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1.30 pm

Mr. Jeremy Corbyn (Islington, North): I am pleased to raise a subject that many Members are keen to debate-- I took part in a similar debate earlier this year. An early-day motion tabled by a Liberal Democrat Member, which has all-party support, seeks compensation for women who suffer the terrible effects of radiotherapy damage and the permanent pain and injury that accompanies it.

On 15 February this year, a debate on breast cancer services was initiated by my hon. Friend the Member for Edinburgh, Leith (Mr. Chisholm). He informed the House about a petition of more than 200,000 signatures from Scotland alone about the need for better treatment. That debate referred to the work of the all-party group on breast cancer, which demonstrates that, unfortunately, one in 12 women in Britain are likely to suffer breast cancer and only 40 per cent. will be able to see a specialist oncologist.

Although today's debate deals with compensation, the wider issue of accessibility to quality diagnosis and treatment of breast cancer is particularly important. I quote from the reply to the debate on 15 February by the Under-Secretary of State for Health, the hon. Member for Bolton, West (Mr. Sackville), who, in reply to the hon. Member for Colchester, North (Mr. Jenkin), mentioned the

Later in his speech, he said:

    "It is well known that too many cancer sufferers, especially women with breast cancer, are not diagnosed swiftly enough. They are not seen sufficiently quickly by people with the appropriate level of expertise, which means that treatment can be delayed. Whatever the clinical effect of waiting for diagnosis and then waiting for treatment may be--it can be serious--the emotional effect is clearly considerable and we need to take action."--[Official Report, 15 February 1995; Vol. 254, c. 953-54.]
I assure the House that we shall return to that issue in future.

The figures relating to people suffering from breast cancer are truly horrendous: 25,000 cases per year are diagnosed and 15,000 die--or 300 deaths a week. Britain has one of the highest death rates in the world from breast cancer and one of the highest occurrences of that disease. The incidence rate is much lower in other countries. There many reasons for that and there is not sufficient time to discuss them today, but they need to be studied.

The treatment has been described as a lottery. I have been trying to raise this subject because of the serious problems faced by hundreds of women in Britain who suffer from permanent, progressive and disabling injuries after radiotherapy treatment for breast cancer.

The issue is not new. The Select Committee on Health examined it in detail in its report on breast cancer. I recommend that the Minister rereads the evidence taken on 30 March from Radiotherapy Action Group Exposure and the very thorough memo that RAGE drafted for the Select Committee on 15 January, setting out its aims and objectives and what it saw as the way forward.

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Since its invention, the dangers of radiotherapy have been fully recorded and recognised, yet hundreds of women have been treated without informed consent or warning of its dangers. It is routinely prescribed, often without consultation and purely as a precautionary treatment. There is very little recognition in the medical profession of the true extent of the injuries caused by radiotherapy.

RAGE helped me a great deal in preparing the debate, and I pay the strongest possible tribute to that organisation for its work and for the hope that it has given many of its members and supporters round the country. It was formed in July 1991 and aims

It lists as its objectives:

    "To seek independent inquiry. To seek remedial action, including compensation. To urge the upgrading of radiotherapy practice and seek national quality standards. To provide support."
It is doing that extremely well.

The work of RAGE took off as a result of the withdrawal at trial of Lady Ironside's High Court action for medical negligence. A handful of the victims met to discuss the situation and it immediately became apparent that there was a common pattern of injury among them. While RAGE cannot pretend to represent every woman who has ever had radiotherapy treatment or every sufferer from breast cancer, it certainly has a large membership and wide support, so it represents an authentic voice of people who are suffering because of such treatment.

There is something seriously and unaccountably wrong with the radiotherapy treatment techniques and procedures being applied in the United Kingdom. All the work of RAGE has been done by women in constant and dreadful nerve pain, whose personal and professional lives have been shattered. Some members of RAGE have had their limbs amputated and almost all have been left with only one usable arm. For the rest of their lives, in addition to being under the cloud of the possible recurrence of cancer, they will become progressively disabled.

I find it a humbling experience to talk to victims of breast cancer for whom, although their cancer has been treated, the permanent damage and injury and the constant pain means that they may never get a night's sleep or a day free from pain for the rest of their lives. As a man, I find their plight hard to contemplate. I am sure that many women will understand what I am saying and the requests that I am making today.

The Government should give urgent consideration to what is happening to those women and to giving them the compensation that they so desperately need and deserve. It is not just my view, but one shared by Professor Karol Sikora, professor of clinical oncology at Hammersmith hospital and a leading pioneer in the fight against breast cancer.

The members of RAGE have all contracted breast cancer and have experience of the treatment protocol and of receiving radiotherapy treatment of the brachialplexus at one of the 53 treatment centres in the United Kingdom, as it is invariably prescribed as a precautionary measure following surgery. While the women, as patients, were generally made aware of the temporary nature of the side effects such as sickness and nausea, they were not made aware of the risk of serious and permanent injury involving arm paralysis and other disabling consequential effects that have been identified.

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The Department of Health should look seriously at the facilities that are made available to support people going through the treatment process. While consultants and doctors give medical advice and try to explain the possible effects, there is a need for women who are feeling desperately anxious and often isolated to receive that advice in a supportive environment. Unfortunately, that does not often happen. The debate earlier this year drew attention to the lack of specialist centres and the fact that many women are misdiagnosed because there is not sufficient expertise in all areas of the medical profession. The Minister conceded that point.

Some of the consequential effects are lymphoedema, lung burn leading to severe breathing difficulties, deadened bones--often leading to spontaneous fracture-- heart damage, jaw bone pain, amputation of an arm as a last resort, skin burn and psoriasis. The onset of injury has occurred as long as 20 years after the treatment.

I hope that the Minister will listen to this carefully. It is important that the information collected by RAGE shows that there are clusters of cases at certain hospitals in certain years. In some hospitals, they coincided with a cost-cutting exercise to treat more women in the same time scale. Women were treated in 15 fractions instead of 25 to 30 fractions, thus enabling doctors to treat twice as many patients. Many RAGE members sustained injuries while being treated in 30 fractions. British hospitals use higher doses per fraction compared with other European countries and the USA. The records show a higher recovery rate, and that would be justified.

Britain's record of deaths from breast cancer is among the most horrifying in the world. In the United States, the issue has been taken seriously. A committee was already established, and President Clinton convened a special conference to examine the issue and the problems faced by women throughout the United States. We also must acknowledge the need for serious examination.

The marked clustering of injured women in certain hospitals in certain years--while other centres have experienced no cases--seems to suggest faulty protocols, inevitably at the cluster hospitals. Injury does not have to be inevitable. It is also worrying that the number of radiotherapy injuries after breast cancer reported to RAGE have increased, not declined, in recent years. The lack of a national reporting system makes it difficult to see the total picture. The Government have sought to dismiss the increase in notifications, claiming that it can be attributed to more women learning of the existence of RAGE. That may be so, but if there were national analysis and reporting, that argument would disappear. I ask the Minister to consider establishing such a system as a matter of urgency.

It is often said that it is difficult to identify causation, but that is not necessarily so. RAGE's work in increasing awareness of radiotherapy injuries has led to causation being unequivocally identified and admitted in the majority of cases. The Government's present position is that victims must seek compensation through the courts. Replying to Lorna Patch of RAGE on 7 August, the Minister stated, on compensation:

That is unacceptable, because one must be very rich to pursue compensation that way. It costs around £200,000 to mount an effective case to prove medical negligence in

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the High Court, which is totally beyond the means of almost everyone in this country. It would certainly be beyond the means of an individual who has suffered as a result of breast cancer, lost her income and, more importantly, forgone any prospect of future income. The individual might try to obtain legal aid, but there is a legal threshold of the probability of success and one must also pass a poverty threshold. The Government must instead produce a compensation package.

The injurious effects of altering the time dose fractionation plan were known to practitioners as early as 1966--29 years ago. The alteration continued at the Royal Marsden hospital until as late as 1982, 16 years after its injurious effects were first known, as a measure to increase productivity. RAGE members to whom I have spoken--and this comes through in all their documentation--had no prior warning before radiotherapy of the risk of permanent injury. As a result of such injury, entitlement to statutory benefits and state pensions has often been eroded, exacerbated by lack of Department of Social Security recognition of the type of injuries.

The compensation package suggested by RAGE-- which I and a large number of hon. Members in all parts of the House endorse--is an annual figure for extra expenses, such as splints, slings, medication and hospital transportation; a sum to cover the net cost to date, net of any disability benefit or attendance allowance; and a payment to cover loss of earnings to date and to retirement. Victims can be women of all ages and classes. Many of them may have been in high-paid jobs, while others might have looked for career development and additional qualifications that would have improved their life style--and that potential has been cut by the inability to pursue their career.

Those calculations, however, take no account of the constant, nagging pain that victims suffer and their inability to lead a normal life and to pursue ordinary leisure pursuits. Where the loss of an arm is involved, the victim is unable even to pick up her child or grandchild-- something that the rest of the population takes for granted as normal behaviour. Loss of mobility is an important factor.

The Department of Health is about to publish an audit conducted by the Royal College of Radiologists on the practices of its own members, to establish how such injuries occurred. RAGE was denied an independent, multidisciplinary inquiry. I hope that the audit will go some way to supporting the arguments constantly made on causation and for proper compensation. There is strong support for an independent inquiry that is not dominated by the medical profession, but takes evidence from its members--in the way that a Select Committee does.

We should be concerned to study the causes of breast cancer in Britain and why the incidence is so high, examine facilities for diagnoses and treatment, and look at increasing and making more readily available specialist treatment centres so that breast cancer can be detected earlier and be properly treated. We should ensure also that women who receive radiotherapy are made fully aware of what it involves, the dangers and possible side effects, which may not appear for many years.

We should also acknowledge the dreadful damage done to many women by mistakes, misdosage and a failure to explain possible after effects. The least we can do is to

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ensure that women who have suffered so grievously in the past receive proper compensation, ensure that such suffering does not recur and try to conquer that awful illness.

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