Breast cancer in NE London Frances Haste, Public Health lead

Population of NE London Age profile of London boroughs, % 65+ London has a younger age profile than England Inner NE London has very young population Outer NE London older population

Ethnic composition - Inner NEL

Ethnic composition - Outer NEL

Average life expectancy

General 5 boroughs are in poorest 10% have significantly worse life expectancy 2 boroughs average economic have significantly better life expectancy 6 boroughs very ethnically mixed

The problem , NEL found to have worst 5yr survival from breast cancer in the country

The questions.... Why is survival in NEL so poor? Also: When – is it changing? Who – is it all groups? Where – are some areas worse than others?

2008 Commissioned Thames Cancer Registry to do a ‘forensic analysis’ to understand what were the factors driving poor survival, and what more we needed to know.

What can we do? How can we get earlier diagnosis How can we improve access

Reasons for late stage diagnosis Late presentation - lack of awareness of symptoms - perceived barriers to Primary Care Delays in Primary Care - referral delays - communication issues Delays in secondary care - diagnostic delays - pathway delays

Factors affecting delay Late presentation CAM survey 2010 – 50% of people recall lumps as symptom, less in BME groups - 25% perceived barriers to going to GP Primary Care delays - 50% referred urgently (CWT) - 8% presented in A&E (GP Audit 2010) Secondary Care delays - awaiting audit results

Unprompted recall of cancer symptoms % of respondents in NEL and national survey* (*Robb, BJC 2009)

Possible other factors Poorer cancer survival in younger black women – Studies at Homerton and UK Black women: Are less likely to be diagnosed through screening Have more risky tumour characteristics Have worse prognosis and survival in younger women Age related decisions? Poorer survival of older people in UK

What have we done? Public awareness campaigns Improving screening uptake through community action Engaging with primary care clinicians - audit cancer cases - Cancer training sessions Engaging with acute clinicians - audit of all cancer cases in one year - improving the quality of data

2009 / 2010 Breast cancer awareness in Black women DVD Project led by Homerton Hospital

Improving uptake of breast screening Action with community groups talking to women Telephone calls to people who DNA from local community group

Coverage of breast screening in NEL

Meanwhile ……. Trends in one year survival from breast cancer, NEL

Lessons learned Population needs are variable, need to understand needs of different groups Clinical engagement both acute and primary care is vital – no change can happen without it Change is hard to implement Establishing a commitment to population based work is hard in a climate of reduced funding