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Mr. Dismore : I get the impression that the hon. Gentleman is about to move on to another point, but, having just mentioned charities, he will recall that I asked in my earlier intervention whether Breakthrough Breast Cancer supported his Bill's proposal to reduce the age range of women being called for mammograms. Perhaps he will confirm whether that charity supports the pitch that he is making to the House.
Mr. Vara: I repeat the answer that I gave the hon. Gentleman earlier. I appreciate the concerns, but I shall address them. Breakthrough Breast Cancer has reservations, but that is not to say that it has not sent me a letter encouraging the debate in which I am engaging. The hon. Gentleman will doubtless be aware of charities other than Breakthrough Breast Cancer. I have had a letter from Breast Cancer Care saying that, in the light of the Swedish experience, it welcomes the proposal to screen women aged 45 to 50. I remind the hon. Gentleman that the issues related to breast cancer are not to be dictated by one charity alone.
Mr. Stewart Jackson (Peterborough) (Con): I congratulate my hon. Friend and neighbour, and praise his consistency and hard work in bringing the Bill to the House. For the benefit of the hon. Member for Hendon (Mr. Dismore), irrespective of the efficacy or otherwise of the current clinical trials and research for women aged between 45 and 50, does my hon. Friend agree that giving his Bill a Second Reading would raise the issue and have a positive impact on engaging women in the hard-to-reach category for breast screening, such as those in ethnic minorities or lower socio-economic groups?
Mr. Vara: I am grateful to my hon. Friend and constituency neighbour. He made a valid point, and the debate has certainly been raised. While there are reservations, which I shall seek—indeed am seeking—to address, the fact is that there will never be 100 per cent. certainty in the field of medicine. At times, we have to take a view when certain factors are present. We must also recognise when excuses are being made for not having the will to take matters forward. I shall certainly address that.
Angela Browning: Does my hon. Friend think that the reservation about extending the age range in either direction is perhaps influenced by the shortage of radiographers around the country?
Mr. Vara:
Certainly that is one of the issues that has been raised. As well as a lack of funds, there is a lack of technical equipment and of specialist staff. The Government have a record: when issues need to be addressed and they have the will to do it, they are prepared to make long-term plans. In the 2001 manifesto, for example, Labour thought that there ought to be more hospitals. It said that by 2010—a five year plan—there would be 100 more hospitals. It is somewhat inconsistent that the Government are able to be far sighted in some areas and think of a programme,
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yet for this issue, which affects one in nine women in the country, the excuse is often made that there is a lack of resources, and the arguments stop at that point. I am grateful to my hon. Friend for raising the point and allowing me to make matters a little clearer.
What is the value of a life? The terminology is crude, but the reality is that we talk of money. No precise value has been put on a life, but I understand that the Department for Transport made an effort and in 2004 valued the lost economic output of an individual who dies in a road traffic accident at slightly less than £1.4 million. I repeat, £1.4 million is the value that the DFT puts on the life of someone who dies in a road traffic accident. It is fair to say that the value of a life lost to breast cancer is similar. That £1.4 million covers lost output, medical costs and human costs—an amount to reflect grief, pain and suffering.
My proposals would cost a mere £40 million. The breakdown is simple: I advocate four more screenings, two at the lower age range and two at the upper age range; each screening round costs £10 million, so the total cost of the extra screenings would be £40 million. It is clear that not many deaths would have to be prevented to justify the expenditure of £40 million.
Some people argue that there should be annual screenings for women aged 45 to 49 to take account of breast tissue being more dense and the fact that tumours progress more rapidly in younger women. In an ideal world, that would of course be preferable; but until the ideal is attained, the two screenings that I propose must be preferable to the none that women in that age range currently receive.
I am mindful of the age trial—a survey that has been in progress since 1991 and is considering annual screening for women aged 40 to 50. Like the Minister, I look forward to seeing the results, which I understand are due very soon.
My hon. Friend the Member for Tiverton and Honiton (Angela Browning) alluded to the argument that there is a lack of the resources, equipment and specialists necessary to do as I propose in my Bill. The answer is not to use the lack of resources as a reason not to act; it is to provide the resources. Those resources do not have to be provided tomorrow. There is no reason why a plan cannot be put in place for the future—for five, seven or 10 years hence—which would allow time to train specialists, obtain equipment, find accommodation and deal with all the other requirements. It is a matter of the Government having the political will to recognise that there is an issue to be addressed and to commit themselves to dealing with it.
In the context of breast cancer screening, that is precisely what happened in 2000. In a statement on 5 December 2000, the then Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), made financial provision for a breast cancer screening programme that was implemented four years later in 2004, in effect, extending screening to women aged 65 to 70. I also remind the House of the words used by the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), in her foreword to the breast screening programme's 2005 annual review. She wrote:
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We must also recognise that the technology is changing. The traditional mammogram X-ray is slowing making way for the digital mammogram. That point is well made in the annual review of 2005, which states that new technology is easier to use, more reliable and quicker for all concerned. The view has also been put forward that it is better to concentrate on increasing take-up in the 50-to-70 age range. I am not against that—far from it—but there are also other vulnerable groups, and we should not exclude them.
It is difficult to argue against the extension of routine screening for women between the ages of 70 and 75. Breast tissue is less dense, the cancer is easier to detect, women are living longer and more healthy lives, and the risk of breast cancer increases with age. For the 45-to-50 age range, I accept that it is more difficult to detect cancer. That does not mean that it cannot or should not be done, however. Early detection saves lives and substantially reduces the cost of lengthy treatment. As the lost economic output has been valued at £1.4 million per life, such a programme would clearly be cost-effective, and the cost of increased screening can be justified. Moreover, the latest technology allows for greater capacity.
We are talking about saving lives—nothing more and nothing less. We must be ambitious. Yes, in this country, we do have one of the finest screening programmes in the world. Considering Britain's economic strength in the world, it would be surprising, and a shame, if we did not. The challenge, however, is to refrain from comforting ourselves that we have a successful programme, and instead to strive to make that programme even better.
2.7 pm
Mark Simmonds (Boston and Skegness) (Con): I congratulate my hon. Friend the Member for North-West Cambridgeshire (Mr. Vara) on introducing his Bill, which, to his credit, he did with great articulation and passion. The Bill addresses a subject of great importance to many thousands of women.
I am extremely aware of the prevalence of breast cancer. East Lincolnshire, the area of the country that I represent, has one of the highest incidences in the country—152.9 cases per 100,000 people, compared with a national average of 137.7 cases per 100,000. That is 200 new cases of the disease being diagnosed every year in the East Lincolnshire primary care trust area alone. I have met many of those involved in local support groups in my constituency who do excellent work supporting women during and after this traumatic illness. I want to place on the record my thanks for their excellent work both in my constituency and elsewhere in the country.
My colleagues and I are broadly sympathetic towards the aspirations of the Bill—to build on the success of the NHS breast screening programme introduced by a Conservative Government in 1988. Since that time, the programme has been instrumental in catching breast cancers early and saving lives. In 2003–04, approximately 1.5 million women were screened and more than 11,000 breast cancers were detected through screening—approximately a quarter of all breast cancers diagnosed each year.
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That success has contributed to a substantial fall in the number of UK women dying from breast cancer since the scheme was introduced. Between 1993 and 2002, deaths from the disease among women fell by 12 per cent. Sadly, however, the annual figure still stands at around 13,000. What is more, almost two thirds of women diagnosed with breast cancer are now likely to survive for at least 20 years, according to Cancer Research UK. Ten years ago, that figure was only 44 per cent. Clearly, extending the scope of the programme and improving take-up could improve health outcomes further.
I must, however, express some reservations about my hon. Friend's proposals. The scheme currently operates for women aged between 50 and 69; it was recently extended from 64 on the basis of the issuing of an invitation to attend a screening once every three years. Above the age of 70, women are entitled to request a screening but invitations are not issued as a matter of routine. Conservative Members welcomed the increase from 64 to 69 in the upper range of the programme. In addition, we called for all national guidance on cancer, including appraisals of drugs such as Herceptin, to be fully implemented.
The National Institute for Health and Clinical Excellence has recently issued guidance in respect of women with a family history of breast cancer, many of whom are at a significantly increased risk of developing the disease. NICE recommends that women in that category aged between 40 and 49 should be entitled to annual screening in view of their increased risk. Again, we support the extension of screening for women with a family history of this terrible disease.
There are, however, good medical reasons for being wary of extending routine screening at the lower age range for all women. Clinically, the case is yet to be proven. As my hon. Friend has said, pre-menopausal breast tissue in younger women tends to be denser, making it more difficult to obtain an accurate and reliable mammogram. The value of routine breast screening for that category of women, without the high risk associated with family history of cancer, needs further research and analysis. Long-term studies are considering what benefit, if any, can be derived from inviting women for screening from the age of 40. My hon. Friend's proposals would benefit enormously from an encouraging report on that matter, which clearly warrants further examination in Committee.
Meanwhile, our priority must be to see that NHS breast screening is rolled out across those ages already specified and to ensure that NICE guidance is fully implemented. According to Breakthrough Breast Cancer, in some parts of the country the scheme is failing to meet the minimum take-up standard of 70 per cent. In October 2004, the all-party parliamentary group on breast cancer produced an extremely valuable report highlighting inequalities in the uptake of NHS breast screening among women. The report found that one in six women did not attend their screening appointment because it was inconvenient for them to do so—a point highlighted by my hon. Friends the Members for Peterborough (Mr. Jackson) and for North-East Milton Keynes (Mr. Lancaster). More therefore needs to be done to promote awareness of breast cancer and to encourage an understanding of the importance of early detection. More could also be done
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to locate NHS breast screening facilities closer to women's places of work. That would increase the convenience of daytime appointments, which it is often difficult for women to get away from work to attend.
There is also a challenge to improve take-up of screening in communities with little tradition of accepting invitations. The all-party group's report highlighted the fact that areas with a highly mobile population, such as Milton Keynes, or with a significant ethnic minority population are likely to be affected by low take-up. Women over the age of 70 are entitled to attend a screening once every three years. It might be advantageous to extend the age range further. However, improving the effectiveness of existing arrangements must be the health service's priority, so we should be extremely careful when imposing additional duties.
Conservative Members hope that the Bill will be considered in Committee and look forward to seeing how the new requirements could be made easier or phased in. Meanwhile, we remain convinced of the importance and impact of cancer screening services. I commend the staff working to save lives by detecting cancer early and look forward to the day when cancers in addition to cervical and bowel cancer, which are both subject to screening schemes, can be detected in that way.
Breast cancer is a killer. Nearly 13,000 women die from the disease each year. We should investigate all proposals to raise awareness, increase education, improve early detection and ultimately save lives. Therefore, notwithstanding the reservations that I have expressed about my hon. Friend's Bill, we believe that it warrants further scrutiny in Committee, and I therefore commend it to the House.
2.14 pm
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