Reconstruction surgery denied to hundreds of breast cancer patients

Despite guidelines from health watchdog NICE stating that all women should be offered breast reconstruction surgery, recent research has found that one in four health trusts are denying patients the procedure.

Of the 42,000 women diagnosed with breast cancer in England each year, around a quarter undergo a mastectomy. Around a third of these women opt for reconstruction, although a large number (around 10%) delay the procedure until they are better recovered.

However, the new figures show that many health trusts are only giving women the option for reconstruction if they have it right away. And others are refusing to carry out the procedure more than once if the first reconstruction is unsuccessful.

‘Backwards step in treatment’

The report was led by charity Breast Cancer Now, whose chief executive, Baroness Delyth Morgan, called the restrictions a “backwards step in treatment” for thousands of women, and said it was “not in the best interests of patients”.

She described how the surgery has “profound benefits for those that choose it, helping give many their confidence and their lives back after breast cancer”.

She added: “It is totally unacceptable that any patient is being denied the reconstructive surgery they need or rushed into potentially life-changing decisions, at such a difficult time”.

The charity’s research found that of 208 Clinical Commissioning Groups (CCGs) in England, 47 (22.6%) have seen the introduction of policies that restrict breast reconstruction under the NHS for non-clinical reasons. In addition to this, a further 30 CCGs (14.4%) have unclear, draft or informal guidelines in place.

New guidelines

These policies directly contravene NHS England’s Breast Cancer Clinical Expert Group’s 2017 advice that stated: “patients make decisions at very different speeds so delayed reconstruction or further operative procedures to optimise symmetry should be available without time restrictions”.

To coincide with the report, Breast Cancer Now have launched new guidelines in conjunction with the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) which will ensure reconstructive services are available to all patients who need them.

Concerns have been raised by the charity and other experts that the rise in this rationing of treatment is fuelled by financial pressures on the NHS.

NHS cuts to blame

Baroness Morgan said: “With the NHS facing unprecedented pressures, their introduction despite clear clinical advice begs the question whether they are being driven by a desire to reduce costs. For those that want it, reconstruction must not be dismissed as a cosmetic or dispensable part of breast cancer treatment.

“We hope these new guidelines will be practice-changing, ensuring all patients have access to the services they need and enabling more to live well beyond breast cancer.”

These concerns were also echoed by breast surgeons who say that equal access to services is needed. Joe O’Donoghue, member of BAPRAS, said: “It is unacceptable for some women to not be given access to essential reconstructive or balancing surgery purely because of where they live.

“We know that this surgery is a vital part of breast cancer treatment, recognised by the National Institute for Health and Care Excellence and internationally as beneficial to women’s psychological recovery and wellbeing”.

In addition, the president of the ABS, Mark Sibbering, said that it is not a surgery that should be cosmetic, as it is part of the patient’s treatment, and should be “available to all patients equitably”.

First4Lawyers back new policies

We agree. The NHS are clearly trying to cut costs, but in doing so are failing to realise the impact of denying reconstructive surgery to women recovering from breast cancer. For many, the reconstruction and the treatment go hand in hand - to be denied it is unfair, especially if it’s a decision based on geography.

Healthcare should not be dependent on your postcode. Women everywhere deserve the right to reconstruction under the NHS, and we hope that the policies put into place by Breast Cancer Now, the ABS and BAPRAS, will see this happen nationwide rather than in select areas.