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2.47 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate. The measures in the NHS cancer plan on early screening, early diagnosis and better treatment are beginning to be significantly beneficial in the field. We have a genuinely good story to tell about screening but there is also more to do to extend the programmes.
Reducing the incidence of cancer is vital to long-term efforts to reduce cancer mortality. If we can screen early, we can reduce the number of deaths. Vigilance against the onset of disease is absolutely crucial. When screening is possible, it is an important method to detect abnormalities at an early stage, which allows treatment
when the cancer is most likely to be curable or, in some cases, even before it develops. That is why the cancer plan proposes a major expansion of screening programmes that is absolutely based—this is not quite a caveat—on the fact that they should be used when it is clear that screening can reduce mortality. We want to use screening when there is evidence that it works and has a proper effect.The UK was the first country in the European Community and one of the first in the world to launch a nationwide breast cancer screening programme based on computerised call and recall services in 1988. Women aged between 50 and 64 are invited for breast screenings every three years and women aged over 65 may request free three-yearly screenings. In 2001–02, 1.3 million women were screened at an estimated cost of £52 million. More than 8,500 cancers were detected, many of which were small and could not be detected by hand because they had not developed into a lump. The breast cancer screening programme can help to save lives. We funded pilot studies that showed that extending screening to women aged between 65 and 70 is feasible and cost-effective.
The hon. Gentleman asked whether we might be able to extend screening to women under 50. The Forrest report, on which the whole breast cancer screening programme is based, recommended further research to assess the clinical and cost effectiveness of offering routine screening to women under 50, and that research is under way. The study began in February 1991. Recruitment to the trial has stopped, but 160,000 are now on it. It costs about £1 million to run, and looks primarily at mortality benefits. Interim results are expected late this year, with full results expected in 2005. We are extremely interested in using it to decide whether such a programme is feasible and cost-effective.
The hon. Gentleman asked about work force capacity in breast screening programmes. I am delighted to be able to tell him that we have run several pilot programmes in trying to get a greater skill mix among the various professions involved and trying to ensure that radiotherapists and radiographers can perform tasks that previously only radiologists could perform. Those pilots have been evaluated, with an extremely successful outcome. Practitioners are now able to put markers on to X-rays to show where cancers are, and some are able to do basic radiotherapy. That frees up consultants to carry out the work that they should properly be doing, and perhaps which only they can do, and enables us to get more people through the programme. We have increased training places for radiographers by some 55 per cent. since 1997: we are getting more people into training, changing the skill mix and increasing capacity. I entirely accept, however, that there is tremendous pressure in this field, because as we get more equipment and do more screening, we create more demand, and rightly so. We need to keep on top of that.
The hon. Gentleman asked about time between diagnosis and treatment. In the cancer plan, we said that it would be a maximum of one month for breast cancer. I can tell him that the latest figures that we have for 2001-02 show that 96.5 per cent. of women with diagnosed breast cancer received treatment within that month. I am pleased to reassure him that the example that he gave relates to a very small minority. Early
treatment is absolutely key, especially after a diagnosis, because a great deal of distress and worry can be caused at that time.Moving on to cervical screening, the national computerised call and recall system was, again, introduced in 1988. Again, it was the first such programme. Women aged 20 to 64 are invited for a free cervical screening test every three to five years, and women aged over 65 are invited for screening if their previous two tests were not clear or if they have never been screened. In 2001–02, 3.9 million women were screened in England. Research has shown that death rates from cervical cancer fell by 43 per cent. between 1988 and 1997. Lives are being saved by the screening programme.
On 6 June 2000, we announced that we would pilot the introduction of new technology—liquid-based cytology, or LBC, along with the use of human papilloma virus, or HPV, testing—as part of the NHS cervical screening programme. LBC techniques offer a new way to prepare cell samples for examination in the laboratory. The National Institute for Clinical Excellence has suggested that introducing LBC could increase the sensitivity of slides, reduce the number of inadequate screening tests—an area of concern—and improve the speed with which slides can be read. The report of the independent evaluation has been sent to NICE, and final appraisal guidance is due in August. If that is positive, LBC techniques will be introduced across the NHS in England, as promised in the NHS cancer plan.
The hon. Gentleman mentioned that the system is being adopted in Scotland. Obviously, it will be a much bigger programme in England and Wales if we decide to adopt it nationwide: there will need to be a phased transition in terms of work force capacity and changes in laboratories. We are working with the NHS Purchasing and Supply Agency to examine ways in which we can procure the new technology in a cost-effective way to ensure that a programme can be established across the country, if that is what NICE recommends in its final guidance.
HPV is a group of more than 80 viruses that are known to be implicated in 99 per cent. of cases of cervical cancer, but in most women those viruses are cleared naturally by the immune system. The HPV arm of the pilot study tests women if they have a mild or borderline screening test result. That evaluation report is due this autumn. As yet, there is no evidence to support the use of HPV as a primary screening tool.
Professor Henry Kitchener, at St. Mary's hospital in Manchester, is co-ordinating a study to investigate whether it could be used in that way in the future. The study began in January 2001: it will take six years, involving 28,000 women, and we are keen to press on with it.
The hon. Gentleman mentioned bowel cancer, which he is right to say has not received a huge amount of attention in the past, partly because of the difficulties we have in talking about the subject. It is the second largest killer, with 14,000 lives lost a year, so it is an important area for us to concentrate on. We now have breast and cervical cancer screening programmes, and we are sometimes accused of being sexist, because there are no screening programmes for cancers that affect men. In
men's health week, I should like to put it on the record that we are absolutely not sexist. We want screening where it is effective: evidence is key. One area where evidence is increasingly good is in relation to colorectal and bowel cancer.In a speech to the Britain Against Cancer conference in November last year, the Secretary of State reaffirmed his commitment to introduce a national screening programme for bowel cancer for both men and women, and the national cancer director, Professor Mike Richards launched the programme on 4 February this year. There are three main strands: developing the screening programme, streamlining the care for patients who already have symptoms, and improving treatment.
One important subject of current debate is the best screening methodology to adopt. Much research and discussion is taking place about the respective merits of faecal occult blood testing and flexible sigmoidoscopy. In order to take that forward, the screening working group will examine those complex issues and make recommendations about the most appropriate way to make progress. The faecal occult blood testing has a research base, but flexible sigmoidoscopy is becoming increasingly important as a good way of detecting cancer.
On prostate cancer, we are committed to introducing a screening programme if and when screening and treatment techniques are sufficiently well developed. Trials have shown that there is no conclusive evidence from any country that screening for prostate cancer would reduce the death rate, which is our objective. The prostate-specific antigen test, a blood test, is not always accurate. Some men with high PSA will not have prostate cancer, and some with low PSA will have prostate cancer. There is also no clinical consensus on the best way to treat prostate cancer. We need more serious and extensive research in that area—exactly what we are doing. We are on target to spend the promised £4.2 million on research into prostate cancer this year—something like a 20-fold increase on the research carried out in previous years.
However, the fact that there is insufficient evidence for a screening programme does not help men who are worried about prostate cancer, which is why we introduced the prostate cancer risk management programme. Those who go for a PSA test should have good information about the benefits, limitations and risks associated with that test. Evidence-based resource packs were sent to all general practitioners in September last year. They included information leaflets for
patients, and doctors were encouraged to have discussions with their patients when they seek the test and ensure that they have the fullest information available to them.The hon. Gentleman also mentioned ovarian cancer screening. As more technology becomes available, more screening will be a possibility. The health technology assessment programme has undertaken a systematic review of the evidence for introducing ovarian screening. Currently, there is insufficient evidence to reach a firm conclusion, but the UK collaborative trial of ovarian cancer screening began in 2000. About 200,000 post-menopausal women aged between 50 and 74 are being randomised in 12 UK centres. Half the women will be screened, either by annual blood test or annual trans-vaginal ultrasound, with the remainder as the control group. The study is funded by the Department of Health, the Medical Research Council and Cancer Research UK. It is expected to cost some £20 million and will continue until 2010. We are keen to examine further evidence on ovarian screening, which, as the hon. Gentleman said, is an increasing problem and rightly a proper matter of concern.
We are also examining the possibility of lung cancer screening. Recent research has shown that low-dose spiral computer tomography scanning can identify lung cancer in asymptomatic individuals at high risk. That suggests that CT scanning might be a useful screening test for lung cancer. The outcomes for lung cancer are very poor indeed in terms of five-year survival rates, so screening could be useful there.
Finally, I should like to emphasise that no screening programme is perfect. Those who seek it need to understand the potential benefits and limitations, and then make informed choices about them. That is why we said that we would produce national leaflets. We have done so for breast and cervical screening, and they are sent out to all women who take part in the programmes. It is important—in every area of health care, not just in screening—that patients are able to participate in the decisions about their health and feel some ownership of the process of managing their own clinical conditions.
I am delighted that we have had the debate today, and wish to place on record my personal thanks to all the staff who are involved in the screening programme. They work incredibly hard and do a fantastic job. They have contributed enormously to the good health of thousands of people in this country, and they have helped to save lives, too.
- Adjourned accordingly at Three o'clock.
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