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6.28 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam) rose--
Mr. Jeremy Corbyn (Islington, North) rose--
Mr. Horam: I hope that it will be for the convenience of the House if I intervene at this point. I apologise to the two hon. Gentlemen who want to speak, and I shall try to ensure that there is time for them to come back after I have spoken. But if I do not speak now there is a danger that I might be squeezed out of the debate, which would not be in the interests of the House.
Mr. Corbyn: That is not our intention.
Mr. Horam: Nevertheless, I ought to get in to the debate now; otherwise there may be a risk. I believe that we have to finish at 7.4 pm promptly.
First, I am delighted that there is a health subject for debate today. Secondly, I am particularly glad that my hon. Friend the Member for Broxbourne (Mrs. Roe) has been able to secure the subject of breast cancer for the debate, as it is a matter of great concern to us all because of the incidence of the condition in the UK. I
also congratulate the Select Committee on Health on its report on the subject, which has been widely welcomed by Members on both sides of the House.
I congratulate my hon. Friend the Member for Broxbourne on her report. My hon. Friend has been a particularly vigorous and effective Chairman of the Select Committee since she took on that responsibility. She has a number of successes to her credit, of which this report is one. I think we all agree that it is an excellent report. It is also fair to say that there is extensive all-party parliamentary interest in this matter.
The Health Committee has considered ways in which the quality and availability of breast cancer services in the UK might be improved, concentrating particularly on the progress made by the breast screening programme in reducing breast cancer mortality, the role of clinical trials in evaluating treatments and ways in which more women might be recruited into trials and the benefits of specialised breast units in the provision of high-quality breast cancer care.
The all-party breast group has explored issues around rising incidence, mortality, treatment and research, and called for a national strategy for breast cancer. The group has done much, in my view, to make its presence felt and has lobbied on behalf of the thousands of women who contract this terrible condition each year.
I am pleased that hon. Members on both sides of the House share our concerns about the high level of breast cancer incidence and mortality. Hon. Members have already told us this afternoon of the statistics, but they are worth repeating because they are truly dreadful. Breast cancer is increasing internationally, with registration data for England and Wales showing that age-standardised incidence rose by 22 per cent. between 1979 and the latest available figures. We know that there are even greater increases in other comparable countries. In England and Wales, breast cancer is the leading cause of cancer deaths in women. Each year, some 27,000 new breast cancer cases are registered and some 13,000 women die from it.
No Government could underestimate the seriousness of a condition which affects so many women, or results in so many deaths each year. We do not know why breast cancer is increasing internationally, but some suggestions have been made. My hon. Friend the Member for Colchester, South and Maldon (Mr. Whittingdale) suggested that an aging population was one possibility, and obesity is another possible factor. The rate of incidence is higher in developed countries--particularly western developed countries--than in less developed countries.
These are all suggestions, but--as has been stated in the debate--there is little evidence to suggest that there are clear links between the various factors involved in this dreadful disease. I emphasise to the House that, while these are the facts, we must take account of the evidence of increasing mortality. We have to take breast cancer very seriously, and we do. That is why in 1987 we announced the setting up of a breast cancer screening programme throughout the UK--the first of its kind in the European Union and one of the first in the world.
All women aged from 50 to 64 are invited for a three-yearly mammogram, with women aged 65 or over being screened on request. Some £55 million has been allocated to establish the programme in England, with
£70 million being spent on the programme for the whole
UK. Funding for running the services has now been built into health authorities' allocations at an estimated cost of
£27 million a year.
The screening programme is a success, and I am pleased that the Committee accorded it such praise. I am sure that the whole House will join me in congratulating those who work on the programme. A number of hon. Members made that point, and I would like to underline that. The breast screening programme is now screening some 4.5 million women and has detected more than 26,000 cancers, many at an early stage when treatment is more successful.
Fewer women are being recalled unnecessarily, and every precaution is taken to minimise women's anxiety about the test and about recall for further assessment. A number of hon. Members--including my hon. Friends the Members for Croydon, North-East (Mr. Congdon) and for Colchester, South and Maldon, and the hon. Member for Woolwich (Mr. Austin-Walker)--made this point. It is a very serious matter and while the situation is getting better, there is clearly further to go and I want to see progress being made.
I come now to quality assurance questions. We built quality assurance standards into the programme from the start, and we will continue to monitor achievement against these standards. I appreciate, though I do not accept, the Committee's concern that devolving of purchasing of quality assurance to health authorities could lead to a pursuit of cheaper options than the gold standard set nationally. We believe strongly that the independence and effectiveness of the quality assurance programmes will continue to be guaranteed by the regional directors of public health, who have been charged with ensuring that quality assurance continues, and by the national NHS screening co-ordination team.
My hon. Friend the Member for Broxbourne asked me for a particular assurance in her speech. She said that there was a danger that the QAP would become simply a means for purchasers to check on provider units, and she asked whether it would continue to ensure that the service which is purchased meets the national standard. I am glad to say to my hon. Friend that the answer to that is yes. The regional directors of public health have been charged with the task of ensuring that quality assurance is purchased to the standard set nationally, and that the service continues to the current high standards. I give her an unequivocal assurance on that point.
The breast screening programme has been based on firm evidence, and one of its strengths is that it is constantly reviewed to ensure that standards are kept up to date. That is why we introduced last August the taking of two views of each breast for all women attending their first screening appointment. We have also announced proposals for the setting up of pilot projects to evaluate the effectiveness of extending the screening programme to women up to the age of 69. That is a particular point of concern which I fully accept, given the mortality rates among women in that age group. I am glad to say that we are making progress in that area. A number of hon. Members made that point, and I can reassure them that--as far as I am concerned--the matter will be a high priority.
We are funding further research into the effectiveness of screening women from the age of 40 and screening more frequently and exploring the management of screen-
detected ductal carcinoma in situ. That is going on, although I think that the priority is women up to the age of 69.
A mark of our commitment to cut breast cancer deaths is shown by the fact that we have made this a target in our
"The Health of the Nation" initiative. Our goal, as has been said during the debate, is to cut the number of deaths among women invited for screening by 25 per cent. by the end of this decade. That should mean a saving of at least 1,250 lives each year in England alone.
I wish to say something at this point on the question of the regional variations in the figures, a subject mentioned by the hon. Members for Doncaster, North (Mr. Hughes) and for Fife, Central (Mr. McLeish). The hon. Member for Fife, Central made a point about access to screening, but I think he used the wrong word. In looking at the regional and district variations, he should have said take-up instead of access.
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