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5.28 pm
Mr. John Whittingdale (Colchester, South and Maldon): Breast cancer should not be a party political issue. In that spirit, I welcome the contribution of the hon. Member for Fife, Central (Mr. McLeish). I am particularly grateful to him for his praise of the Select Committee's report and I agree with at least part of what he had to say.
Before the Committee's inquiry, I must admit that I had little knowledge of breast cancer. As a man, it is still hard for me fully to appreciate the true horror of the disease. We were fortunate that a quarter of the Committee members were ladies, who perhaps have a better understanding of the trauma that a diagnosis of breast cancer can cause. Although I do not have a full appreciation of that trauma, the inquiry was one of the most harrowing in which I have been involved. All the Committee members found the evidence of Dr. Gwyneth Vorhaus particularly moving. She was undergoing intensive chemotherapy for the disease at the time that she spoke to us. We also heard evidence from the representatives of RAGE--Radiotherapy Action Group Exposure--which is a group of women who have had radiotherapy and some terrible injuries following it.
In examining the diagnosis and treatment of breast cancer, we looked first at its rate of incidence and the associated rate of mortality. The statistics on incidence are cause for alarm. In England and Wales, the incidence rate is 56.1 cases per 100,000 of population, which puts us approximately in the middle of the range for developed countries but certainly well below the United States, which has an incidence rate of 89.2 per 100,000 for white Americans, although the rate is only 65 cases per 100,000 for black Americans. However, the rate is increasing. In this country, it rose by more than 40 per cent. in the 10 years to 1992, although that is less than in some other countries.
There is widespread variation in the incidence rate between different regions in the United Kingdom, as several hon. Members have already said. The 28 per cent. average increase which occurred between 1979 and 1989 masks increases that range from only 3.2 per cent. in the Trent region up to 47 per cent. in Wessex.
There may be a number of reasons for the variation in incidence and for its increase. I accept that the quality of statistics certainly varies widely and that, in some countries, the figures that have been quoted may be highly suspect. Improvements in detection may also explain part of the reason for the rise in incidence. All our witnesses agreed, however, that very little is known about the reasons for international or regional variations in the incidence of breast cancer or why the incidence rate is rising. The variations are so great and the rise is so sharp that there can be little doubt that women in some countries are far more prone to breast cancer than those in other countries and that the number getting the disease is rising rapidly.
The evidence is still more frightening when one comes to examine the mortality rates. As has already been said, on this measure the United Kingdom has almost the highest breast cancer mortality rate in the world. It is way above that of many countries whose incidence rate is higher than our own. That may be because our treatment of the disease is inferior to the treatment in other countries; it could also be because women in the UK are prone to suffer a far more aggressive form of the disease.
One of the first questions that I asked our witnesses was why the USA had a higher incidence rate of breast cancer than the UK but a lower mortality rate, and what were they were doing in the USA that we were not doing here? Professor Vessey, the chairman of the advisory committee on breast cancer screening, concluded his reply to me by saying:
In our inquiry, it quickly became abundantly clear that we do not know the answers to these questions. What causes breast cancer? How can it be prevented? Why are there such enormous variations in its incidence between and within countries? Why is it that Japan, which is a developed country with a high standard of living, has one of the lowest rates of breast cancer in the world? Why is it that the incidence is rising rapidly, and why is it that more people die from it in the UK than almost anywhere else in the world?
My first conclusion was that much more research needs to be done. For some reason, research into breast cancer is not accorded the priority that it deserves. One in 20 women is likely to die from breast cancer and, in 1993, there were more than 13,000 registered deaths of women from it in England and Wales. That compares with approximately 1,150 notified deaths from AIDS in the UK. Government expenditure on research into AIDS, however, through the Medical Research Council and the Department of Health, was £17 million. That amount is nearly five times the expenditure on research into breast cancer.
When expenditure by charities such as the Imperial Cancer Research Fund and the Cancer Research Campaign is added into the total, the amount still comes to only £12.5 million, which is 70 per cent. of the figure spend on research into AIDS. We do not have a world breast cancer day, and we do not see celebrities organising concerts to raise money for research into breast cancer. I am not suggesting that we should not be spending money on researching AIDS, but I must question whether we have our priorities right. I think that there is more than a whiff of political correctness about those figures.
Given the lack of knowledge about the disease, I understand why the NHS decided to concentrate on establishing a breast cancer screening programme to enable the early detection and treatment of the disease. We were given ample evidence that screening programmes result in fewer deaths, and we have every right to be proud of the fact that the United Kingdom is one of the first countries to set up a national screening programme. Since the programme was started in 1987, 5 million women have been screened and approximately 20,000 cancers have been detected as a result.
As my hon. Friend the Member for Croydon, North-East (Mr. Congdon) pointed out, however, for every cancer that was detected, nearly 10 women who did not have cancer were recalled because they had false positive results. The anxiety and fear that were raised as a result of those false results can only be imagined. In some cases, women had to undergo unnecessary clinical investigations--even surgery--as a result.
There is also a problem of false negative results when women have been told that they do not have breast cancer but who have gone on to develop the disease shortly afterwards. That is something which might be addressed by the more widespread use of double-view exposures, as has been mentioned already.
It may be that false positives and negatives are a price worth paying. We must address the question raised by Professor Michael Baum, our specialist adviser from the Royal Marsden hospital, as to whether the small benefit of reducing the risk of dying from breast cancer compensates for the undoubted harm resulting from false alarms and unnecessary interventions. He was right to ask whether the money spent on population screening would
save more lives if the scarce resources were redirected to the more efficient care of symptomatic women and greater spending on research into improving the treatment of those already suffering from the disease.
I am sorry that Professor Baum did not raise those issues at the time of our inquiry. They are, however, serious issues which deserve examination, and it was a great pity that the media chose simply to report that he had declared the breast test to be useless, which was certainly not the case. I believe that Professor Baum remains a supporter of the breast screening programme.
Professor Baum was also entirely right about the need for more informed choices by patients. All too often clinicians assume that patients do not want to know the details of their condition or the options that are available to them. Alternatively, clinicians do not bother to inform their patients because they think that they will not understand. I suspect that all of us have come across terrible examples of the lack of sensitivity of doctors and consultants when advising patients about their condition. Perhaps the worst example that I have ever heard was the treatment of Dr. Vorhaus, who told us that the night before surgery a junior doctor had casually informed her:
Dr. Vorhaus also told us that she met only two doctors who extended any degree of human concern, courtesy and willingness to give her information about her condition and treatment. On the other hand, she told us that she did not meet one nurse who was not helpful and supportive. Of course, that is just one person's experience, and I accept that it does not apply in the vast majority of cases. Nevertheless it should not happen, and we still have much to do to ensure that doctors treat women with this condition with the sensitivity that they deserve.
Finally, I must also pay tribute to my own constituent, Mrs. Hazel Thornton, who came to give evidence to us. She is a lay person. After an abnormality was found in a routine screening, she was invited to participate in a randomised control trial. She was given no information about the options available to her, or any details about what the trial would involve, so she refused to take part. Instead, she found out for herself about the disease and became an expert on it.
"there are plenty of suggestions but I do not think that anybody really has a very good answer".
"We have decided to do a mastectomy instead of a lumpectomy."
When she asked why, he said:
"I really don't know what you are worrying about--you've got such small breasts it doesn't matter and anyway, someone with cancer should not be worrying about what happens to their breasts."
That was how she was formally told that she had cancer.
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