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Mr. Kevin Hughes (Doncaster, North): I welcome the opportunity to take part in this important debate. Breast cancer services for women in the national health service are an important issue. As the Health Select Committee acknowledged in its report on breast cancer services, we have learnt that although England does not have a particularly high rate of breast cancer occurrence, it has almost the highest recorded breast cancer mortality rate in the world.

Currently, almost 30,000 women are diagnosed with the disease annually and around 14,000 die of it. It is responsible for about 5 per cent. of all women's deaths throughout the country. Understandably, breast cancer is an emotive issue. It is also a very real issue for the tens of thousands of women who have the disease and the thousands who die from it.

We must set this debate against the background from which it emerges--the increasing inequalities in public health. Since the Black report was published, socio-economic differences in health have increased. The difference in mortality rates between the deprived and the affluent has increased substantially. The recent widening of health inequalities mirrors the gross upward redistribution of wealth since 1979. It is vital that patients

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should have access to the same standards of health care throughout the country, irrespective of where they live or to what socio-economic class they belong. Inequalities in health should be targeted and eradicated.

In the Government's "The Health of the Nation", mortality rates for women suffering from breast cancer are targeted as a leading priority to be reduced in the long term. The Government have recognised the importance and significance of mortality rates for women suffering from breast cancer. They know that the figures are illustrative of the condition of the public health services.

In "The Health of the Nation", targets were set for a reduction in mortality of those screened for breast cancer. In progress reports on "The Health of the Nation", the Government are, I believe, complacent in stating:


Yet statistics from the House of Commons Library show that 60 per cent. of district health authorities are unlikely to meet those targets. Of the 112 district health authorities in England, 54 will fail to meet the target of a 25 per cent. reduction in mortality rates by the year 2000.

The Government's comments are therefore misleading and superficial. The Government's document on variation in health, in commenting on variations in breast cancer, stated:


"The Health of the Nation" dedicates only one page to regional variations but socio-economic variations show that, although the incidence of breast cancer is higher among the wealthier classes, the lower classes are more likely to die from the disease.

Leading health professionals are concerned that breast cancer services continue to vary considerably throughout the United Kingdom.

Mr. David Congdon (Croydon, North-East): Will the hon. Gentleman give way?

Mr. Hughes: No.

Department of Health public health common data showing regional and local mortality rates from breast cancer illustrate the huge variations between local health authorities and, on a wider and more significant level, large variations between regional health authorities.

I am particularly concerned about those alarming figures because they highlight the high rate of breast cancer mortality in and around my constituency. Although the registration rate for breast cancer in Doncaster is some 7 per cent. lower than the national rate, we have a disturbingly high mortality rate from breast cancer. For most of the past 11 years, the rate has been significantly higher than the national average. In 1993, it was 13 per cent. higher than the national average yet in neighbouring areas mortality rates from the disease have been consistently below the national average. The figures for North and West Yorkshire, for example, are significantly lower.

The House of Commons Library has analysed the progress made towards "The Health of the Nation" targets and assessed Doncaster as having made negative progress. Indeed, it is moving away from the targets set in 1990. A snapshot assessment of breast cancer mortality for women aged between 50 and 69 in 1993 puts the rate in Doncaster at 118 per 100,000 women, one of the highest

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rates in the country and the fourth worst for that year. The figures for 1994 are 82 per 100,000 women. Despite the reduction, Doncaster will still fail to meet the national standards set by the Government in their report. The Government are failing to meet their standards and failing badly the women of Doncaster.

Figures for the Trent authority show that, once again, there has been a higher than average mortality rate for the past 10 years. Let me compare those statistics with those of the neighbouring health authority. Northern and Yorkshire's statistics show a consistently below average mortality rate for each year in the past 10. The Government must recognise that those variations exist and begin to assess the local rates. They must set local targets rather than rely on a national target that could be set by a collection of varying mortality rates around the country, and seek to achieve those local targets. Perhaps they are too frightened to do so because local targets would emphasise what the Labour party has illustrated--that regional variations mean that many district health authorities would fail the Government's test.

As in any area of the health service, it is vital that women throughout the country receive the same standard of treatment wherever they happen to live. It is important that the Government make progress in meeting the targets that they have set. Why do not they publish local targets? Why has it been left to the Labour party to put those variations in the public domain? Are the Government too ashamed of the progress that has been made? We talk of statistics, but those represent people--in this case, women who suffer and die.

Access to health care and a chance of survival must not depend on where one happens to live. They must be accessible to people in all areas. The Government must monitor more effectively the progress towards their targets. They must deal with those regional variations in health care. We have shown that they have not dealt with those issues. They must now begin to do so.

4.44 pm

Mr. David Congdon (Croydon, North-East): I was appalled by the speech of the hon. Member for Doncaster, North (Mr. Hughes), who refused to accept an intervention when he was using statistics selectively. The Select Committee asked to see the regional differences in rates of breast cancer and those are published on page 239 of the Select Committee report.

In no area of health care can it be argued that an average figure will be the same for each area of the country. There is no reason why it should be. The population profile of each area differs and it is naive and ludicrous for the hon. Gentleman to think that all areas should conform to the norm. Each health authority should aim to bring about an improvement in the figures for its area, which is why it is important to publish figures and aim at a target. To pretend that differences show that the system is failing is wrong. As the hon. Gentleman said, although he did not pursue the point, breast cancer appears internationally to be a disease of affluence.

Mr. John Austin-Walker (Woolwich): The hon. Gentleman referred to page 239 of the Select Committee report, which gives the regional figures. Those figures are for breast cancer incidence whereas my hon. Friend the Member for Doncaster, North (Mr. Hughes) said that,

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although the incidence may be higher in affluent areas, the mortality rate was higher in less affluent areas. Those figures do not reflect mortality rates.

Mr. Congdon: I accept that the table contains incidence figures. If the hon. Gentleman wishes to provide me, after this debate, with figures for mortality in relation to incidence, I should be pleased to study them. I cannot look at figures that the hon. Member for Doncaster, North holds up on the opposite side of the Chamber. I am not complacent about the incidence of or death rate from breast cancer, but it is shameful to try to make party political capital out of this issue.

Mr. Henry McLeish (Fife, Central): Disgraceful.

Mr. Congdon: The disgrace is that Opposition Members are trying to make party political capital out of such an important issue.

Ms Jean Corston (Bristol, East): Will the hon. Gentleman give way?

Mr. Congdon: No, I shall not give way at this point. I want to make some progress.

The Select Committee carried out a useful inquiry into an issue that concerns many people, particularly women. Cancer in any shape or form is a disturbing disease that causes great anxiety and concern, and breast cancer probably causes more concern than most. It tends to strike younger women. Perhaps the most serious cause of concern is that it is often not identified until it is too late.

I said earlier that the incidence of breast cancer tends to be higher in wealthier countries. I would welcome more research into why that is so. The incidence of breast cancer is rising in the United Kingdom but, so far as I am aware from the Select Committee inquiry, no one could give substantive evidence as to why that is so. Perhaps we are simply getting better at diagnosing the disease, so we must take care when arguing about incidence.

The Select Committee was also advised that suddenly in 1989 the death rate started to decline, but nobody seems to know why. It cannot be because of screening because the programme had not started at that time. The importance of the Forrest report's recommendation to implement a screening programme has been acknowledged by all. That programme appears to have been successful, although more evaluation of the figures is necessary.

The United Kingdom was the first European Community country to introduce a national breast screening programme. It is acknowledged to have a good system of quality assurance, which ensures that it is implemented effectively. It was decided that all women between the ages of 50 and 64 should be screened regularly. The Committee received a great deal of evidence to suggest why that should be so. We were advised that screening has not been introduced for younger women because it has no particular impact on mortality; equally important, and more significant, there are difficulties in reading mammograms of pre-menopausal women. Members of the Committee were broadly prepared to accept that advice from the medical profession.

There is far more controversy, understandably, about the decision not to screen regularly women above the age of 64. The Committee was advised that there would be a

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lower take-up by older women, and that there is a greater risk of older women dying from other diseases. The Committee was, frankly, unconvinced by those arguments. I was therefore pleased to support the Committee's recommendation that the screening programme should be extended to women aged 69.

It is particularly interesting to look at the relevant figures on breast cancer, which show that it is more common among older women. In 1989, 8,752 women between the ages of 50 and 64 died from breast cancer, and, 11,179 over the age of 64 died. Those figures reveal that more than 60 per cent. of breast cancer deaths occur in women over the age of 64. Surely that is a good reason for extending screening to include women up to the age of 69.


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