9 Nov 2004 : Column 173WH
Westminster Hall
Tuesday 9 November 2004
[Sir Nicholas Winterton in the Chair]
Breast Cancer
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Hutton.]
9.30 am
Dame Marion Roe (Broxbourne) (Con): During October, we witnessed another successful breast cancer awareness month. That campaign, which is now in its 11th year, raises at least £10 million annually, and it has helped many of those suffering from breast cancer.
As a joint chairman of the all-party parliamentary group on breast cancer, I am delighted to have the opportunity this morning to initiate a debate on the primary prevention of breast cancer.
The latest figures from Cancer Research UK indicate that a woman's lifetime risk of suffering breast cancer rose between 1995 and 2001 from one in 12 to one in nine. Breast cancer is the most common cancer in the UK; there has been a steady rise in new cases per year—from 21,446 new cases in 1979, to 34,824 in 1998 and 40,989 in 2003.
Dr. Ian Gibson (Norwich, North) (Lab): I thank the hon. Lady for allowing us to debate such an important issue; the work being done on breast cancer is similar to that on many other cancers. However, it is an international problem. In the United States, 192,000 new cases of invasive breast cancer were diagnosed in 2001, and about 50,000 women died of the disease in that year. It is a serious problem. Does the hon. Lady agree that we could play a leading role in an international movement to tackle the disease?
Dame Marion Roe : I thank the hon. Gentleman for that intervention. He is right to say that it is a worldwide problem, and I fully agree that the United Kingdom could take a lead in the fight against this terrible disease.
Breast cancer is currently the most common cancer among women in the UK. Unfortunately, more than 40,000 women are diagnosed with this devastating disease each year, and more than 1,000 women die from it every month. The incidence of breast cancer in the UK continues to rise year on year. However, we should remember that better detection of the disease through the NHS breast screening programme and better breast awareness among women has contributed to that rise.
Mr. Iain Luke (Dundee, East) (Lab): I, too, congratulate the hon. Lady on gaining this debate. We obviously welcome the extension of screening to older women, but when I raised the issue last year, I mentioned the need to reduce the age limit from 45, perhaps to 40, to allow the screening of younger women. There is an increase in the number of younger women suffering from the disease, and earlier screening might allow for more successful treatment.
Dame Marion Roe : More and more younger women are being diagnosed with breast cancer. The hon. Gentleman makes a good point, and I am sure that the Minister will have noted it.
9 Nov 2004 : Column 174WH
Breast cancer is a complex disease, and we do not yet fully understand what causes it. Scientific evidence indicates that breast cancer is caused by a complex mixture of factors, some to do with lifestyle, some to do with environmental factors, and some genetic—in other words, inherited. Those factors act at many different stages of life, probably starting before birth and continuing to the menopause and beyond. Unfortunately, we do not yet know how to prevent breast cancer.
Professor Jack Cuzick, the head of Cancer Research UK's epidemiology, mathematics and statistics department at the Wolfson Institute of Preventive Medicine in London, has stated:
Several established risk factors have been identified, including age, gender and pregnancy. The biggest risk factor for women is age, and as a woman gets older, her risk of getting breast cancer increases. More than 80 per cent. of all breast cancer cases in the UK involve women over the age of 50. Unfortunately, most of the established risk factors, such as age, are outside our control.
However, women could do something about other risk factors, such as alcohol intake. In a recent survey carried out for Breakthrough Breast Cancer, for example, only 7 per cent. of the women surveyed were aware of any link between alcohol and breast cancer. However, an intake of 1 unit of alcohol daily is estimated to result in one extra case of breast cancer among every 100 women who drink, compared with 100 women who do not drink at all. Based on that information, more than half the women surveyed by Breakthrough Breast Cancer said that they would be willing to limit their alcohol intake or to stop drinking completely to reduce their risk of breast cancer. That example highlights the importance of public education and public awareness of breast cancer risk factors. Based on such information, women can make informed choices about their lifestyles.
If breast cancer is to be prevented, its causes must be found. Studies are currently taking place to investigate some of those causes. The Breakthrough Generations study, for example, was launched in September. It will investigate the causes of breast cancer, and in particular gain information about those causes that might be prevented. It will be the largest study of its kind in the world and will cover more than 100,000 women in the UK. It will continue to give information for the next 40 to 50 years, although the first results will be available within the first few years of the study. Similarly, the Long Island breast cancer study project is a multi-study effort to investigate whether environmental factors are responsible for breast cancer in particular areas of America.
Every day, we are all exposed to many different chemicals through our diet, our lifestyle and the environment. Before we can conclusively determine what factors, other than better detection, are contributing to the increasing incidence of breast cancer, we must carry out further in-depth and robust
9 Nov 2004 : Column 175WH
research. The National Cancer Research Institute analysis of cancer research funding in the UK revealed that only 2 per cent. is spent on prevention.
Although the incidence of breast cancer is increasing, the good news is that the number of people dying from the disease is decreasing, and more women are surviving than ever before. That is partly due to the NHS breast screening programme. As we do not know how to prevent breast cancer, it is important that all women between the ages of 50 and 69 attend their appointments. Most cancers picked up by screening are at an early stage, with five-year survival rates of more than 90 per cent. The World Health Organisation's International Agency for Research on Cancer recently identified a 35 per cent. reduction in mortality from breast cancer among screened women aged between 50 and 69, which may go some way to explaining the dramatic 22 per cent. fall in breast cancer mortality rates in the United Kingdom in the 10 years between 1990 and 1999. More than 1 million women are screened every year in the UK.
Mr. Luke : I agree with the hon. Lady that early detection is important for the prevention and successful treatment of breast cancer. Does she feel that the breast-screening programme for women between 50 and 60 can be impeded by the acknowledged shortage of radiologists, which has delayed screening programmes around the country?
Dame Marion Roe : I again take the hon. Gentleman's point and I am sure that the Minister has listened to his important contribution.
Bearing in mind the importance of the NHS screening programme and the fundamental role that it plays in early diagnosis and, therefore, better prognosis, we should be concerned that not all women are attending their screening appointments. The recent report by the all-party group on breast cancer, entitled "Early Detection Saves Lives: Tackling Inequalities in Breast Screening", found that one in six women not attending screening said that it was because the appointment given to them was not convenient. They cancelled and never rearranged another time. Indeed, in some areas of the country, the uptake of screening falls far short of the programme's 70 per cent. target. For example, in one part of London, the take-up rate was only 51 per cent.—19 per cent. below the target rate.
As a result of the all-party group's report, we are calling on the Secretary of State for Health to encourage screening services to make local changes and increase the choice of when and where women can be screened, including considering the possibility of screening women in units outside their local breast-screening service catchment area—for example, nearer to their place of work. We also call on the Secretary of State to put renewed efforts and resources into public education to promote the importance of attending breast-screening appointments, and to help make people more aware of the common signs and symptoms of cancer.
At the moment, we do not have enough information or the means to prevent breast cancer. However, our growing knowledge of breast cancer risk factors means
9 Nov 2004 : Column 176WH
that we may be able to reduce the risk of developing the disease. More research and better public education about the risk factors are needed. In the meantime, since we do not know how to prevent breast cancer, it is important that women over 50 years of age attend their screening appointments and that women of all ages are breast aware. Being breast aware and having regular mammograms will not prevent women developing breast cancer, but may help them to find it early when it is more likely to be successfully treated.
I want to raise another preventive measure. Last night, many parliamentary colleagues and I attended a reception in the House of Commons organised by Macmillan Cancer Relief to promote its campaign to obtain a better deal for people with cancer—that is to say, to prevent cancer spreading to people's finances. Macmillan claims that cancer patients tell it that they suffer financial hardship as a result of having cancer. More than three quarters of people that it surveyed said that they ran up extra bills, and, for most people affected by cancer, money worries are second only to pain as a cause of stress. However, the disability living allowance and attendance allowance, which should ease the burden for many patients, are designed for long-term conditions. We all know that cancer is different, because the debilitating effects of treatment are frequently immediate and drastic. The sudden extra costs, such as travel for treatment, hospital car parking and heating, can be equally drastic, and generate an urgent need for benefit support.
What action is being taken to arrest the rising incidence of breast cancer in the United Kingdom? What action is being taken to identify the various risk factors for breast cancer and to understand how they affect the risk of breast cancer? What support are the Government giving to breast cancer research, particularly to the causes and possible prevention of breast cancer? Will the forthcoming public health White Paper specifically address the issue of breast cancer incidence and risk? What public health policies do the Government propose to adopt to address the rising incidence of breast cancer and to improve public education about and awareness of breast cancer and its risks?
As many of the risk factors, such as age, are not within the control of any woman, does the Minister agree that it is particularly important that we educate women about risk factors such as alcohol intake and post-menopausal obesity that are within their control so that they can do something about them? How do the Government propose to improve public understanding of those risk factors? What action have the Government taken to increase the uptake of the NHS breast-screening programme, particularly in areas of low uptake and in social groups, such as minority ethnic groups, in which uptake is below the average? What are the Government doing to promote a co-ordinated and joined-up approach to breast cancer research and prevention that involves all relevant agencies, and what are they doing to ensure that every cancer patient is offered specialist benefits advice when diagnosed? Finally, what are the Government doing to improve
9 Nov 2004 : Column 177WH
cancer patients' access to the disability living allowance and attendance allowance? I look forward to the Minister's replies.
Mr. Deputy Speaker : Order. Before I call the hon. Member for Norwich, North (Dr. Gibson), I advise the Chamber that the hon. Gentleman has told me that he will have to leave the debate early. We all understand why.
9.47 am
Dr. Ian Gibson (Norwich, North) (Lab): I apologise for having to leave the debate early, Mr. Deputy Speaker, but I have a constituency appointment at 10 am.
It is a delight to follow the hon. Member for Broxbourne (Dame Marion Roe) and her erudite exposition of the risk factors of breast cancer and what we should be doing about them. I congratulate her particularly on highlighting the Macmillan campaign event, which I had the pleasure of hosting last night. It was a brilliant event attended by many people, and is another great initiative in our development of cancer services, which have been improving in this country since 1997.
We all realise that the work never stops. We must continue to make improvements until we eliminate the sad incidence of breast cancer, which continues to increase, unlike death rates, many of which the Government have brilliantly turned around. I will not quote the figures, but I will say that I spend a fair bit of time talking to people about breast cancer on Capitol Hill. They are a fearsome bunch. It must be like playing against Thierry Henry of Arsenal. They are brilliant at advancing their arguments, and the breast cancer lobby groups in this country—the hon. Lady is a member of a prominent one in this place—have played a major part and have moved the debate forward. The Government have reacted to that in many ways.
It is agreed in the United States that it should be the goal of medicine to detect breast cancer early and to provide a possible cure. Breast cancer prevention strategies in this country and the States have been developed recently to include a comprehensive breast cancer screening programme, which I agree we should broaden to include risk assessment as well as breast examination and screening mammography. This is a new concept. The hon. Lady described all the risk factors of various degrees. There is a nine-point programme in the States now and one could argue that perhaps every woman, of whatever age, should have this risk assessment.
There is a high incidence of breast cancers caused by genetic factors—some 10 per cent, possibly more. As more genes are discovered we may find that it is more complicated and that genes form the basis. Risk assessment is a way to decide whether better scrutiny, such as every six months or every year, is needed. We need to grasp this nettle. It is a new concept that the Americans have taken on strongly because of the lobby and the interest it has generated.
Incidentally, men get breast cancer too. It is a low incidence, but because men do not present as well as women to the medical profession, many are not
9 Nov 2004 : Column 178WH
diagnosed until a late stage. We should remember that. Men must not feel that they are immune. It happens to a reasonable number of men. Who knows what causes it. Very little work has been done on this. The breast cancer screening guidelines can be applied to the population in general, but patients at this increased risk should be identified through risk assessment.
For those at risk, screening, mammography and proven prevention strategies can be individualised according to the level of risk. There is the most intense debate about how screening should be done, when and how often. I would not like to count the number of times that I have been at conferences debating the issue. Results often conflict. It is difficult to get information. The Swedes say, "Yes, if you do it here it works." Someone else in Britain will say, "No, it does not work." We have to find this out. We know that we do not know all the answers, but we certainly know how to handle some of the problems that we have at this stage.
There will be really big technological developments and advancements in digital mammography. The Government have put in many scanning machines. The technology is moving almost faster than the machines can be put into the district hospitals. We have to encourage that. It will improve the accuracy of the screening method and, I think, reduce breast cancer mortality. The implementation and further development of breast cancer prevention strategies give us hope that the reduction in the incidence of breast cancer may be within reach and may happen within some of our lifetimes. We should be heartened by the political dimension and its interest, but we must continue to press on this issue and keep it high on the agenda in medical practice. I finish by congratulating the hon. Lady once again.
9.53 am
Mrs. Patsy Calton (Cheadle) (LD): I, too, congratulate the hon. Member for Broxbourne (Dame Marion Roe) on securing this important debate. It is just over a year since the last debate. Sadly, there are not quite so many people here today as I would have hoped, but it is first thing in the morning and the morning after a significant event for my party—our annual dinner.
The hon. Lady has once again established the seriousness of this issue. Were it not so serious, one would think it amazing that more money was not being spent on research into the prevention of breast cancer. She said that 2 per cent. of the research money is spent on prevention. This is something that affects 40,000 women and 300 men a year. We are talking about a large section of the population, because families and friends are affected too. This is a scourge on modern life. We do not know enough about it to understand why it happens.
I imagine that few people do not have direct experience of breast cancer in their family or their circle of close friends. Those of us with such experience want our children and grandchildren to know what to do to avoid the very high risk that exists currently.
I want to dwell specifically on prevention. The primary prevention of breast cancer depends on two things—a real knowledge of the associated risk factors, based on hard evidence and research and, as the hon. Lady said, education so that young and old have the
9 Nov 2004 : Column 179WH
information necessary to make rational choices about the factors that they can change. We know that breast cancer occurs as a result of complex interactions between genes, lifestyle and environmental factors, but we are finding it difficult to separate those issues out, because we simply do not have the body of research evidence that will give us the necessary information.
The hon. Member for Norwich, North (Dr. Gibson) reported that Cancer Research UK has said that we must do more to establish the risk factors. That is absolutely right; 2 per cent. as a proportion of what is spent on research is simply not enough.
Dr. Gibson : Does the hon. Lady agree with me that the Americans are taking knowledge about cancer to the next level? The National Cancer Institute has developed a risk assessment tool, which is on a website. Using nine factors, it can estimate for anyone the risk of developing breast cancer over five years or a lifetime. Whatever the risk factors are currently, we should plug that information into the equation, which would enable us to see that some people are more at risk than others. That tool seems to provide an accurate reflection of what happens, and we should pick it up. It is great in America; it is possible to find everything to do with cancer on websites there. We should develop that risk assessment technology now.
Mrs. Calton : I thank the hon. Gentleman for his intervention, because I was about to mention that risk assessment tool. It is one of a battery of tools that can be used to assess someone's risk at, say, age 20, 15 or whatever age. Once people have some knowledge of their risk, they can modify the factors that might contribute to it. Obviously, I am talking about the things that they can alter. Clearly, as we have said, age and gender cannot be altered. Those things are part of us and we have to accept that. However, it is very important that people have information about the risks to which they are exposed and that they can do whatever it is possible to do to minimise those risks, if they choose to do so. Personal choice comes into this; people will make their own decisions.
We have heard that one unit of alcohol a day increases the risk of breast cancer by 6 per cent. and 2 units a day increases the risk by 12 per cent. It would be pretty rare for people in our society to say, "Well, that means I won't drink at all." If people wanted to remove the risk, they would be talking about not drinking at all. People will make individual choices about what they intend to do, based on the risk factors that they know about. I agree with the hon. Gentleman that we need the risk assessment tool as one of an armoury of tools, but it will not replace the need for fundamental research. The needs have been identified and the money needs to be spent.
We have talked about age. As the hon. Member for Broxbourne said, the one thing that we can do about age is to attend screening. However, some groups are difficult to reach and do not, for whatever reason, attend screening. The all-party breast cancer group's report clearly pointed out that a high number of women said that it was not convenient to attend screening. There has been passing comment on some women's concern that
9 Nov 2004 : Column 180WH
they will experience pain when they have the test. It would be wrong for us to assume that women's fear of the pain involved is irrational, as some women undoubtedly experience pain. It would be useful if the Minister reflected on what could be done to minimise the pain that some women definitely experience with mammography through a change in technique, and to find out whether pain is caused by the technique or by something in the woman concerned, for example her cycle.
It is fairly common among the women to whom I spoke to experience pain—sometimes severe—when the mammogram is taken. That sort of information passes around women like a piece of folklore. It is not good enough simply to say that it does not happen, or that it need not be taken into account; it should seriously be taken into account. Some women may say that it is inconvenient to go for a mammogram, and may not give it top priority, when really they are worried about experiencing pain. It would be interesting to see how many women will not return for a second mammogram—not when something has been found to be wrong, but in the normal course of events—if they experienced considerable discomfort the first time. That problem needs to be addressed. It is not enough simply to pass it off as one of those things. Some women experience quite severe pain.
We have discussed the gender issue. We have not talked much about family history. We know that small numbers of breast cancer cases run in families, and we think that about 5 per cent. of cases are due to changes in the BRCA1 and BRCA2 genes. It is possible that cancer generally, breast cancer included, is caused by other genetic problems, and that some families' and people's immune systems have an inability to deal with cancer. General research in that area may give the most benefit, because if we can identify why some families experience cancer more often, we may be able to find some way of preventing it, or of boosting the immune system so that cancers do not take hold.
There is little that anyone can do about early periods or late menopause—they happen in the natural course of things—but there is some indication that they are associated with increased rates of breast cancer, probably due to an increased lifetime exposure to oestrogen. However, there is an issue with early periods, because they occur in girls who are heavier than average. If work can be done to prevent young women from becoming obese in their early years, there is a strong possibility that the onset of their periods will be held off for a little longer.
The association with height is also complex, but women over 5 ft 9 in are more likely to get breast cancer. That seems a bit unfortunate, and there is little that they can do about it, but there is a range of established risk factors about which something can be done. Pregnancy is one such factor. In this society, we generally frown upon and are concerned about early pregnancy, particularly teenage pregnancy. Most of us want our children, and other children, to wait until their 20s before their first pregnancy, but a pregnancy before the age of 20 seems to be protective. That is an indication that sometimes such matters are not as black and white as society believes. Perhaps we should be more careful about being so condemnatory of people who
9 Nov 2004 : Column 181WH
have children at a younger age—they may save the country a great deal of money, if they do not get breast cancer at a later stage.
The other worry is that women have an increased risk if they have their first child at over 30 or if they do not have children. That is a matter for women to take into consideration when they are looking at their range of risk factors. Perhaps if women applied the risk factors mentioned by the hon. Member for Norwich, North, they would not delay having children until they were in their 40s or late 30s. Women need to be able to take those issues into consideration. Many women and their families have not had that information, and so have not been able to take those issues into account.
We know that breast feeding for more than a year in total reduces risk. I know that the Government have done considerable work, particularly through the Sure Start programme, in trying to encourage breast feeding. We know that breast feeding is best for children, but society still has a tendency to regard it as unnatural and to imply that it should not take place. We need to do a great deal more to educate the public that breast feeding is good not only for babies but for mothers, and that mothers who breast feed for at least a year in their lives reduce their risk of breast cancer.
The Million Women study reported recently on the effects of hormone replacement therapy. We now know that there is an increased risk of breast cancer with HRT, particularly with the combined oestrogen and progesterone drug, and if the drug is taken over long periods. GPs and their patients are talking about that matter in a considered way, to try to minimise women's risk. There is an indication that once women come off HRT, their risk is lowered within a few years. However, it is important that women are aware, before they engage in HRT, of the effects that it might have.
Similarly, we know that there is a slightly increased risk for women who take the pill. We are told that 10 years after stopping taking the pill, that risk disappears. Women need to know that they increase their risk if they take the pill. Those factors all build up.
Women's weight is a major issue. Women who are overweight, particularly after the menopause, are more likely to get breast cancer. It is thought that that happens because fat tissue is the primary source of oestrogen after the menopause. Therefore, the more fat women carry, the more oestrogen they will produce, and the greater risk they will have of getting breast cancer. If weight gain can be minimised, women have more chance, in those circumstances, of reducing their breast cancer risk.
There is another issue. We cannot isolate breast cancer from everything else. Breast cancer is linked to a range of other diseases. Obesity appears to be associated with a variety of health problems, including heart disease, high blood pressure, diabetes, arthritis and several other cancers. Persuading women to reduce their weight or to keep it within normal bounds will reduce their risk not only of contracting breast cancer but of developing a variety of other health problems. Women who are high risk for breast cancer or who have breast cancer, possibly because they are overweight, are also high risk for those other factors. That needs to be taken into consideration.
9 Nov 2004 : Column 182WH
The alcohol issue is very important indeed. As an aside, whenever my younger daughter tells me that she is going out for the evening, my standard text message back to her—we text each other, as mothers and daughters do these days—is "Think of your long-term health." She sends a text message back to me saying, "Yes, all right, don't worry." I ask her to be aware that she needs to minimise her alcohol intake and should not go along with the craze for binge drinking, which appears almost to be the norm.
I have recently been concerned about local papers in my area showing pictures of young people who are clearly under the influence of alcohol enjoying themselves. There is nothing wrong with people enjoying themselves, but it is worrying when newspapers make it look as if being over the limit in alcohol and indulging in what most of us would call binge drinking is the norm. Society needs to do more about reducing the tolerance of binge drinking.
We know that radiotherapy can increase the risk of breast cancer. There are some treatments for which a balance of risk factors has to be taken into account. Hodgkin's lymphoma treatment leads to increased risk of breast cancer, because of the site of the radiation therapy. However, if people did not have that radiation therapy, they would be at greater risk from Hodgkin's lymphoma. Those things have to be taken into account.
There are strong suspicions that diet and exercise are inextricably linked with the risk of breast cancer, but we simply do not know enough yet about how they affect it. More work needs to be done on that. Work has been done on diet and exercise separately; indeed, I myself was a subject in a study of diet. There is no clear link between diet and exercise and breast cancer. However, because the issue is complicated and because modifying behaviour seems a likely avenue if the two are in fact implicated, it is important that more research should be done, so that we can iron out some of the conflicts in the existing research.
We are absolutely certain for other reasons, however, that eating a healthy diet rich in fruit, vegetables and whole grains, is good for a range of other things, particularly maintaining lower body weight. Although it is difficult to separate diet and exercise, we know that controlling diet and exercising are important for other health reasons. People are likely to be leaner if they exercise regularly. As somebody who exercises regularly and struggles hugely with her weight, I sometimes think about such things with a wry smile and ask myself, "How much do I have to do to get my weight down?" Well, I can tell the Chamber that it is necessary to do enough training for the London marathon. Weight goes down once exercise gets up to about 25 miles a week; below that, it does not go down particularly.
A further factor, which has not had enough exploration, is exposure to low-dose radiation. Cancer Research UK is doing a great deal of work on mapping the incidence of cancer across the country. I would like research to be done into the effects of low-dose radiation in those areas of the country where background radiation is higher than average. I am thinking of parts of the south-west, where the main rock is granite, a relatively new rock that gives off more radiation. It would be useful to know whether there was a higher incidence of breast cancer in those areas. It is difficult to
9 Nov 2004 : Column 183WH
know precisely what anyone would do about it, but it would be useful to have an understanding of whether high radiation levels cause that difficulty.
We do not know about telecommunications masts yet, or about in vitro fertilisation treatment—although studies so far show that that there is no increased risk. We do not know about the impact of stress, although if one talks to people who have had breast cancer they often identify a major stress event in the previous two years, either in their family or affecting them personally. A major stress event could involve the death of someone close, or something else that is really serious; it does not refer to general levels of stress. I think that most of the work that has been done has looked at the background stress that most of us feel as we go about our day-to-day lives; I am talking about the major life events that cause massive stress. We could do with more work on those.
There is some research into exposure to light at night. People who sleep with the light on, it is thought, produce rather less melatonin, and because of that they are more likely to end up with cancers. That is the theory. We need more research into that, because it would be very simple to ensure that one never slept with the light on. That would be something that every one of us could do. Melatonin, we believe, may suppress the growth of breast cancer.
We do not know enough yet about childhood risk factors. The hon. Member for Broxbourne made quite a lot of comments about concerns that breast cancer may start in childhood or even earlier, in the womb. Some research indicates that factors in the womb have an effect.
We do not know enough about ethnicity yet. We know that breast cancer is a worldwide problem and that it affects some populations more than others, but we do not know enough about that.
I make a plea that the newspapers and media are a little more responsible when it comes to parading some of the risk factors. I sometimes wonder where they pluck them from. They suggest that underwired bras could increase the risk, which does not seem to have any research foundation, or that bumps or bruises to the breast, breast implants, abortions, deodorants and anti-perspirants could do so. Research does not show that, but sometimes the media get hold of a piece of research, parade a great headline and frighten people with issues that have not been shown definitively to cause an increased risk.
We do not know about smoking—there have been differences of view about that—or about chemicals that people come into contact with in their environment. We do not know about pesticides. There is a tendency to think that because everybody is exposed to so many chemicals and trace chemicals, we can do nothing about it. I do not agree with that. I was a chemistry teacher. I taught in a school in which, within a fairly short period, something like half the women had a breast lump—a breast cancer—that had to be removed. Clearly, that may just have been an isolated cluster. When people asked me what my occupation was, I did not write just "teacher", but "chemistry teacher", because a chemistry teacher will have a very different exposure to chemicals. It is important that such issues are looked into.
9 Nov 2004 : Column 184WH
Once again, I congratulate the hon. Lady. She has again brought this important issue to the attention of the Chamber. I do not think that it will go away in the immediate future. I hope that we will see a turnaround in the dreadful figures of 40,000 women and 300 men affected every year, and that that work will be done with some speed. I look forward to the public health White Paper, because I hope that it will address some of those issues in the round, perhaps not just for breast cancer but for women's health—and men's health—in general.
10.20 am
Mr. John Baron (Billericay) (Con): I congratulate my hon. Friend the Member for Broxbourne (Dame Marion Roe) on yet again securing an important debate on this issue; I thank her for doing so, and for all her work on the matter, which is recognised by hon. Members on both sides of the House. I thank other hon. Members, too, for their interesting contributions.
The importance of the debate can be clearly illustrated by the statistics. One in nine women will, as we have heard, develop breast cancer at some point in their lives, and 41,000 cases are diagnosed each year according to the latest figures, and that includes 300 men. Something like 13,000 deaths a year are caused by breast cancer.
It is unusual in some respects to talk about primary prevention strategies in the context of breast cancer. All the major risk factors, such as age, genetic code, endogenous hormone levels, late age at menopause and late age at first pregnancy, are not in any way modifiable through traditional intervention strategies. Meanwhile, drugs that have proved to prevent breast cancer or to have some effect are also of limited use, given their side-effect profile. It has been clearly shown, for example, that tamoxifen reduces the incidence of breast cancer by something like 6 to 8 per cent., but it produces bad side effects, which rules it out of a responsible prevention strategy.
Mrs. Calton : Perhaps we should mention that although tamoxifen is useful for women with the potential for oestrogen-positive tumours, or who have had such tumours, it is not of value for anyone whose tumour is not of that kind.
Mr. Baron : I accept that, but it is still relevant to the issue of breast cancer generally, and breast cancer prevention; as I have said, side effects have ruled it out of any responsible prevention strategy.
Several factors are modifiable through intervention, as my hon. Friend mentioned. One of those is diet. The NHS cancer plan rightly focuses on tackling cancer by reducing the number of people who smoke and promoting a healthier diet through initiatives such as the five-a-day programme. There is strong evidence to suggest that because people have taken more care with their diet over time and have become more knowledgeable about cancer in general, cancer death rates have fallen.
The Government make great claims about the 10 per cent. fall in cancer mortality rates since 1997—which is right—but those declines are part of a longer-term trend not only in this country but on the continent, for
9 Nov 2004 : Column 185WH
example. Under Conservative Governments, between 1990 and 1997, cancer mortality rates also declined by 10 per cent. It is important to recognise that those welcome figures are part of longer-term declines.
There is no doubt that initiatives such as five-a-day are a step in the right direction, but the Government's record on matters such as obesity and drinking has been quite poor overall. Figures from the Health Committee's report on obesity this year found that between 2000 and 2002 the proportion of women who were obese or morbidly obese increased by 7 per cent. I am sure that the Minister will be aware that if present trends continue, one quarter of the population will be obese by 2010.
The biggest failure in tackling obesity—this is relevant to all developed countries, not just this one—is the absence of a co-ordinated programme accommodating individual and public health approaches to the problem. The net effect of the anti-obesity drive, whether in this country or other developed countries, has been the introduction of a wide variety of individual treatment and prevention programmes, the published success rates of which have been disappointing overall.
Those concerns are reflected in current Government policy. As the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson) told the Health Service Journal last year:
"We have a 'five-a-day' programme, the schools' fruit scheme. I'm not sure you need a strategy because we are talking about some very simple messages".
I suggest that that approach is wrong. Indeed, the Health Committee's report highlighted the naivety of approaching obesity in such a simplistic manner. It said:
"The causes of obesity are diverse, complex and, in the main, underpinned by what are now entrenched societal norms. They are problems for which . . . no one simple solution exists."
Drinking is another matter on which the Government's record could be better. It is a shocking trend that the number of women drinking above recommended guidelines—35 units a week—has risen by more than half during the last 15 years, although I accept that that has taken place not only in very recent years. Breakthrough Breast Cancer believes that, as my hon. Friend mentioned, drinking on average one extra unit of alcohol a day increases a woman's risk of breast cancer by about 6 per cent. and the risk increases by a further 6 per cent. for each additional unit of alcohol consumed on a daily basis.
The important message is that the Government must do far more to make people aware of how many units they drink and that they should drink in moderation. What is needed from the Government, as a matter of urgency, is the implementation of an integrated and co-ordinated wide-ranging programme of solutions to tackle these issues.
We hope that the White Paper on public health, which will be published next week, although it was due in the summer, will tackle these matters. I hope that the Minister will be able to give us an early indication of what is in that White Paper, because the approach to the issue so far has been disappointing—indeed, its approach has been described as "dilatory and disgracefully complacent" and a "calamity" by the BMA as recently as last month.
9 Nov 2004 : Column 186WH
The Government's failures on obesity and alcohol illustrate perfectly why public health should rest not in the hands of a junior Minister but with the Secretary of State. Public health challenges need to be recognised and tackled at the highest levels across Government, through a broad, population-based programme that aims to change behaviour at a collective environmental level. My colleague Lord Foster's HIV/AIDS campaign is an example of how public health challenges should be tackled.
The Minister should consider our proposal to establish a public health commission—an independent body with a similar role in public health to that of the National Audit Office. Its functions would be to gather evidence, publish reports and make recommendations to Government and Parliament. The commission would ensure that there was a research-effective, evidence-based approach to the matter, which would help to form public health policies.
Meanwhile, we would establish public health directors to work at city or county levels, as there is evidence to suggest that PCTs are too small to carry out population-based interventions to safeguard public health. In addition, we would instruct the National Institute for Clinical Excellence to include in its future work programme reviews of public health measures—for example, in the provision of alcohol clinics and drug therapies for the morbidly obese.
I look forward to hearing from the Minister how the Government will improve their performance on the issue, as there is little doubt that there is a lack of a co-ordinated approach to public health. We sincerely hope that the White Paper will focus on the necessary answers.
Other hon. Members have rightly focused on the importance of screening. As we still know so little about the causes of breast cancer, it is vital that the UK has adequate screening and surveillance programmes in place to aid early detection, which we know saves lives. I hope that the NHS breast-screening programme will continue to be rolled out; NICE guidance published this year recommended that women between the ages of 40 and 49 with a high family risk of breast cancer should be screened annually. I would welcome the Minister's assessment of the extent to which that guidance has been implemented nationally.
As my hon. Friend said, research published last month by Breakthrough Breast Cancer and the all-party group on breast cancer found that, in some areas only about half the women who should be screened were going for screening—20 per cent. below the 70 per cent. target among that group. The report also revealed that one in six women who did not take up their breast screening appointment said that that was because it was not convenient. In addition, as the Minister will be aware, the National Audit Office found this year that women from lower socio-economic groups and ethnic minorities were less likely to attend screening appointments.
The Conservative party fully supports the all-party group and Breakthrough in calling on the Health Secretary to investigate ways of making the screening service more flexible and accessible to the women it was set up to serve and to put renewed effort into promoting public education and the importance of attending
9 Nov 2004 : Column 187WH
appointments and making people more aware of the common signs and symptoms of breast cancer. We all know that making women more aware of the importance of screening is, in a way, primary prevention and that the earlier breast cancer is detected, the better the chances of survival. I therefore look forward to hearing what the Government propose to do to address the action points raised by the all-party group and Breakthrough on this important issue.
I want to leave the Minister plenty of time to wind up, so let me briefly add a few words to those of my hon. Friend and other hon. Members about the Macmillan reception yesterday evening. The event tried to focus on something that is almost a crime—the fact that many cancer patients are simply not accessing the disability living allowance or attendance allowance to which they are entitled. Something like half of all cancer patients who die—I think this statistic is accurate—did not receive DLA or AA, to which they were entitled. I would therefore endorse a good number of Macmillan's recommendations, including that all cancer patients should be made aware at diagnosis of the benefits to which they are entitled. That would be a useful way of ensuring that they access those benefits.
At the moment, about £126 million of benefits are unclaimed, and I ask the Minister to address the issue, because there appears to be a lack of co-ordination between the various Departments. Many cancer patients are falling between Departments and suffering as a result. As my hon. Friend the Member for Broxbourne said, people at such a crucial time in their lives, who are having to deal with cancer, should not have to contend with financial stresses.
We all want to improve the primary prevention of breast cancer and the treatment of cancer patients generally. I would be the first to acknowledge—it would be churlish not to—that the Government have made improvements in the provision of cancer services and treatment. However, given the money that has been invested in the NHS, not enough of those improvements have shown up in front-line services—a lot of the money simply is not reaching them.
Many services need urgent attention. There is strong evidence that radiotherapy waiting times are deteriorating badly, and the situation is not helped by "Agenda for Change", which has alienated many radiographers, who will be meeting this Saturday to express their opposition to the changes proposed under it.
We know of the referral lottery, which has, to a certain extent, been created by the Government and their two-week target, under which nearly 10,000 women are routinely referred and subsequently diagnosed with breast cancer. That places GPs in a difficult position, because they are not necessarily best placed to decide what is a routine and what is an urgent referral. We also know about the postcode lottery, which leads to wide disparities across the country in terms of access to cancer drugs such as Herceptin. That is another failing that must be addressed.
Having pointed out those failures, it would be wrong not to return to this morning's discussion and focus on the Government's failures with regard to primary
9 Nov 2004 : Column 188WH
prevention and care. The Government are failing to provide a comprehensive and co-ordinated public health agenda. They are failing to get across the importance of screening and to create a more flexible system of appointments. They are also failing to make sure that benefits are available to cancer sufferers who are entitled to them. I ask the Minister to address those issues in his response.
10.35 am
The Minister of State, Department of Health (Mr. John Hutton) : May I join others in warmly congratulating the hon. Member for Broxbourne (Dame Marion Roe) on calling for this debate and drawing the attention of the House to what we all accept is an important issue affecting tens of thousands of women and many families in this country? All hon. Members who have spoken have made thoughtful and balanced contributions. The focus has been on prevention and I shall deal with that in my remarks.
It is a fact of life that many issues divide this House along party political lines. We are all grown up and we accept that—it is partly why we are here. However, breast cancer should not be such an issue. We all have a perspective and we share the general view that we must continue to improve the range of services deployed in the national health service to help tackle and get on top of this serious problem.
The hon. Member for Billericay (Mr. Baron), as a party spokesperson, introduced a more party political tone into the debate than the hon. Member for Broxbourne, my hon. Friend the Member for Norwich, North (Dr. Gibson) and the hon. Member for Cheadle (Mrs. Calton), who made no party political points whatever. It is part of my job as a Minister to respond to some of the party political attacks that have been made. I shall do that briefly, but I do not want to get into a party political debate because the issue is much more important than that.
If more of my hon. Friends were present today, we would all have been slightly puzzled to hear the hon. Member for Billericay complaining about postcode lotteries and insufficient investment, because his party voted against the additional investment that we are giving to the NHS, without which it would have been difficult to sustain the progress that we are making.
Mr. Baron : Will the Minister give way?
Mr. Hutton : No, not yet. The hon. Gentleman also claimed that the Government were not doing enough to tackle the problems of obesity and excess alcohol consumption. I cannot recall a single suggestion that he made about how he would deal with those two problems, other than establishing a public health commission to advise Ministers.
Mr. Baron : Will the Minister give way on that point?
Mr. Hutton : I will in a moment. The hon. Gentleman criticised the Government for setting up arm's-length bodies—he would use the term quangos—yet his suggestion was that we needed another quango to deal with those problems. He also said that it was not proper for a junior Minister to deal with this issue and that
9 Nov 2004 : Column 189WH
it should be the responsibility of the Secretary of State. Everything in the Department of Health is the responsibility of my right hon. Friend the Secretary of State, so I do not understand his point. He wants me to give way, and I am happy to do so.
Mr. Baron : I want to raise two quick issues. The Minister said that I suggested that there had been a cut in investment. I did not. I am the first to admit that there has been an increase in investment, and we would match Labour's planned increase in investment over coming years to the tune of about £34 billion. My point was that, bearing in mind the amount of investment in the NHS, much of the money is not reaching front-line services, of which breast cancer care is, unfortunately, an example. That is not a party political point. We are all trying to improve services for those suffering from breast cancer and it is a perfectly valid point to make.
As for the co-ordinated approach, I suggested to the Minister that we had a well-thought-through policy for dealing with obesity and drinking. We would introduce a much more co-ordinated approach on public health generally—and the HIV campaign co-ordinated by Lord Foster shows what such an approach can achieve. Those are concrete proposals, and I look forward to hearing what the Minister has to say about them.
Mr. Hutton : I really do not want to continue with this; it is a familiar merry-go-round, and it would be rather dispiriting to get bogged down in these issues. The hon. Gentleman says that we need a more co-ordinated approach. With the greatest respect, that is not a specific policy. It is a generalisation. I hoped that he would make some concrete suggestions today, but he may be holding them back for another occasion.
I was not arguing that the hon. Gentleman wanted to reduce expenditure on the NHS, although some of his policies would have that effect. I was simply saying that it is a matter of historical record—it is not contestable, and I do not want spend more time on it—that the present Leader of the Opposition described the increase in expenditure that we announced in 2001 as reckless and irresponsible. It is obviously of interest, therefore, to hear that it is now proper, responsible and the right thing to do. But that is opposition politics.
Mr. Baron : Will the Minister give way?
Mr. Hutton : Let us leave all that to one side. I did not intervene on the hon. Gentleman; and the hon. Member for Broxbourne deserves the courtesy of a proper response to the nine specific questions that she asked me.
The hon. Lady referred to the convenience of a booking system for local screening services, as did the hon. Members for Billericay and for Cheadle. That is an important point. The hon. Lady will be aware of the work that we are doing to move to a system of booked appointments across the NHS, particularly for referrals by GPs for hospital-based appointments for secondary care. People using the NHS will not have to wait for someone to tell them when they can be seen; at the beginning, they will agree with the clinician or the referral service when they are to be seen; they will be able to negotiate the time and place. The system will be built around people's needs, not the convenience of the provider who is running the service.
9 Nov 2004 : Column 190WH
Exactly the same logic applies to breast cancer screening as applies to booking appointments for secondary care. The hon. Lady was right to raise the issue. I and my ministerial colleagues will reflect on what more can be done to improve the convenience of booking systems for breast cancer screening. However, I am sure that she will understand that it is a local issue. The local primary care trusts and providers are responsible for putting the service in place, and I would expect them to organise similar access arrangements for breast screening services as we hope to achieve with booking appointments for secondary care. There is plenty of food for thought; we need to reflect on what more can be done to promote that sort of approach for local screening services.
The hon. Lady asked us to renew our efforts to promote the importance of breast cancer screening and the need for people to attend appointments. We need to do more on that, and I shall write to the hon. Lady and set out in more detail some of our thoughts on the subject.
Like all who spoke in the debate, the hon. Lady raised the question of access to benefits. In our work as constituency Members, we all have to deal with terminally ill patients who know that benefits are unlikely to arrive in time to provide any measure of comfort to their families. However, we are realistic and know that if a member of the family is terminally ill, it will have an effect on the family's finances. There is no question about it. However, the state's job is to ensure that the maximum amount of help is delivered promptly in such circumstances. I shall refer the hon. Lady's comments to my right hon. Friend the Secretary of State for Work and Pensions. I shall ensure that she receives a proper response to the points that she raised, particularly about how disability living allowance can be paid conveniently in order to allow for the needs of people with terminal illnesses.
Mr. Baron : Will the Minister specifically consider the Macmillan suggestion that cancer patients should be made aware of benefits, perhaps as early as on diagnosis, in order that they receive the benefits to which they are entitled?
Mr. Hutton : Yes, they should be told; that issue does not come between us. The question is who is best placed to provide that advice. I suspect that health care professionals are probably not well placed to provide proper benefits advice. An interesting trend in many primary care locations is that work is being done to ensure that patients have access to proper welfare benefits advice. I am aware of GPs who work with benefits advice agencies and sometimes with the local authority to provide drop-in clinics at GPs' surgeries so that patients can receive more convenient advice. That is entirely sensible. We have tried to encourage that development, and will continue to do so.
The hon. Gentleman is absolutely right that people should have access to the right advice on which to base the decisions that they need to take to get their lives in order. That is particularly true of benefits advice, which is especially important at a moment of undoubted crisis when someone is told that they have cancer and it could be terminal. There is obviously some common ground between the hon. Gentleman and me on that point, at least.
9 Nov 2004 : Column 191WH
Many statistics have been used in the debate, and I do not take issue with any of them. It is salutary to think that breast cancer is the most common form of cancer in women in Britain today. More than 34,000 new cases are diagnosed each year in our country, and as the hon. Lady rightly said, the incidence of breast cancer is also rising. Between 1996 and 2001, for example, it rose by more than 10 per cent. Those statistics are one reason why preventing cancer and improving services for those who develop the disease should rightly be a top priority for the NHS.
We have made significant progress in reducing deaths from breast cancer. As the hon. Gentleman said, despite the increase in the incidence of breast cancer, mortality in England dropped by more than 10 per cent. between 1997 and 2002. In the past decade, England has seen the greatest decrease in the number of deaths from breast cancer than anywhere else in the world.
Survival rates are improving. A women diagnosed with breast cancer between 1986 and 1990 would have had only a 67 per cent. chance of being alive after five years. A woman diagnosed with the same disease between 1996 and 1999 now has an 80 per cent. chance of being alive five years later. I argue very strongly that the progress that we have been making has been made possible at least partly by the increased investment in the NHS. That has allowed the NHS to employ an extra 1,182 cancer consultants, as well as an additional 2,800 consultants who spend a significant amount of their time caring for cancer patients.
The hon. Gentleman referred to radiography. It is certainly not my argument today that we have enough consultants or radiographers. I am unsure that we will ever be in that position. I do, however, argue that we have significantly more consultants and radiographers than we have ever had. The number of therapeutic radiographers has increased by almost 20 per cent. since we took office, and we also have doubled the number of therapeutic radiography training places.
Mr. Baron : I thank the Minister for his generosity. In a totally non-party political way, may I ask him to explain why, if there is such an increase in numbers, radiotherapy waiting times have deteriorated so badly? There is no dispute about that when one sees the figures.
Mr. Hutton : I probably would want to reflect on what the hon. Gentleman has said, as he has said several times that the figures for radiotherapy waiting times are deteriorating. I want to see the evidence for that, so perhaps he can provide it.
We intend to measure, in a way previous Governments have not, the entire waiting time for patients at various stages on the various care pathways along which they need to go. For the first time, that will include waiting for diagnosis, treatment and therapy.
More diagnostic radiographers and therapeutic radiographers are working in the NHS than ever before. I have not tried to claim today for a second that that is anywhere near enough, but it is worth pointing out that vacancy rates are starting to move in the right direction for radiographers from a peak of more than 10 per cent. last year to 8.8 per cent. this year. I accept that that is not enough, but we are making significant headway.
9 Nov 2004 : Column 192WH
We are therefore increasing the fiscal capacity of the NHS as well as the human resources that are available to it. Significant investment has been made in new MRI scanners, CT scanners, linear accelerators and breast cancer screening equipment, which have all become available to the NHS since April 2000. That is part of a £520 million capital investment programme. Those investments have helped us to get to the point at which 99 per cent. of women with suspected breast cancer are seen by a specialist within two weeks of being urgently referred by their GP. More than 97 per cent. of women receive treatment within two months of GP referral and 97 per cent. receive it within one month of diagnosis. By 2008, patients will experience a maximum one-month wait from urgent referral to treatment for all cancers, including breast cancer. I hope that hon. Members will welcome those objectives.
The National Institute for Clinical Excellence has also been playing its part in ensuring that the latest drug treatments are made available more quickly to NHS patients. NICE has to date approved for use 15 new cancer drugs, five of which are for use against breast cancer. That is one of the ways we are trying to tackle the problem of variation in access to such treatments.
Mr. Baron : Will the Minister give way?
Mr. Hutton : No, I really do not think that I will any more, although I should like to make one final party political point, because we all like doing it on occasion.
Mrs. Calton : I really am grateful to the Minister for giving way. I have listened carefully to what he has said. He has spoken a great deal about work that is being done on improving treatments, and those of us who have been personally involved are grateful for that. However, the debate is about the prevention of breast cancer. The point that the hon. Member for Broxbourne (Dame Marion Roe) made, and which I reinforced, was that only 2 per cent. of research is currently on prevention. What are the Government planning to do to change the balance of research, so that we look at prevention rather than simply treatment?
Mr. Hutton : I am grateful to the hon. Lady, who anticipates what I want to say later about prevention. She is quite right; I have been focusing on treatment. Perhaps I should have started with prevention, but no speech of mine is ever perfect, so we are where we are.
On the subject of NICE, I feel rather depressed now, because I was about to make my party political point, but I think that I shall move on, except to say in passing that the hon. Member for Billericay and his lot voted against the creation of NICE in the first place.
There is a great deal that we can feel represents good progress, but I do not want to give anyone the sense that we are complacent or make anyone feel that we can rest on our laurels. That would not be right. Many hon. Members still have concerns about breast cancer services, many of which have been raised this morning.
The national cancer director, Mike Richards, published a report earlier this year that showed that not all eligible breast cancer patients had access to Herceptin, for example. The differences in take-up around the country are simply not acceptable. The
9 Nov 2004 : Column 193WH
Department is taking action to improve information on prescribing and ensure that clinicians all over the country are made aware of the benefits of drugs that have been positively appraised by NICE. We are also working with strategic health authorities where particular problems have been identified.
We are also trying to make better use of staff through new skill-mix programmes, allowing qualified professional staff to focus on the tasks that need their input, by training others to perform the more routine functions. A practical example of that is the introduction of new roles in radiography, which allows radiographers to extend their roles into some of the tasks previously undertaken by oncologists and radiologists, such as reporting on X-rays. In turn, assistant practitioners are being trained to take on roles traditionally performed by radiographers, and can now perform plain film radiography and diagnostic imaging examinations.
All of us will be concerned about the rise in the incidence of breast cancer. I do not think that there is a single explanation for that, and I am sure that other hon. Members share that belief. However, we know that exposure to increased amounts of oestrogen can increase the risk of breast cancer. The hon. Member for Broxbourne referred to that.
We also know that some synthetic chemicals, including some organochlorine insecticides, may have a very weak ability to act as oestrogens in the body. That has led some people to make a connection between organochlorine insecticides and breast cancer. However, there is no evidence at all that such chemicals cause breast cancer. An independent committee that recently published a review on the issue concluded that individuals exposed through air, water or food to environmental levels of DDT, betalindane and lindane insecticides were not at risk of developing breast cancer due to exposure to those chemicals. The committee could not reach a definitive conclusion about dieldrin because of a lack of epidemiology.
It is not permitted to add chemicals that are known to cause cancer by interacting with DNA or chromosomes to food or to use them in food production. We are aware that some environmental contaminants may be present at low levels in food and that others may be formed during cooking, but they have not been linked to breast cancer.
We are firmly of the belief that in the long term the best and most efficient way of beating cancer is prevention, both for individuals and in terms of NHS resources. We know that diet plays a role in about a quarter of cancer deaths in this country, and are taking action to tackle that problem. We are encouraging people to eat more fruit and vegetables through programmes such as the five-a-day initiative, to which the hon. Gentleman referred—I am glad that he supports them—to increase access to fruit and vegetables. We are also testing different ways of increasing physical activity.
The hon. Gentleman invited me to say a few words about the White Paper, as did the hon. Members for Broxbourne and for Cheadle. It was a nice try; obviously, I cannot say anything today about its content, but it will become apparent quite soon. However, I can say that it will set out how we can do more on diet and nutrition, physical activity and
9 Nov 2004 : Column 194WH
obesity, all of which can help to reduce cancers, including breast cancer. It will also have more to say about how we can tackle behaviour that increases the risk of developing cancer.
Of course, even with the best prevention services in the world we would not be able to prevent every case of breast cancer. Early identification and intervention must remain central to our plans, beginning with the overriding importance of teaching women to be breast aware, as 90 per cent. of breast cancer is found by women themselves. We have some of the best national screening programmes in the world. The national computerised call and recall system for breast screening was introduced by the previous Conservative Government in 1988, and was the first such programme in the EU. They made the right decision, and as a result thousands of women are alive today who might otherwise have died. Our predecessors deserve to be congratulated on that.
For our part, we constantly encourage women to attend the NHS breast-screening programme, through which nearly 10,000 cancers were detected in 2002–03—a 13 per cent. increase on the previous year. We have extended the coverage of the screening programme to those aged 65 to 70. Over 250,000 extra women in that age group have been invited to attend since the extension began in April 2001. That number will rise to 400,000 a year when screening is fully established by the end of this year.
However, we can do more. That is why we are working with GPs to help them to identify those patients most likely to have cancer, so that they can receive fast, efficient and targeted specialist investigation. Guidelines are currently being reviewed by NICE, and are due to be published in March next year.
The hon. Members for Broxbourne and for Cheadle asked about research. I accept that we must always look at what more we can do to promote research into the causes, treatment and prevention of breast cancer. The Department provides about £80 million a year for cancer research. Over the past three years we have dramatically increased our ability to do clinical trials of the latest cancer drugs and treatments. The percentage of cancer patients in trials in the UK is twice that in the United States. Breast cancer trials also constitute the highest proportion of trials within the National Cancer Research Network.
To mention just two such trials, Cancer Research UK is trialling a new chemotherapy regime to test whether it improves survival for women who have had surgery for early-stage breast cancer, and NCRN is providing NHS infrastructure support for a major Cancer Research breast cancer prevention trial called IBIS II. I do not know whether the hon. Member for Broxbourne is aware of that, but I will send her details of it. That trial is an international multi-centre study of Anastrozole—I am sure that someone can help me with the pronunciation: I had it last night, but it has gone today—versus a placebo in post-menopausal women who have an increased risk of breast cancer.
As has rightly been acknowledged, the voluntary sector plays a huge and important role in this area. We are committed to working in partnership with bodies in that sector to improve and deliver cancer services. For example, we are working with Macmillan Cancer Relief
9 Nov 2004 : Column 195WH
to develop local cancer user-involvement work, and with the Royal College of Surgeons in its work to develop training for sentinel node biopsy training. The Department funds 19 cancer charities through its section 64 grants scheme.
Breast cancer is a major issue for our country. The action that the Government have taken confirms the priority that we attach to it, and we are seeing progress as a result. Such progress has been made possible first and foremost by the hard work of NHS staff, and is dependent on our maintaining the right level of investment, and continuing to work with patient groups and the voluntary sector so that we can build a proper national consensus on the best way forward.
| Next Section | Index | Home Page |