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The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for North-West Cambridgeshire (Mr. Vara) on securing a Second Reading for his Bill. He set out very clearly the devastation that breast cancer causes to women, families, friends and society more widely. I agree that it is important that the House should discuss the issues and use such debates to raise awareness of the value of breast cancer screening programmes. Women should be aware of the need for self-examination, but should also participate in those programmes.
As hon. Members are aware, reducing deaths from cancer is one of the top three priorities of the Department of Health. As the hon. Gentleman and the hon. Member for Boston and Skegness (Mark Simmonds) both said, breast cancer is the most common form of cancer in England, and more than 36,000 new cases were diagnosed in 2003. However, major progress has been made in tackling the disease and, since 1997, breast cancer mortality in the under-75s has fallen by 13 per cent., which means that 43,000 lives have been saved. Nearly 80 per cent. of women survive the disease for at least five years. Breast cancer screening has made an important contribution to that progress. May I add my thanks to everyone in the NHS whose dedication and hard work have led to those improvements?
The national computerised call and recall scheme for breast screening was introduced in 1988, and was the first such programme in the European Union. Women
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aged 50 to 70 are invited for free breast screening every three years. Breast screening by mammography is an X-ray examination of the breast, and can show breast cancers at a very early stage. Early detection is important, and that system in particular can show breast cancers when they are too small to see or feel. If changes are found at that early stage there is a good chance of a successful recovery.
The NHS breast cancer screening programme is a great success, and it is regarded as one of the best breast screening programmes in the world. I am pleased to inform the House that in 2003–04, 1.3 million women were screened for breast cancer in England. Over 11,000 cancers were detected, 42 per cent. of which were small cancers that could not have been detected by hand. Of course, we wish to make further improvements to our breast screening programme, which I shall outline later. However, first I shall deal with the measures in the hon. Gentleman's Bill, particularly his wish to extend breast screening to women aged 45 to 50, and 70 to 75. He and I had an interesting and informative meeting about those issues in December, when we discussed many of the points that he has made today. I hope that he found that discussion helpful. Since that time I have had further meetings with Breakthrough Breast Cancer. As we discussed at the meeting, the Bill is an important way of raising awareness of the issues.
I hope the hon. Gentleman will accept that a number of the reasons that I set out at that meeting, which were echoed by the hon. Member for Boston and Skegness from the Conservative Front Bench today, still stand. The Government's stance is supported by organisations such as Breakthrough Breast Cancer. I reiterate that that does not mean that there will not be improvements in future, but it is important that any changes are based on the available evidence supporting them, so that we can ensure that the existing programme for women between the ages of 50 and 70 is the most effective and of the highest quality before we extend it. I hope the hon. Gentleman will accept the need for an evidence base strong enough to support any extension.
Mr. Vara: The Minister mentions Breakthrough Breast Cancer, but I hope she will acknowledge that a number of charities do an enormous amount of work. I have a letter from Breast Cancer Care, which states:
"Following the publication of results by Cancer Research UK of a Swedish trial that screened women aged 40–50 in 2003, Breast Cancer Care believes screening women between the age of 45 and 50 can be successful in detecting breast cancer."
The charity goes on to list various caveats, including a reference to resources. Those are legitimate concerns, but it is important to remember that charities that are doing very worthwhile work are slowly moving towards the 45 to 50 age group, although, as I say, they do have reservations.
Ms Winterton:
I accept that there may be slightly different views. I am certainly not insinuating that Breakthrough Breast Cancer is against screening in the longer term for that age range, if it was supported by evidence. The trials being undertaken should be allowed to finish and report before further decisions are taken.
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I understand that the Swedish study to which the hon. Gentleman refers was a review of previous trials. There are indications—he refers to the caveats—that the results were not necessarily statistically significant for women in that age group. I am prepared to write to the hon. Gentleman with more details of that study. I shall return to the studies that we are undertaking and hope that will reassure him that we are not turning our backs on the idea, but we need to follow up the progress that has already been made to ensure that existing programmes are of the highest quality. We will look at the evidence and move on to further consideration of extension of screening.
Mr. Vara: For the record, the caveats to which I referred were not to do with the survey in Sweden. They were to do with resourcing, manpower and so on.
Ms Winterton: Let me explain some of the programmes that are in place, because, as the hon. Gentleman said, at the moment all women aged between 50 and 70 are entitled to free breast screening on the NHS every three years. Women aged 50 to 70 are invited as part of the national programme and women aged over 70 are encouraged to consider self-referring for screening every three years.
I will draw hon. Members' attention to the evidence bases that we are looking at and set out how we are taking forward some of the research. The International Agency for Research on Cancer, which is part of the World Health Organisation, evaluated the evidence on breast cancer screening in March 2002. It concluded that trials have provided sufficient evidence for the efficacy of mammography screening of women between 50 and 69 years of age. It also concluded that the reduction in mortality among those women who choose to participate in breast cancer screening programmes was estimated to be about 35 per cent. The agency's working group consisted of 24 experts from 11 different countries.
For women aged between 40 and 49 years, the agency concluded that there is only limited evidence for a reduction in mortality, but that in no way means that we are complacent about the issue. The advisory committee on breast cancer screening, which is appointed by Ministers, keeps the screening of women aged over 70 and under 50 actively under consideration based on the evidence as it emerges. As I have already said, women aged over 70 are offered three-yearly screening on request, and those who have already participated in the breast screening programme are informed of that right after the age of 70.
The hon. Gentleman and the hon. Member for Boston and Skegness referred to the need to increase awareness, and I can reassure the House that we have taken a number of measures, including working with Age Concern on a leaflet informing those over 70 that they are still entitled to breast screening. That leaflet is widely available in GP surgeries, health centres, breast screening units and Age Concern outlets, and about 2,000 are requested every month.
It is important when considering the extension of any of these programmes to ensure that we have properly researched how people will react to being invited. The advisory committee on breast screening has therefore
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commissioned a research report from the cancer screening evaluation unit of the Institute of Cancer Research to try to answer that very question. That report is due to be discussed by the committee in the summer.
With regard to women aged between 40 and 49, those with a moderate or high family history of developing breast cancer should be offered annual mammography outside the NHS breast cancer screening programme, but to an equivalent quality and standard. That, as the hon. Gentleman said, is in accordance with NICE guidance that was published in May 2004. The guidance is currently being implemented, and the Healthcare Commission will assess the progress made by trusts in implementing it. In particular, the Healthcare Commission will consider how to identify the women in that age group who are most at risk from breast cancer. As I have said, all the evidence points to the fact that that is an effective way of ensuring that those women come forward.
It being half-past Two o'clock, the debate stood adjourned.
Debate to be resumed on Friday 3 March.
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