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7.38 pm
The Minister of State, Department of Health (Jacqui Smith): I thank the hon. Member for Twickenham (Dr. Cable) for raising this important subject. I am sure that all hon. Members will join me in offering him our condolences. He clearly has a personal commitment to this subject and an understanding of the issues.
He outlined the key point, which is to ensure that our programmes are effective and that we do what is necessary to safeguard women from cervical cancer to the best of our ability.As the hon. Gentleman said, we already have significance evidence that the NHS cervical screening programme is successful. Research has shown that it saves about 1,300 lives per year. It was directly responsible for a 43 per cent. drop in the incidence of cervical cancer between 1988 and 1997, and more than 8,250 lives were saved over the same period. In 2000–01, 83 per cent. of eligible women in England had had a test in the previous five years, 3.6 million women were screened and laboratories reported 4.1 million tests. I pay tribute to the hard work and dedication of cervical screening staff across the country.
Organised screening, as the hon. Gentleman said, is available nationwide only in the United Kingdom, the Netherlands, Denmark, Sweden and Finland. In 1988, the UK was the first country in the now European Union, and one of the first in the world, to launch a nationwide cervical cancer screening programme based on computerised call and recall. The UK programme is among the best in terms of numbers. The Dutch programme is similarly nationwide and organised, but no other country screens as many women per year as the UK, where coverage is highest.
Cervical screening is the most reliable method of detecting changes to the cervix that, if left untreated, may go on to develop into cervical cancer. However, like all screening techniques, it is not perfect. There is a measure of interpretation, as the hon. Gentleman said, based on the expert judgment of the individual cytoscreeners involved in assessing abnormalities in screening samples. In a proportion of cases, the abnormalities will be so slight that different cytoscreeners could reach different decisions as to the correct result. In addition, the test itself is not 100 per cent. sensitive.
Women invited for cervical screening need to understand the potential benefits and limitations, in order to be able to make an informed choice about whether they wish to proceed. Information provided to women must be honest, comprehensive and understandable. That is why the NHS cancer plan said that all women will receive a national information leaflet on cervical screening when they are invited to attend. The new leaflets will be launched at the end of this month, and are based on research, including discussions with a diverse range of women. The development of the national leaflets was overseen by the Advisory Committee on Cervical Screening and the national cancer director.
The new screening leaflets are an important step under the new principle of openness in the NHS to which we are all committed. For the first time, women will be given all the facts about cervical screening and a real informed choice about whether they wish to be screened.
The hon. Gentleman concentrated on the opportunities provided by developments in technology, and I want to follow him in that. New developments may help to address some of the problems surrounding cervical screening. That is why the Government are currently piloting both liquid-based cytology and human papilloma virus testing in the cervical screening programme.
The two pilots are related. Liquid-based cytology techniques offer a new way to prepare screening test samples for examination in the laboratory. By offering a new way of storing and preparing cervical samples, liquid-based cytology may improve the quality of the cervical screening test. The National Institute for Clinical Excellence has suggested that introducing liquid-based cytology could increase the sensitivity of slides, reduce the number of unsatisfactory tests and improve the speed with which slides can be read. The LBC arm of the pilot is designed to collect information on the effect, costs and practical implications of introducing LBC technology into the cervical screening programme.
As the hon. Gentleman said, human papilloma viruses are a group of 80 viruses known to be implicated in 99 per cent. of cervical cancers. In most women, the virus is cleared naturally by the immune system, but in some it persists and goes on to cause cervical abnormalities that, if left untreated, may develop into cervical cancer.
The hon. Gentleman's questions about the speed and effectiveness of HPV screening partly come down to whether we are talking about that screening as a primary screening method or as a method of sorting, following a smear test that suggests a mild or borderline case. I wish to address both of those issues.
As yet, there is no evidence to support the use of HPV testing as a primary screening tool. The health technology assessment review of research into HPV testing, published in September 1999, concluded that the evidence might support testing for HPV only in certain situations, such as the management of mild and borderline screening tests. The HPV arm of the pilot is therefore using HPV testing as triage—sorting—for women with mild or borderline test results to provide stronger evidence on which women should return for further screening and how soon.
We are not ignoring the issue of primary screening. St Mary's hospital in Manchester is co-ordinating a study to investigate HPV as a primary screening method. The study began in January 2001 and will take six years, including the following up of the data, and will involve 28,000 samples. The Department of Health is funding equipment for the study, at a cost of £90,000.
Mrs. Patsy Calton (Cheadle): I was interested to hear the Minister's comments about the Manchester trial, because I have also been in contact with the people there. Is she aware that a significant part of the trial includes the examination of the stigma associated with cervical cancer, of the resultant depression when women believe that they have contracted cervical cancer, and of the expensive prescribing of anti-depressants that results? Is she also aware that significant bodies of medical research suggest that HPV testing can be used as a predictive measure to identify those women at particular risk of developing cervical cancer and enable follow-up work to be done?
Jacqui Smith: The hon. Lady makes important points about the range of the research, the complexity and implications of screening programmes—for diagnosis and the effects on the women involved—and the procedures before and after diagnosis that we need to ensure are in place.
The hon. Member for Twickenham raised the issue of the timing of the pilots. It is beneficial to pilot the HPV testing and the liquid-based cytology together, which is
one of the reasons for the timing; HPV testing can be carried out on the original LBC slide, whereas at present a woman would need to be called in for a separate HPV test.The pilot of HPV testing as triage and of liquid-based cytology began in April 2001 at three sites in Newcastle, Norfolk and Norwich and north Bristol after the selected sites had addressed the issues of training and installation of equipment. Results of the liquid-based cytology arm of the pilot should be available early next year. The HPV arm of the pilot will end in September 2002. Analysis of the data on HPV will begin in October 2002, and the report on the evaluation of the HPV arm of the pilot will be submitted in early 2003. As the hon. Gentleman will know, the NHS cancer plan set out the commitment that, if the pilots prove successful, the Government will fund implementation of the programme across the NHS.
In addition to piloting the new technologies, strict quality assurance operates across the cervical screening programme, at a cost of £3.5 million a year. Quality assurance is an important part of the cervical screening programme. It acts as a safety lever by maintaining standards and continuing improvement in the performance of all aspects of cervical screening in order to ensure that women have access to a high-quality service wherever they live.
The performance of laboratories is kept under close review. They are subject to rigorous external quality assurance procedures. The procedures aim to spot potential problems before they become serious and quickly to identify solutions. This, together with the ever-increasing expertise of screening staff, means that the observed benefit of cervical screening is set to continue to increase.
The improvements in cervical screening would not be achievable without investment in cancer staff. Cervical screening staff are an important group and we will invest
to support their continuing development. Arrangements for new ways of working are under development. They will explore the potential for an advanced practitioner grade, which will lead to a more flexible work force. New pay arrangements to support this measure have now been agreed with staff representatives.In conclusion, I thank the hon. Member for Twickenham for raising this important subject. The NHS cervical screening programme is successful, enabling us to identify and support women. It has enabled us to diagnose early and to save women's lives. However, we need to ensure that as we develop the technology, we introduce it into the screening system effectively and appropriately. We are committed to ensuring that we maintain a high quality of monitoring and staff development.
I hope that the hon. Gentleman will accept that the issue is not only of personal importance to him, but of significant importance to the NHS, and one that we are committed to continue to develop.
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