'Breast cancer in women over 70' campaign: Campaign overview

Advertising ran across England from 13 July to 6 September 2015.

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’ 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.

View the campaign TV advertising

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 reinforces 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 is to encourage more women aged 70 and over with unusual breast symptoms to go and see their GP.

All women over the age of 70. By targeting this age group, Public Health England, the Department of Health and NHS England aim to focus the campaign on those with the greatest risk of developing the disease.

Regardless of age, if a woman has an unusual or persistent change to their breasts, they should contact their GP.

The first national ‘breast cancer in women over 70’ campaign that ran in early 2014 has shown promising results, with notable changes in symptom awareness and referral activity. The most recent data builds on this and, when comparing February–April 2012 with February–April 2014, there was a statistically significant 25% increase in the number of breast cancers diagnosed via an urgent GP referral.

We want to keep the campaign message at the front of people’s minds since there is still a great deal of potential to improve breast cancer survival for women aged over 70 in England. Therefore, Public Health England and its partners are running this campaign again on a national level.

View evaluation findings

Download NHS tripartite letter (campaign announcement)

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’, 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’ 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 http://www.breakthrough.org.uk/sites/default/files/media/Campaigns/Age%20is%20just%20a%20number%20-%20APPG%20report%20on%20older%20people%20and%20breast%20cancer.pdf
12. Two years on: Age is still just a number. The All Party Parliamentary Group on Breast Cancer. 2015

In a report by the National Cancer Equality Initiative (NCEI) in March 2010, ‘Reducing cancer inequality: evidence, progress and making it happen’ (link is external), it is suggested that inequalities in access to cancer services and treatments may be one of many reasons for poorer survival and mortality rates in older women in the UK. The report highlights that:

‘In general, older people with cancer receive less intensive/radical treatment than younger people [1]. The issue is whether or not this is appropriate for their condition. Older people may be frailer than younger people and thus less able to withstand intensive treatment. They may also present with more advanced disease, for which radical treatments may not be appropriate. However, older people are not uniformly frail and may enjoy good biological health and many years’ life expectancy.’

Detailed research studies have been undertaken on the treatment given to older women with breast cancer in the North West. These have shown that older women are investigated less intensively and are less likely to receive potentially curative surgery. Older age was shown to be the major factor determining treatment even when tumour characteristics had been accounted for [2]. A study on chemotherapy has also revealed that age is a major factor in influencing clinical judgement, irrespective of other factors such as co-morbidities and tumour size. Existing evidence indicates that under-treatment of older people with cancer may be a substantial problem.’

In a report by the All Party Parliamentary Group on Breast Cancer, ‘Age is just a number’, it is recommended that an accurate, reliable and practical method of assessing patient frailty is required to help inform treatment decisions, as age alone is not a good predictor of how a patient will tolerate cancer treatment. The ‘Two years on: age is still just a number’ report published in 2015 details progress to date.

References

1. Turner NJ, Haward RA, Mulley GP, Selby PJ. Cancer in old age – is it inadequately investigated and treated? BMJ. 1999  319:309-12.

2. Lavelle K, Todd C, Moran A, Howell A, Bundred N,  Campbell M. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or =65 years. Br J Cancer. 2007  96:1197-203.

The key risk factor for breast cancer is gender, with more than 99% of breast cancers diagnosed in women [1]. Age is also an important risk factor with around 33% of breast cancer cases being diagnosed in those aged 70 and older [1,2]. It is also more common among women from less socioeconomically deprived areas [3]. Other factors including being overweight and alcohol consumption increase the risk of breast cancer [4]. The public facing leaflet for the campaign highlights that you can reduce your chances of getting breast cancer by:

Maintaining a healthy weight

Keeping a healthy body weight is a great way to help reduce your risk of cancer.

Cutting down on alcohol

Drinking too much alcohol can lead to a number of health problems and is linked with breast cancer. By drinking less, you’ll reduce your health risks.

Looking after yourself

Keep fit and stay active. Swimming, exercise classes, dancing or yoga – no matter what type of exercise, the more you can do, the better.

References

1. National Cancer Registration Service, analysed by West Midlands Knowledge & Intelligence Team, PHE

2.Incidence data supplied by West Midlands KIT based on NCRS data

3.Cancer Research UK and Public Health England.Cancer by deprivation in England: Incidence, 1996-2010, Mortality, 1997-2011. London: PHE; 2014.

4. Parkin DM, Boyd L, Walker LC (2011) The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer. 105, S77-S81.

This campaign focuses on symptomatic breast cancer and how older women are at greater risk.

The NHS breast screening service is mentioned in the leaflet which will be distributed to key locations such as GP surgeries and pharmacies. Women aged 70 or over are still entitled to NHS breast screening every three years – they just need to make their own appointment.

Women over 70 who want to make a breast screening appointment can find details of their nearest NHS breast screening unit by entering their postcode or town on the NHS Choices (link is external) website. Some women may appreciate support in booking an appointment, therefore community based partners may find it useful to make a note of the contact details for their local screening units.

A leaflet is available for women, which gives information about the possible benefits and risks of breast screening to allow them to make an informed and personal decision about whether to have breast screening.

View the leaflet

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. The independent panel published the results of a review of the UK’s breast screening programmes. Find out more about the review and its findings.

A range of Be Clear on Cancer materials have been developed for the national reminder ‘breast cancer in women over 70’ campaign, including a leaflet, poster and symptom cards. These items are available to order from the Health and Social Care Orderline or you can download them from the ‘Resources and tools’ page.

Download campaign materials from the Resources and tools page.

Order printed materials online (link is external) from the Health and Social Care Orderline or call 0300 123 1002

Product codes:

A3 Breast poster – 3047694

A4 Breast poster – 3047717

Symptom cards English – 3054349

6pp A5 leaflet – 2903919

Symptom cards Bengali – 3047757A

Symptom cards Gujurati – 3047757B

Symptom cards Urdu – 3047757C

Symptom cards Punjabi – 3047757D