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Rev. Martin Smyth (Belfast, South): The Government argued that they had decided not to go ahead with breast screening for older women because they felt that it was not cost-effective. Does the hon. Gentleman agree that the evidence that we received suggests otherwise? The Government's response was a disappointment to many members of the Select Committee and to people throughout the country.
Mr. Congdon: I am grateful to my hon. Friend for that intervention. If he had asked me that question half an hour ago I would have agreed with him entirely, but I have just happened to read in Hansard of 4 December that the Government have announced that, from 18 October, pilot schemes have been operating in the Northern and Yorkshire and South Thames regional health authorities to evaluate the effectiveness of extending breast screening to women up to the age of 69. I am a bit behind the times, and was unaware of that when I read the Government's response at the weekend. I welcome that announcement, and I am particularly pleased that I read about it just 15 minutes ago. I am sure that my hon. Friend the Member for Belfast, South (Rev. Martin Smyth) will be pleased about that announcement as well.
Screening is effective if it succeeds in identifying those women with breast cancer early enough so that they can be treated and prevented from dying. The hon. Member for Doncaster, North referred to the relevant figures, which reveal that in 1992, just under 14,000 women died from breast cancer, which is just under 5 per cent. of all female deaths. That is a staggering number of deaths from one particular disease--something that hon. Members on both sides of the House take seriously. Perhaps it is even more significant to note that breast cancer accounts for more deaths than any other form of cancer, including lung cancer. I find that pretty incredible.
A particular problem struck me as I was interviewing witnesses before the Select Committee about screening. The one problem with breast screening is that, apart from identifying those women with breast cancer, it generates a false positive. If a woman is recalled because there is something about which the doctors are concerned on her mammogram, she may have to wait a couple of weeks for an appointment. That woman is obviously subject to unnecessary worry and anxiety. The worst thing about any form of diagnosis is when the doctor says, "We think you have a problem, but we're not sure; we'll need to see you again in two to three weeks' time." That causes a great deal of anxiety.
The key point is revealed by the following figures. Since 1987, 5 million women--a staggering figure--have been screened. Of those, 270,000 have been recalled for further
assessment. That does not mean that those 270,000 women had cancer, because just 20,000 of them were identified as suffering from it. I questioned witnesses in the Select Committee about those figures and drew to their attention the fact that that means that for every woman identified by screening as having breast cancer, a further 12 went through an awful lot of anxiety. The thing that surprised me was that a strange atmosphere then descended on the Committee, as though the witnesses had never heard of those figures before. I am concerned about that.
I understand the medical profession's proper desire to ensure that the screening programme works properly and succeeds in identifying those women suffering from cancer, thus preventing them from dying. That is a fantastic achievement, but I do not believe that the profession has paid enough attention to the flip side of the coin--the anxiety caused because the screening programme fails to reduce the number of false positives. That is an important issue.
Mr. Harry Greenway (Ealing, North):
I apologise, Madam Deputy Speaker, for missing the beginning of this debate. I have some constituents in the House, and they have allowed me to pop in for 10 minutes, so I am grateful to my hon. Friend for giving way. Administrators in Ealing are strongly inclined to move the breast cancer service from Ealing hospital to other hospitals at some distance from my constituency. Women in my constituency, however, feel confident about the services that they receive at their local hospital. Does my hon. Friend agree that it is important to avoid imposing difficult, if not impossible journeys on women who go for breast screening? Does he agree that that service should be offered at the hospital in which they are confident, such as Ealing hospital? I am grateful to my hon. Friend for allowing me to say that.
Mr. Congdon:
My hon. Friend raises an important point, which reveals the dilemma created when planning any services relating to breast cancer and other diseases.
All recommendations suggest that three-tier models represent the best means of providing a screening service. One needs to ensure that a woman receives good primary care when she goes to her general practitioner, and that she is properly referred on for treatment--assuming that she has not been identified through the screening programme.
As my hon. Friend the Member for Broxbourne (Mrs. Roe), the Chairman of our Select Committee, has already said, all the research shows that a woman stands a better chance of survival if she goes to a unit that deals with more than a few cases of breast cancer a year. It has been recommended that breast cancer units should be established to cater for populations of about 200,000. I cannot comment specifically on Ealing, but from time to time there will inevitably be conflicts between trying to ensure that units of a sufficient size are provided so that an appropriate number of patients can be treated and the unit can develop the necessary skills, and ensuring that those units are not too far away from their patients.
The number of false positive results can be reduced in a number of ways. For instance, I welcome the decision to ensure that women receive their second mammogram at the same time as the first one, because that improves reliability. One will never be able to prevent all false positives, so it is even more important to ensure that all the services that a
women may require, including further assessment, are carried out at the same time. That means that they do not have to return for further visits, which is important.
Having identified those women suffering from breast cancer, it is crucial to ensure that they receive appropriate treatment to try to reduce the number of deaths--a point made by the hon. Member for Doncaster, North. The Select Committee report contained a number of recommendations; the Cancer Relief Macmillan Fund has also made a number of important recommendations. It suggested that there should be minimum standards of care based on a list of principles.
A significant factor in the Select Committee's investigation was that a number of separate studies had all come to the same conclusion about cancer treatments, including breast cancer. I understand that it is important that people suffering from breast cancer should be treated by not a general surgeon, but a specialist. It is important that patients have a specialist breast care nurse to provide the necessary counselling during a traumatic period.
Mr. Henry McLeish (Fife, Central):
I am pleased to participate from the Front Bench in the debate initiated by the hon. Member for Broxbourne (Mrs. Roe). I agreed with much of what she said and with the polite way in which she suggested that the Government might want to be more ambitious about the future of the service than they are currently willing to contemplate or resource.
I say to the hon. Member for Croydon, North-East (Mr. Congdon) that passions often run high in the House. Today's debate is on a serious subject that requires discussion, dialogue and informed criticism. My hon. Friend the Member for Doncaster, North (Mr. Hughes) gave some key statistics on access. One of the most important features of the subject is access--patients' access, access to screening and access to appropriate treatment.
It is worth placing on record some of the cold and clinical statistics. Breast cancer is the leading cause of female cancer death in the United Kingdom. It is the commonest single cause of death in women aged 35 to 54. There are about 24,000 new cases of breast cancer every year and about 15,000 women die from the disease. There are nearly 500 new cases every week and nearly 300 deaths every week. Behind every individual statistic there are members of families and extended families. The problem is huge and, in presenting the case from the Select Committee, the hon. Member for Broxbourne suggested its seriousness.
It is also important to identify the fact that mortality rates have remained virtually unchanged for the past 50 years. It is encouraging to note--as the hon. Members for Broxbourne and for Croydon, North-East did--that in the latter part of the 1980s the mortality rate figures started to come down. That is to be welcomed and one of the outstanding challenges in relation to breast cancer is to maintain that reduction.
Statistics can be translated into humans. I estimate that 15,000 deaths will mean that about 100,000 people-- a large number--could be involved in the bereavement process every year. The emotional and physical damage done can be devastating. All those who are given a positive diagnosis face the trauma of uncertainty and they do not know whether treatment might lead to death or a much longer remission period. A hallmark of the national health service programme is the sensitivity surrounding the treatment.
One of the key aims is to try to reduce mortality rates, but it was interesting to read in the section on variations in health in "The Health of the Nation", produced by the Government, an apt phrase that sums up the second major objective: adding years to life and life to years. Clearly, mortality rates provide a fixed benchmark in the debate; they are easily recorded. Not always so obvious are those people who have been screened, receive the appropriate treatment and may go into long-term or short-term remission, when the years-to-life and life-to-years issue is an important factor. I hope that the Minister appreciates-- I am sure that he does--that the subject involves not merely death, but living. That key objective should underline our agenda.
We should place on record the House's appreciation of the national health service breast screening programme; the hon. Member for Broxbourne did so and the Opposition agree with her comments. The programme does an excellent service and has a tremendous staff; it is a national programme that is extremely well led. When attacking breast cancer over the next decade it is important to keep the national dimension firmly before the House and the general debate.
Although the service was introduced in 1987 and was fully operational in 1990, there still seems to be huge potential. There have been three or four years in which the service has made an impact on breast cancer. Bearing in mind many of the changes suggested by the Select Committee and some of the advances in technology, and given the necessary resources, the service is well placed to achieve much more in the new millennium, which is now only a few years away.
My key concern involves access and availability; at the argument's core lies the availability of screening, the availability of diagnosis and prognosis and the availability of treatment. We can argue on the degree to which availability varies throughout the nation, but we can possibly agree that availability differs throughout England, Scotland and Wales. That is not necessarily a political point, but is a fact of life: variables will influence health that the health service cannot tackle. But some variations in the figures can be tackled by effective intervention from the health service.
The availability of the service is one factor, but access to it is another. My hon. Friend the Member for Doncaster, North and others have suggested that social and class differences have an impact on access to screening and treatment. Some district health authorities may be more enthusiastic and energetic and may give breast cancer a higher priority. I do not say that as a criticism of the national standards but, clearly, the success or otherwise of the service depends on the approach on the ground. Therefore, the key aspect of
my contribution concerns the availability and quality of services, and how access to them varies throughout the country.
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