breast cancer guidelines to be updated to recognise lobular breast cancer. Will the Minister commit to reviewing and updating the guidelines with the National Institute for Health and Care Excellence? We have also heard about devolved powers. Scotland, for instance, has the Scottish Intercollegiate Guidelines Network. It would be useful to know whether the Minister will raise this issue with the devolved nations to ensure we have a joined-up approach, without any cross-boundary difficulties. I do not want to turn this into a political battle because this is not the place, but I put it gently to the Minister that we have heard about the need for support, a lot of which comes from charities. The changes in national insurance contributions for employers have hit charities, including the likes of Breast Cancer Now, Macmillan and Marie Curie. They are not shielded from the rises. I will be grateful if the Minister considers raising with Treasury what can be done to help support those crucial nurses, advice lines and workers, so as to make sure that when people are going through these difficulties—we have heard how complex the scene can be, particularly in breast cancer—advice is accessible to all. I thank all those who took part in this debate, and I remind people to regularly examine their breasts. If there is a change, seek help. If a diagnosis of cancer is given, ask if it is lobular or ductal. Finally, remember that no one is alone. As we have heard today, many people suffer from cancer and there is support out there—from the NHS, charities, family and friends—so do not be fearful. Speak out and get that support.

15:25:00

It is a real pleasure to serve under your chairship, Ms Vaz. I add my thanks to all hon. Members for their contributions and to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). First let me say how sorry I am to hear about her friend. Those are very precious friendships and I think my hon. Friend articulated that well today. My deepest sympathies to Heather’s loved ones who are with us today and to her wider family group. It is a really difficult time and this is a very recent bereavement to be talking about. My hon. Friend has used her voice as a parliamentarian to good effect, as she always does, and I congratulate her on doing that. I hope I can go some way to answering the questions she raised at the end of her speech. If I do not and she is not satisfied, I will make sure officials get back to her on the specifics. I also echo the words of the hon. Member for Hinckley and Bosworth (Dr Evans) about hon. Members raising their personal experiences and the importance of support from partners and wider family members for people who are going through diagnosis, treatment and sadly, often, death. We know that too many cancer patients are being failed. They are waiting too long for life-saving treatments and receiving a diagnosis too late. As my right hon. and learned Friend the Prime Minister reiterated last week, we have inherited a broken NHS but it is not beyond repair. We know it needs to be fixed and there is not a single solution. To ensure that more people survive cancer, including lobular breast cancer, we have to take a multi-pronged approach—catching it earlier so more treatments are available, raising awareness of its specific symptoms, and investing in equipment and research, as many hon. Members have raised today. All those actions are part of our plan to put the NHS on the road to recovery. As we have heard today, according to Cancer Research UK lobular breast cancer is the second most common type of breast cancer. Also known as lobular carcinoma, it impacts the lives of many—around 15 in every 100 breast cancers are invasive lobular. Treatments for lobular breast cancer are broadly similar to those for other breast cancers. Surgery and radiotherapy are effective for most patients with primary invasive types, meaning those which have not spread to other parts of the body. Systemic therapy such as chemotherapy, hormonal treatment, targeted therapy or immunotherapy are usually offered based on the stage at which the NHS catches that cancer. Another factor which can determine clinicians’ decisions on the best treatment option is how the cancer has spread or developed in each patient’s case and we understand that is different for different patients. Sadly my understanding is that when cancer is growing in more than one location, as is more common in lobular breast cancer, treatment is more challenging. The same is true when a cancer has spread to other parts of the body. To improve outcomes in such challenging cases, NHS England funded an audit into both primary and metastatic breast cancer that has spread. The scoping for this audit began in October 2022 and the results were published in September this year. NHS England are hopeful that the results will help to improve the consistency of treatments offered, as well as stimulate improvements. We know that for far too many women, lobular breast cancer is diagnosed at a later stage, which means that treatment options are more limited. The key to improving survival must lie in raising awareness, and early detection and diagnosis. I am not sure I can do it as well as the shadow Minister, but I want to use this opportunity to raise awareness of the fact that not all breast cancers form a firm lump. I think he articulated really well what women should be looking for. Lobular breast cancer patients are more likely to have thickened areas of breast tissue. Possible symptoms include an area of swelling, a change in the nipple or a change in the skin, such as dimpling. I encourage everyone to check their breasts regularly and to consult their GP straightaway if they have any concerns. While more people are surviving breast cancer than ever before, we know that lobular breast cancers can be particularly hard to detect. Another measure to support earlier diagnosis of breast cancer is screening before people notice symptoms. Our screening programme sends women their first invitation at the age of 50. To support detection, the NHS carries out approximately 2.1 million breast cancer screens each year in hospitals and mobile screening vans, usually in convenient community locations, but—this is a really shocking figure that I learned recently in another debate in Westminster Hall, which shows how important it is that Members raise these issues—take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to improve it. Every effort that hon. Members here and people listening to this debate can make to improve that take-up rate will help save lives. If someone is eligible for screening, they should come forward and take up that important offer. Unfortunately, even for those women who come forward for a mammogram, we know that lobular breast cancer can be more difficult to catch than other types of breast cancer. We have heard some shocking stories and examples today. To ensure that women survive, we need to be relentless in researching every possible avenue of treatment and diagnosis. Examples of innovation supported by my Department include £1.3 million invested in a Bristol-based FAST MRI project, which will determine whether different types of scans can help detect cancer in a cost-effective manner. The FAST MRI project focuses on an abbreviated MRI, which is a shortened version of a breast MRI. This type of imaging can help to detect the most aggressive forms of breast cancer sometimes missed by screening through mammography, including lobular breast cancer. My Department is also working closely with UK Research and Innovation and the Medical Research Council. These bodies are responsible for studies that look to understand the basic mechanisms of disease. Combined, they spend £125 million on cancer research each year. My officials also meet regularly with partners to discuss a wide range of our research investments and ways to stimulate new proposals. These include those for lobular breast cancers. Through the National Institute for Health and Care Research, my Department will continue to encourage and welcome applications for new research in this area. I hope this addresses the shadow Minister’s point, but funds for research are still available through the NIHR. Funds are awarded through open competition informed by expert peer review, with active involvement of patients and the public. The Department and NIHR also advise the campaign on the Lobular Moon Shot Project. It has already contracted £29 million, which I think is the figure the shadow Minister referred to, to the Institute of Cancer Research and its partner at the Royal Marsden. This proposal included work on lobular breast cancer. I hope I have addressed that point, but if I have not, then please let me know. We know that we must do more to rise to the growing challenge that cancers including lobular breast cancer represent, but for our efforts in detecting and understanding this complicated disease to be effective, we need to back fundamental reform in the health service. That is why we have launched the biggest national conversation about the future of the NHS since its birth to shape the 10-year plan. We need suggestions from hon. Members on how to go further in preventing cancer where we can. I urge everyone to visit the website change.nhs.uk to do so.

The risk of all breast cancers in women is reduced by 4.3% for every 12 months of breastfeeding, but the UK has one of the lowest breastfeeding rates in the western world: only 1% of children are still exclusively breastfed at six months. Does the Minister agree that community initiatives to encourage women to breastfeed for longer support the Government’s mission to reduce the risk of breast cancers and improve health outcomes overall?

I thank the hon. Lady for that really important point. She highlights another important issue affecting the health of women and children, and I agree with her. My hon. Friend the Member for Dulwich and West Norwood spoke about women’s health overall, which is an important priority for this Government, as are these forms of cancer and the wider preventive agenda. That is another point that can be made on the change.nhs.uk website, which I will keep plugging. The issues that have been raised on it by the public and staff are really interesting and informative. My right hon. Friend the Secretary of State has been clear that there should be a national cancer plan. The hon. Member for Wokingham (Clive Jones) made helpful points about that opportunity. I will not take up his invitation for a meeting; his point would be better made by being inputted into the process with the organisations he is in touch with. That would help to shape the national cancer plan, which we can all buy into as a country. The plan will include more details about how to improve outcomes for all tumour types, including lobular breast cancer, and ensure that patients have access to the latest treatments and technology. We are now in discussions about what form that plan should take and what its relationship with the 10-year health plan and the Government’s wider health missions should be. We will provide updates on that in due course. I thank my hon. Friend the Member for Dulwich and West Norwood for bringing this important matter to the House.

I want to draw the Minister’s attention to the point about guidelines. Will she consider speaking to the devolved nations and, in England, to NICE, about guidance on lobular breast cancer?

I was going to come to that. I am not fully au fait with the change in guidelines that the hon. Gentleman referred to, so I will happily take that point away. He made a wider point about aligning across the devolved regions. Obviously, some of these issues are devolved and we have to respect the devolution arrangements. On the wider research, we should learn from each other, understanding that we have similar patient cohorts. There is lots of good medical work going on, and the Government are determined to work respectfully across the devolved nations. I will ensure that the hon. Gentleman gets a written answer on the specifics of his question. Heartbreaking stories such as Heather’s remind us that diseases such as lobular breast cancer are complex. They are hard to catch, and therefore treat. Such tragic losses are a wake-up call for us all, and I commend all hon. Members for raising those stories. For people listening in, as well as those who have attended the debate, they are an important way to raise awareness. We are grateful to those who have shared their personal stories, which help us get the NHS back on its feet so that we can better serve the people who need it. Improving cancer survival requires a multi-pronged approach to ensure that patients have timely access to effective treatments, built on the foundations of world-class research. We have already taken immediate steps to allow cancer patients to benefit from the most up-to-date technology. Through the recent Budget, we committed to surgical hubs and scanners to allow for 30,000 more procedures each year, and we are increasing capacity for tests. We have also committed another £70 million for radiotherapy machines. Lots of hon. Members have raised those points. I have outlined several measures today, and I assure Members that improving outcomes for cancer patients, including those with lobular breast cancer, remains a top priority for this Government.

15:39:00

I thank all hon. Members who have contributed. They have brought their constituents’ stories and their own personal experiences to the debate. We have many issues to work on in this House, but there is a particular responsibility when an issue presents itself in a personal way through a devastating story, whether that is through a constituent, somebody we know or our own personal experience. When we see an opportunity for things to be done, it is imperative for us all to bring that to this place. I am grateful to hon. Members for the spirit in which the debate has been conducted, the high level of consensus and the high level of commitment to see change for patients with lobular cancer. I am grateful to the Minister for her engagement with the debate. I know she is committed to this area. In closing, I ask that she looks in further detail at two issues. The first is the proportional allocation of the funding available through the NIHR for research into breast cancer. We have heard again and again today that lobular cancer accounts for 15% of all breast cancers, yet currently attracts only a tiny fraction of dedicated research. We know that the improvements we have seen in treatments and outcomes for different types of cancer diagnosis always hinge on the investment put into research to find the cures. There is a disproportionality there that can and must be changed. The second area I ask the Minister to look at in a little more detail is the advice and guidance given to clinicians in primary care, to make sure that there is a consistent understanding of the symptoms of lobular cancer and its distinctiveness as a disease compared with ductal cancer, and to make sure that every woman presenting to her GP is able to access accurate advice and swift onward referral. It is important across the whole range of women’s health conditions that women are trusted and listened to when they present with symptoms to their GP, and this is an area where I believe primary care can do better, be more consistent and deliver better outcomes as a consequence. I pay tribute once again to Dr Susan Michaelis and all those who campaign on this issue on the basis of their deeply difficult personal experiences. I give my commitment that for as long as I have a voice in this place, I will continue to work on this issue until we see the changes that are needed.

I thank everyone who took part in and attended this debate. Question put and agreed to. Resolved, That this House has considered the treatment of lobular breast cancer.

15:43:00