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Hon. Members: Object.

To be read a Second time on Friday 20 June.


Order for Second Reading read.

Hon. Members: Object.

To be read a Second time on Friday 20 June.


Order for Second Reading read.

Hon. Members: Object.

To be read a Second time on Friday 4 July.


Order read for resuming adjourned debate on Question [16 May], That the Bill be now read a Second Time.

Hon. Members: Object.

Debate to be resumed on Friday 11 July.


Order for Second Reading read.

Hon. Members: Object.

To be read a Second time on Friday 20 June.


Order for Second Reading read.

Hon. Members: Object.

To be read a Second time on Friday 11 July.

13 Jun 2003 : Column 999

Cancer Screening

Motion made, and Question proposed, That this House do now adjourn.—[Joan Ryan.]

2.32 pm

Dr. Vincent Cable (Twickenham): I am grateful for the opportunity to introduce an Adjournment debate on the rather broad issue of cancer screening, but my interest is somewhat narrow and is prompted by two considerations. The first is a constituency interest, as the leading bowel cancer charity is located in Twickenham. I met those at the charity recently, and they expressed their frustration about the fact that thousands of people die unnecessarily because the disease was not picked up sufficiently early. They urged me to do what I could at a political level to draw attention to a disease that is not particularly fashionable or that people enjoy talking about, but which deserves more attention, especially in respect of early detection and screening.

The second reason why I feel motivated to raise this subject is a personal one. My wife died of breast cancer two years ago, and we lived with the disease for 13 years through all its stages. That left me with the very strong feeling that nobody should have to go through the same experience if at all possible. I am also left with a lingering doubt; although my wife was wonderfully cared for by the NHS, she was diagnosed in her early 40s. One is always left with the thought that, if there had been screening and early detection for women in their 40s, she might still be here. One is bound to have that thought in the circumstances.

For those two reasons, I have a personal motivation for pursuing the issue. I approach it in a positive spirit. I acknowledge that in Britain, certainly in relation to breast cancer and cervical cancer, we probably have the most ambitious and long-standing, and arguably the most successful, approach in the world. That is certainly the British reputation and we must be proud of it, so I approach the matter in that upbeat spirit. One reason for that success is a general popular understanding of why screening is important—that screening leads to early diagnosis and early diagnosis saves lives; it is as simple as that.

I was a little concerned to read a couple of months ago the conclusions of Professor Baum, one of the leading cancer specialists, who argued against cancer screening on the grounds that it raises anxiety and leads to what I believe are called in the trade "false positives": people who are falsely diagnosed with various forms of cancer, thereby leading to unnecessary operations. I hope that that has not led to confusion or doubt—certainly in the Government's mind—about the virtues and importance of cancer screening. It is important that public confidence be restored.

Having made those general points, I want quickly to discuss the main cancer screening areas for which there are outstanding and important questions about Government policy, and to seek reassurance from the Minister. In many ways, the breast cancer programme is the best-established, best-understood programme. The mammography programme deals with some 1.3 million women a year aged 50 to 64. By common consent, it has a demonstrable and proven record in saving lives; indeed, there has been a sharp decline in mortality rates.

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In 2001, 13,000 women died of the disease, but that constituted a 20 per cent. reduction on the figure for a decade earlier.

There are also some very simple comparisons that can be made. Of a sample of women diagnosed with breast cancer in the mid-1990s, 76 per cent. survived for five years. However, the rate for those who had been screened rose to 93 per cent. So over the years, some 80,000 cases have been detected and very many lives saved as a result of this programme. I appreciate that the Government have indicated that they are willing to extend breast cancer screening to 70-year-old women, thereby removing a rather arbitrary element of age discrimination, and that in the process they will make the tests more comprehensive and less liable to faults.

I have three questions for the Minister on breast cancer specifically. First, as a result of research carried out in Sweden in particular, empirical proof has emerged in just the past few months that the lives of a substantial number of women in their 40s could be saved if screening were extended to them. Indeed, an article in the April edition of The Lancet reached a very strong conclusion to that effect. Are the Government aware of that finding, do they accept it and do they propose to act on it?

The second question is a related one. There have been worrying reports that in some parts of the country, particularly in the London boroughs, the cancer screening programme had to be stopped—it happened last year—because there simply was not the personnel capacity to cope with the number of women involved. I seek some reassurance from the Minister that that problem will not recur, and that the capacity will be available to cope with the expanded numbers if we quickly move to including 70-year-old women. Indeed, if the programme is also extended to 40-year-olds, will the system be able to cope with such numbers? Will it be held back, if it is clinically necessary, by lack of capacity, personnel and equipment?

My third question relates to a group of women who came to see me at my constituency advice surgery two weeks' ago. They had been diagnosed early—the system had worked—but they were extremely alarmed to discover that treatment was being very seriously delayed as a result of difficulties in getting appointments at, in this case, Charing Cross hospital. My understanding is that under National Institute for Clinical Excellence guidelines, nobody should have to wait more than a month for cancer treatment at any stage. However, one woman who had already had a mastectomy in one hospital and was referred for radiography at another was told that she would have to wait six months for that treatment—way beyond the NICE guidelines. I seek reassurance from the Minister that such incidents are extremely rare, and perhaps she could tell us how serious and widespread these slippages are. Of course, this issue does not relate to the screening programme, but it would be tragic if people's expectations were raised by good screening and diagnosis, only for it not to be followed up by appropriate treatment.

My second set of questions relates to cervical cancer screening, which is an even bigger programme. As the Minister knows, it deals with 3.5 million women a year, from a much wider age group: 20 to 65. It has a clear scientific rationale, based on the fact that early detection in this area is crucial to cure and the evidence that has

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emerged from past work that something of the order of 1,000 lives a year are being saved specifically as a result of the smear test system—in other words, it is one of the great success stories of the NHS.

However, there are several specific problems surrounding the programme. Seventeen per cent. of women who are entitled to screening do not come, mainly for sociological reasons—ethnic minorities and those from certain social classes—and many of these women die, needlessly because the screening is there. About 10 per cent. have to be recalled and experience all the anxiety associated with that. About 20 per cent. are simply missed because the test is not sufficiently accurate. Of those, there are significant numbers—perhaps half of the 1,200 who die every year—who were screened and passed, but were missed by the test. It is that inaccuracy which gives so much rise to so much anxiety and the necessity for moving on to improved technology.

New technologies are available. The new liquid-based cytology has been extensively trialled and I believe is now available broadly in Scotland. A few weeks ago, I attended an all-day medical conference where the leader of that programme in Edinburgh described the efficiency with which that system now operates in Scotland. The simple question that I put to the Minister is, since it has now being extensively trialled and proven, appears to have few negative side effects and has positive outcomes, when will it be rolled out through England and Wales? When may we realistically expect comprehensive cervical cancer screening, using that new technology?

The other question that I have on cervical cancer relates to the fact that some women report that their results are being seriously delayed. I have had anecdotal evidence of this and surveys suggest that 15 per cent. do not get their results within 10 weeks, which is way outside the guidelines. I should be grateful for some reassurance on that.

The third category to which I wish to refer specifically is bowel cancer, which was where I started. There is increasing anxiety that it is growing rapidly. It has become the second cause of deaths among cancer victims; 35,000 a year are diagnosed, of whom 16,000 die. But there is now effective screening technology, and evidence from trial studies suggests that 2,500 of those who die could be saved if they were screened satisfactorily. I am delighted to read that the Government have now accepted that conclusion and are proceeding to a national screening programme. That is very good news. However, most of the people with whom I have discussed the subject—the action groups and those in the profession—are not sure how the Government's programme will work. Perhaps the Minister would be good enough to tell us as much as possible about how that screening programme will work, and particularly how long it will be—one year, two years or longer?—before most of the men and women who have anxiety on that score can be screened. Are the resources available? Are the nurses and specialists being trained for it?

In conclusion I shall refer to two other types of cancer, in connection with which the screening process and the technology are less advanced, but where there is a growth of cancers and growing anxiety. One is

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prostate cancer. I was horrified to discover that by the age of 80, half of all men will have prostate cancer. Very few will die of it because they have other things, but obviously it is a major source of anxiety for any man, and it is a growing source of death.

Tests are available. There is the prostate specific antigen test, but it is a very primitive testing system. Even the leading prostate cancer action group, the supporters of the charter for action, are not pressing for screening based on that technology because they acknowledge that it has major errors. Two thirds of all men show raised PSA levels when they are tested and 20 per cent. of men with prostate cancer are not picked up by the test, so it is an imprecise system. No one is currently calling for a national screening programme based on the test. None the less, there is a strong desire for the Government to do what they can to promote research on screening technologies and to advance the situation so that we are not quite as helpless in the face of the disease.

My final comments relate to another woman's cancer: ovarian cancer. I know from women who have been affected by the disease that it is a growing source of anxiety because the death rate is so high. Only about 30 per cent. of women affected survive for longer than five years and the problem seems to be growing. There is a worry that the scanning process in the NHS is highly inconsistent. Some parts of the country have ultrasound equipment and actively encourage screening. Some parts of the country offer screening if it is sought, yet it is simply not available in some areas. That reflects the different distribution of resources and differences among health professionals about whether the procedure is useful. Will the Government give clear guidance on whether screening is useful? If it is useful, will there be a consistent approach in the NHS? That information would help the pressure groups and the general public. There seems to be much confusion and uncertainty, although research at Barts and in Cambridge may cast light on the situation.

I have covered a wide spectrum from established programmes for cervical and breast cancers to programmes in which screening and research are at an early stage. The Government and the country can be proud of the programmes but much remains to be done. Enormous numbers of people are dying, but they might not do so if better technology were being better applied. I would be grateful for as much encouragement as the Minister can give me.

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