'Breast cancer in women over 70' campaign

A number of resources and campaign materials were created for the national campaign including briefing sheets and patient leaflets in accessible formats. You can view an example below:

The key message promoted on TV was: ‘One in three women who get breast cancer are over 70, so don’t assume you’re past it.’ The advert also reinforced the message that finding breast cancer early makes it more treatable.

A second message, promoted more prominently in other campaign materials, was: ‘A lump isn’t the only sign of breast cancer. If you’re worried about any changes to your breasts, tell your doctor straight away.’

The aim was to encourage more women aged 70 and over with unusual breast symptoms to go and see their GP.

Communication plans for the campaign included:

TV advertising. This ran for eight weeks. Due to it being a reminder campaign, it had a lower intensity than the first national campaign for breast cancer in women over 70. It was expected that the target audience (women over 70 years) saw the advert about 8 times on average.

Press adverts. This included display adverts in newspapers and women's magazines, together with advertorials which enable more details to be provided.

Out of home advertising. This included promotion of the campaign’s messages on pharmacy bags.

Targeting BME audiences. There was a ‘detect cancer early(link is external)’ advert featured on relevant TV and radio stations. Events were also held in key locations relevant to BME communities.

Social media. Due to the increasing number of older women using the internet, advertising was also featured in key channels, such as Facebook.

Breast cancer is the most common cancer in England, with around 41,200 women being diagnosed with the disease each year [1]. Breast cancer risk increases with age and a third of women diagnosed with the disease are aged 70 and over [1].

Women in this age group are more likely to die from breast cancer than their younger counterparts [2], with more than half of women who die from their breast cancer in England each year aged 70 and over [3].

Patients aged 85 and over are the most common aged group to be diagnosed with breast cancer following an emergency presentation [4]. They are also more likely to be diagnosed at a late stage [5].

Findings from the International Cancer Benchmarking Partnership (ICBP) show that in England when breast cancer is diagnosed at stages 1 and 2, age has little difference on survival; however when diagnosed at stages 3 and 4, women aged 70 and over have considerably lower survival than younger women [6]. We also know that if breast cancer is diagnosed at the earliest stage in women aged 70 and over, one-year relative survival is as high as 99% [7]. At a late stage, it drops to just 53%.

Increased diagnosis by primary care could reduce emergency presentations and improve the prognosis for these patients.

Research shows that older women are less aware of non-lump breast cancer signs and symptoms [8], are more likely to worry about wasting their doctor’s time [9] and delay presenting to their doctor with possible cancer symptoms [10]. Older women also have poorer knowledge that breast cancer risk increases with age, and this may be due to women incorrectly assuming they are no longer at risk of developing the disease after routine NHS breast screening invitations have ended [11].  Women aged 70 and over are still entitled to NHS breast screening every three years – they just need to make their own appointment.

In 2013 there was a parliamentary inquiry in to older women and breast cancer. The inquiry reviewed a range of evidence looking at some of the challenges and inequalities that may occur in breast cancer. The summary report published by the All Party Parliamentary Group on Breast Cancer, ‘Age is just a number(link is external)’, made recommendations aimed at improving the experiences of and outcomes for older breast cancer patients. It recommended that ‘as the overarching Be Clear on Cancer campaign develops, the specific focus on breast cancer in women over 70 should not be lost, given the clearly identified need for tailored breast cancer awareness messages for older women’ [11]. A ‘two years on’(link is external) report has recently been published in which Public Health England was congratulated for running the campaign and its commitment to evaluating the impact of it [12].

We need to make sure that women aged 70 and over are aware of the symptoms of breast cancer, and that they are still at risk of getting the disease, and to encourage women who notice any changes to their breasts to see their doctor sooner. The earlier breast cancer is diagnosed, the higher the chance of survival.

References

1. Incidence data supplied by West Midlands KIT based on NCRS data.
2. Lavelle, K., Todd, C., Moran., Howell, A., Bundred, N. and Campbell, M. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > 65 years. Br J Cancer 2007;96:1197-1203.
3. Deaths data supplied by West Midlands KIT based on ONS data.
4. Data Supplied by Public Health England using Routes to Diagnosis 2006-2013.
5. G Lyratzopoulos, G A Abel, J M Barbiere et al. Variation in advanced stage at diagnosis of lung and female breast cancer in an English region 2006=2009. Br J Cancer 2012; 1068-1075.
6. Walters, S et al. (2013) Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study. British Journal of Cancer 1-14
7. Survival is relative period survival supplied by West Midlands Knowledge and Intelligence Team based on National Cancer Registration Service data. One-year relative survival is based upon staged 2003-2012 diagnoses and five-year relative survival is based upon staged 1999-2008 diagnoses.
8. Linsell L, Burgess CC and Ramirez AJ. Breast cancer awareness among older women. Br J Cancer.2008 October 21; 99(8): 1221-1225.
9. Forbes, L., Atkins, L., Ramirez, A., Haste, F. and Layburn, J. 2010, Awareness of breast cancer among women living in inner North East London. King’s College London.
10. Ramirez AJ, Westcombe AM, Burgess CC, Sutton S, Littlejohns P, Richards MA. Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet. 1999 Apr 3; 353(9159):1127-31.
11. Age is just a number: the report of the parliamentary inquiry into older age and breast cancer. The All Party Parliamentary Group on Breast Cancer. 2013 (link is external)
12. Two years on: Age is still just a number. The All Party Parliamentary Group on Breast Cancer. 2015

The International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO) evaluated the evidence on breast cancer screening in March 2002. IARC concluded that trials have provided sufficient evidence for the screening of women between 50 and 69  years.

The NHS Breast Screening Programme (NHS BSP) is currently undertaking a trial to look at extending the invitation age range. By extending the programme to women aged 47-49, it would mean that every woman receives her first invitation for screening by her 50th birthday. The trial will also investigate extending the programme to women aged 71-73 as the risk of breast cancer continues to rise after the end of routine invitations.

In order to ensure that the most useful epidemiological data can be gathered to inform future decisions about the programme, the extension is being randomised so that half of the groups of women invited will be invited at the age of 47-49, and the other half at age 71-73. The randomisation trial, led by researchers at the University of Oxford, will give directly comparable mortality data on the effectiveness of screening in these age groups, including the risks and benefits. The results, which will be available in the early 2020s, will be  important to show whether screening in the extended age ranges is effective or not.

The independent review of the benefits and harms of  population-based breast cancer screening in 2012, led by Professor Sir Michael Marmot, covered women aged 50 to 70. 

A national ‘breast cancer in women over 70’ campaign ran across England from February to March 2014.

When comparing Feb-April 2012 with Feb-April 2014^, the results for women aged 70 and over show:

• 64%+ increase in 2 Week Wait (2WW) referrals for suspected breast cancer and a 75%+ increase in non-suspected breast cancer symptoms (combined referrals, 67%+ increase).
• 25%+ increase in the number of breast cancers diagnosed via a 2WW referral.*

When taking other routes to diagnosis into account (including breast screening), the total number of women aged over 70, diagnosed with breast cancer following the campaign, increased by 31%+ (comparing March-May 2012 with March-May 2014).

^ Local pilots ran from January-March 2012, the regional pilot ran January-March 2013, therefore 2012 was used as a base year for the referral data. 2011 has been used for the screening data comparisons due to a three year screening round.

+ The result is statistically significant
* Combined results for both the suspected breast cancer and non-suspected breast cancer referrals

A regional ‘breast cancer in women over 70’ pilot campaign ran across the Midlands from January to March 2013. Research after the campaign identified a significant uplift in the belief that one in three women who get breast cancer are aged over 70, from 16% to 25%.

When comparing the campaign period with the same time the previous year, the results for women aged 70 and over were as follows:

• 11%+ increase in 2WW referrals for both suspected breast cancer and non-suspected breast cancer symptoms within the regional pilot campaign area, compared with 5%+ increase seen in control areas.
• 7%+ increase in the number of breast cancer cases diagnosed following a 2WW referral for suspected breast cancer or non-suspected breast cancer symptoms in the regional pilot area.

+ The result is statistically significant

Seven local projects focusing on raising awareness of the symptoms of breast cancer in women aged 70 and over, ran from January to March 2012. These projects covered Lambeth, Lewisham, Southwark, Brent and Harrow, Sheffield, Doncaster, Barnsley, Rotherham, Bassetlaw, Brighton and Hove, Medway, Berkshire East and West, and Lancashire and South Cumbria.

When comparing the campaign period with the same time the previous year, the results for women aged 70 and over show:

• 8% increase in 2WW referrals for both non-suspected breast cancer symptoms and suspected breast cancer in the pilot area compared with 5% increase in the control area.
• 4% increase in the number of breast cancers diagnosed following a 2WW referral for non-suspected breast cancer symptoms in the pilot area compared with a 2% increase in the control area.

Download a Be Clear on Cancer Evaluation Summary 2014