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7.1 pm
The Parliamentary Under-Secretary of State for Health (Ann Keen): I congratulate my hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) on securing this extremely important debate. He has demonstrated the work that he did on this subject before he came to this House. The thought and research that has gone into his contribution was obvious for all to hear.
I would like to start by paying tribute to my hon. Friend’s constituent Claire Walker, and her brave battle against cervical cancer. For such a young woman to find herself in that position with a young family is devastating, and hearing of her brave work throughout what was left of her life is something that we must all take very seriously. I hope that during my speech I will address most of the issues that my hon. Friend raised.
I offer my sincere condolences to Claire’s family, her husband and her son. Of course, these sound like just words, but they are heartfelt words, because as a woman, as a mother, as a sister, and as an aunt, I know of the pressures that are on women today to look after themselves, but with the fear and dread of having bad news whenever one goes for screening. Of course, it makes it worse for the family to have this devastation at this particular time.
The NHS cervical screening programme is a great success, and it is one of the most well-regarded cancer screening programmes in the world. More than 3.5 million women are screened every year, and experts estimate that the programme saves up to 4,500 lives in England alone. However, we cannot be complacent, of course, and we are always striving to improve the programme.
Following the evaluation of a Government-funded pilot study of liquid-based cytology—LBC—the National Institute for Health and Clinical Excellence concluded in 2003 that this new technology should be rolled out across the country. I am pleased to say that the whole of England had converted to LBC by October 2008, as planned. Prior to the introduction of LBC, rates of inadequate samples were over 9 per cent. This resulted in about 300,000 women a year being screened again, just because their initial sample could not be read. As LBC was rolled out, the rate of inadequate samples has fallen every year and is now at a record low of just under 3 per cent., or fewer than 100,000 women. That means that 200,000 fewer women a year do not have to have a repeat test because their original sample could not be read, with all the anxiety that ensues for those
women and the extra costs to the service. It is important to put this on the record because it is a good and welcome change.
The implementation of LBC also allowed us to modernise the programme in other ways. Prior to 2003, there was a longstanding inequality in the NHS cervical screening programme regarding the frequency of invitations for screening. Some local programmes invited all women every three years, some all women every five years, and some used a combination of the two intervals, but there was no clear evidence base. The Advisory Committee on Cervical Screening had always kept the issue under review and commissioned research to find robust evidence to show what was the optimal screening interval. The research, by Sasieni et al., was published in the British Journal of Cancer on 1 July 2003. That research recommended that women aged under 25 should not be screened, as the risk is so low that there may be more harm done than good. It recommended that women aged 25 to 49 be screened every three years, and women aged 50 to 64 every five years.
The Advisory Committee on Cervical Screening carefully considered the research at its meeting on 14 July 2003 and advised that the recommendations in the research be adopted across the NHS screening programmes, but I certainly appreciate my hon. Friend’s comments about the fact that the screening programme in Scotland is offered to women between the ages of 20 and 60. However, I would like to give him details on why it was decided to raise the screening age in England from 20 to 25.
Cervical cancer is very rare in women under 25. Claire’s case is of course tragic, but thankfully it is very rare. All screening programmes must do more good than harm. However, research presented to the Advisory Committee on Cervical Screening, coupled with 15 years of experience of screening, has shown that screening women under the age of 25 may do more harm than good. Women under 25 often underwent unnecessary investigations after results suggested that they appeared to have cervical abnormalities. They were, in fact, normal cervical changes, caused by hormonal changes that will normally resolve themselves naturally over time without the need for treatment.
Back in 2003, when the policy was changed, the 9,000 women under 25 with a high-grade smear whom we sent each year for colposcopy would all be treated, and ran the risk of complications that could lead to infertility. Treatment relating to colposcopy using large-loop excision—the most common procedure—is relatively safe, but there are risks. The short-term risks include pre-operative and post-operative bleeding and secondary infection. It is possible to perforate the uterus and/or cut through the vaginal wall, which may lead to unintentional damage to the bowel or bladder. In the longer term, cervical stenosis, or narrowing, can be a problem, and occasionally there is functional damage that leads to problems with pregnancy. I am explaining the technicalities to show the extent to which the research was looked into.
With young women, there is the possibility of repeated loop excisions. That is not uncommon, and it means that the risk of complication is greatly increased. There is significant bleeding in 5 to 10 per cent. of cases in which a cone biopsy is necessary, and cervical stenosis occurs in 2 to 3 per cent. of patients. Hysterectomy is
occasionally necessary to delay excessive bleeding, and there are arguments about the rate of fertility issues.
Since the policy was changed in 2003, the number of excisional biopsies undertaken as a consequence of the screening programme has fallen by almost 4,000. In 2006, there were only 56 registrations, representing 2.4 per cent., of cervical cancer in women aged under 25, compared to a total across all ages of 2,321 registrations. There were no deaths from cervical cancer among those aged under 25 in 2005, according to the latest figures available to me from the Office for National Statistics; that varies slightly with what my hon. Friend said. Recent work by the National Cancer Intelligence Network, based on figures from cancer registries, shows that no increase in registrations of cervical cancer has been evident in the overall England data for that age group since the frequency policy was changed in 2003.
Screening women from the age of 25 helps reduce the number of unnecessary investigations and treatments in younger women. Treatments to the cervix can cause difficulties later in life, such as raising the risk of pre-term babies if a woman becomes pregnant. That, of course, will affect two lives, not just one.
There is internationally agreed evidence that women should be screened from age 25. A meeting in Lyons in May 2004, organised by the International Agency for Research on Cancer, part of the World Health Organisation, concluded that organised and quality controlled cervical screening can achieve an 80 per cent. reduction in the mortality of cervical cancer. Women aged 25 to 49 should be screened no more than every three years, and women aged 50 to 64 no more than every five years. The group that made these recommendation consisted of 26 experts from 14 countries.
Although some countries, including Scotland, still invite women under 25 for cervical screening, others, such as the Netherlands and Finland, do not start screening until the age of 30. The advisory committee on cervical screening constantly keeps the age range and frequency of cervical screening under review, but would formally review this policy only if there was new evidence that we should be screening from age 20. Ultimately, the NHS in England should not be paying GPs for a procedure that can potentially be harmful.
Mr. Kemp: Earlier in the Minister’s contribution, when she referred to the advisory committee, she used the word “may” cause harm and she has also said “can” cause harm. I am worried that there does not appear to be a definitive view. That is why I would like the Minister to look at the evidence. “Can” and “may” can be made definitive if we examine evidence in Scotland and Wales.
Ann Keen: I thank my hon. Friend for that intervention. I will come shortly to the important issue that he raises.
Women under 25 who are concerned about their risk of developing cervical cancer or concerned about their sexual health should contact their GP or their genito-urinary medicine clinic and go for screening. Clinicians will refer women under 25 who have symptoms of cervical cancer for other more appropriate tests, and women with suspected cancer should be seen by a specialist within two weeks.
My hon. Friend mentioned our HPV vaccination programme, which we are proud of. Cervical screening is not our only strategy for tackling this dreadful disease. The HPV vaccination programme, which protects against two strains of HPV that cause more than 70 per cent. of cases of cervical cancer, commenced in September 2008 for young girls aged 12 and 13. The national vaccination programme against HPV has been extended to offer protection to an additional 300,000 girls aged 17 and 18 from September this year. A catch-up programme will commence in September 2009 and will offer the vaccine to other older girls aged 13 to 18. The introduction of the vaccine will help reduce the number of tragic cases like that of Claire, whom we are discussing tonight.
I want to reassure my hon. Friend that the evidence has to be looked at again. Yes, everything that he has raised in the debate tonight has to be looked at again. Jo’s Trust was mentioned. If my hon. Friend feels that that is important, I would want to include any work that Jo’s Trust has done and any evidence it has produced.
Mr. Kemp: I thank my hon. Friend for giving that commitment to look at the evidence that has been produced and for the commitment to involve some of the charities. That will give great satisfaction to many people who are concerned about the matter. I genuinely welcome the commitment that my hon. Friend has given from the Dispatch Box.
Ann Keen: I thank my hon. Friend again. He has introduced this issue tonight, Claire’s family are involved and Claire had committed to continue to campaign—if we in the House and our debates mean anything, it is our duty to look at the evidence again. I thank all the charities and organisations that have been involved in bringing such detail to our attention and I recognise why the research was acted on as it was. It is always right to look again when issues are introduced as my hon. Friend has introduced this one. I give a commitment to keep a very close eye on the issue and will keep my hon. Friend informed of progress.
7.15 pm
Deferred Division
That this House, at its rising on Thursday 18 December, do adjourn till Monday 12 January 2009.
The House divided: Ayes 266, Noes 214.
AYES
Abbott, Ms Diane
Ainger, Nick
Ainsworth, rh Mr. Bob
Alexander, rh Mr. Douglas
Allen, Mr. Graham
Anderson, Mr. David
Anderson, Janet
Armstrong, rh Hilary
Austin, Mr. Ian
Austin, John
Bailey, Mr. Adrian
Balls, rh Ed
Banks, Gordon
Barron, rh Mr. Kevin
Battle, rh John
Bayley, Hugh
Beckett, rh Margaret
Begg, Miss Anne
Benn, rh Hilary
Berry, Roger
Betts, Mr. Clive
Blackman, Liz
Blackman-Woods, Dr. Roberta
Blears, rh Hazel
Blizzard, Mr. Bob
Blunkett, rh Mr. David
Borrow, Mr. David S.
Bradshaw, Mr. Ben
Brennan, Kevin
Brown, Lyn
Brown, rh Mr. Nicholas
Brown, Mr. Russell
Browne, rh Des
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burgon, Colin
Burnham, rh Andy
Butler, Ms Dawn
Byers, rh Mr. Stephen
Cairns, David
Campbell, Mr. Alan
Caton, Mr. Martin
Cawsey, Mr. Ian
Challen, Colin
Chapman, Ben
Chaytor, Mr. David
Clapham, Mr. Michael
Clark, Ms Katy
Clark, Paul
Clelland, Mr. David
Clwyd, rh Ann
Coaker, Mr. Vernon
Coffey, Ann
Cohen, Harry
Connarty, Michael
Cooper, rh Yvette
Corbyn, Jeremy
Cousins, Jim
Crausby, Mr. David
Creagh, Mary
Cruddas, Jon
Cryer, Mrs. Ann
Cunningham, Mr. Jim
Cunningham, Tony
Darling, rh Mr. Alistair
David, Mr. Wayne
Dean, Mrs. Janet
Denham, rh Mr. John
Devine, Mr. Jim
Dhanda, Mr. Parmjit
Dismore, Mr. Andrew
Dobbin, Jim
Donohoe, Mr. Brian H.
Doran, Mr. Frank
Dowd, Jim
Eagle, Angela
Eagle, Maria
Efford, Clive
Ellman, Mrs. Louise
Engel, Natascha
Ennis, Jeff
Farrelly, Paul
Fitzpatrick, Jim
Flello, Mr. Robert
Flint, rh Caroline
Flynn, Paul
Foster, Mr. Michael (Worcester)
Francis, Dr. Hywel
Gapes, Mike
Gardiner, Barry
Gerrard, Mr. Neil
Gibson, Dr. Ian
Gilroy, Linda
Godsiff, Mr. Roger
Goggins, Paul
Goodman, Helen
Griffith, Nia
Griffiths, Nigel
Grogan, Mr. John
Gwynne, Andrew
Hain, rh Mr. Peter
Hall, Mr. Mike
Hall, Patrick
Hamilton, Mr. Fabian
Hanson, rh Mr. David
Harman, rh Ms Harriet
Harris, Mr. Tom
Havard, Mr. Dai
Healey, rh John
Henderson, Mr. Doug
Hepburn, Mr. Stephen
Heppell, Mr. John
Hesford, Stephen
Hewitt, rh Ms Patricia
Heyes, David
Hill, rh Keith
Hodgson, Mrs. Sharon
Hoey, Kate
Hood, Mr. Jim
Hoon, rh Mr. Geoffrey
Hope, Phil
Hopkins, Kelvin
Howarth, rh Mr. George
Howells, Dr. Kim
Hoyle, Mr. Lindsay
Hughes, rh Beverley
Humble, Mrs. Joan
Iddon, Dr. Brian
Illsley, Mr. Eric
Ingram, rh Mr. Adam
Irranca-Davies, Huw
James, Mrs. Siân C.
Jenkins, Mr. Brian
Johnson, Ms Diana R.
Jones, Helen
Jones, Mr. Kevan
Jones, Mr. Martyn
Kaufman, rh Sir Gerald
Keeley, Barbara
Keen, Alan
Keen, Ann
Kelly, rh Ruth
Kemp, Mr. Fraser
Kennedy, rh Jane
Khan, Mr. Sadiq
Kidney, Mr. David
Knight, rh Jim
Kumar, Dr. Ashok
Ladyman, Dr. Stephen
Lepper, David
Levitt, Tom
Lloyd, Tony
Love, Mr. Andrew
Lucas, Ian
MacShane, rh Mr. Denis
Mactaggart, Fiona
Mallaber, Judy
Mann, John
Marsden, Mr. Gordon
Martlew, Mr. Eric
McAvoy, rh Mr. Thomas
McCabe, Steve
McCarthy, Kerry
McCarthy-Fry, Sarah
McFall, rh John
McGovern, Mr. Jim
McGrady, Mr. Eddie
McGuire, rh Mrs. Anne
McIsaac, Shona
McKechin, Ann
McKenna, Rosemary
McNulty, rh Mr. Tony
Meacher, rh Mr. Michael
Merron, Gillian
Michael, rh Alun
Miliband, rh David
Miliband, rh Edward
Miller, Andrew
Moffat, Anne
Moffatt, Laura
Mole, Chris
Moon, Mrs. Madeleine
Moran, Margaret
Morgan, Julie
Munn, Meg
Murphy, Mr. Denis
Murphy, rh Mr. Jim
Murphy, rh Mr. Paul
Naysmith, Dr. Doug
O'Brien, Mr. Mike
O'Hara, Mr. Edward
Olner, Mr. Bill
Osborne, Sandra
Owen, Albert
Palmer, Dr. Nick
Pearson, Ian
Plaskitt, Mr. James
Pound, Stephen
Prentice, Bridget
Prentice, Mr. Gordon
Primarolo, rh Dawn
Prosser, Gwyn
Purchase, Mr. Ken
Purnell, rh James
Rammell, Bill
Raynsford, rh Mr. Nick
Reed, Mr. Andy
Reed, Mr. Jamie
Reid, rh John
Roy, Mr. Frank
Roy, Lindsay
Ruane, Chris
Ruddock, Joan
Russell, Christine
Ryan, rh Joan
Salter, Martin
Seabeck, Alison
Sheerman, Mr. Barry
Sheridan, Jim
Simon, Mr. Siôn
Slaughter, Mr. Andy
Smith, rh Mr. Andrew
Smith, Ms Angela C. (Sheffield, Hillsborough)
Smith, Angela E. (Basildon)
Smith, Geraldine
Smith, John
Snelgrove, Anne
Soulsby, Sir Peter
Southworth, Helen
Spellar, rh Mr. John
Starkey, Dr. Phyllis
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Straw, rh Mr. Jack
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Mr. Gerry
Tami, Mark
Taylor, Ms Dari
Taylor, David
Thomas, Mr. Gareth
Thornberry, Emily
Timms, rh Mr. Stephen
Tipping, Paddy
Touhig, rh Mr. Don
Trickett, Jon
Turner, Dr. Desmond
Turner, Mr. Neil
Twigg, Derek
Ussher, Kitty
Vaz, rh Keith
Walley, Joan
Waltho, Lynda
Ward, Claire
Watts, Mr. Dave
Whitehead, Dr. Alan
Wicks, rh Malcolm
Williams, rh Mr. Alan
Williams, Mrs. Betty
Winterton, rh Ms Rosie
Woolas, Mr. Phil
Wright, Mr. Anthony
Wright, David
Wright, Mr. Iain
Wyatt, Derek
NOES
Afriyie, Adam
Ainsworth, Mr. Peter
Alexander, Danny
Ancram, rh Mr. Michael
Arbuthnot, rh Mr. James
Atkinson, Mr. Peter
Bacon, Mr. Richard
Baker, Norman
Baldry, Tony
Barker, Gregory
Baron, Mr. John
Barrett, John
Beith, rh Sir Alan
Bellingham, Mr. Henry
Binley, Mr. Brian
Blunt, Mr. Crispin
Boswell, Mr. Tim
Bottomley, Peter
Brady, Mr. Graham
Brazier, Mr. Julian
Breed, Mr. Colin
Brokenshire, James
Browne, Mr. Jeremy
Browning, Angela
Burns, Mr. Simon
Burrowes, Mr. David
Burstow, Mr. Paul
Burt, Alistair
Burt, Lorely
Butterfill, Sir John
Cable, Dr. Vincent
Cameron, rh Mr. David
Campbell, Mr. Gregory
Carmichael, Mr. Alistair
Carswell, Mr. Douglas
Cash, Mr. William
Chope, Mr. Christopher
Clappison, Mr. James
Clark, Greg
Clarke, rh Mr. Kenneth
Clifton-Brown, Mr. Geoffrey
Curry, rh Mr. David
Davey, Mr. Edward
Davies, Mr. Dai
Davies, David T.C. (Monmouth)
Davies, Philip
Djanogly, Mr. Jonathan
Dodds, Mr. Nigel
Donaldson, rh Mr. Jeffrey M.
Drew, Mr. David
Duddridge, James
Duncan, Alan
Dunne, Mr. Philip
Ellwood, Mr. Tobias
Evennett, Mr. David
Fabricant, Michael
Fallon, Mr. Michael
Field, Mr. Mark
Foster, Mr. Don
Fox, Dr. Liam
Francois, Mr. Mark
Fraser, Christopher
Garnier, Mr. Edward
Gauke, Mr. David
George, Andrew
Gibb, Mr. Nick
Gidley, Sandra
Gillan, Mrs. Cheryl
Goodman, Mr. Paul
Goodwill, Mr. Robert
Gove, Michael
Gray, Mr. James
Grayling, Chris
Greening, Justine
Greenway, Mr. John
Grieve, Mr. Dominic
Gummer, rh Mr. John
Hague, rh Mr. William
Hammond, Mr. Philip
Hands, Mr. Greg
Harper, Mr. Mark
Harris, Dr. Evan
Hayes, Mr. John
Heald, Mr. Oliver
Heath, Mr. David
Heathcoat-Amory, rh Mr. David
Hemming, John
Hendry, Charles
Herbert, Nick
Hoban, Mr. Mark
Hogg, rh Mr. Douglas
Hollobone, Mr. Philip
Holmes, Paul
Horwood, Martin
Hosie, Stewart
Howard, rh Mr. Michael
Howarth, David
Howarth, Mr. Gerald
Howell, John
Hughes, Simon
Huhne, Chris
Hunt, Mr. Jeremy
Hunter, Mark
Jack, rh Mr. Michael
Jackson, Mr. Stewart
Jenkin, Mr. Bernard
Jones, Mr. David
Kawczynski, Daniel
Keetch, Mr. Paul
Kennedy, rh Mr. Charles
Key, Robert
Kirkbride, Miss Julie
Knight, rh Mr. Greg
Kramer, Susan
Laing, Mrs. Eleanor
Lait, Mrs. Jacqui
Lamb, Norman
Lancaster, Mr. Mark
Lansley, Mr. Andrew
Laws, Mr. David
Leech, Mr. John
Liddell-Grainger, Mr. Ian
Lidington, Mr. David
Lilley, rh Mr. Peter
Llwyd, Mr. Elfyn
Loughton, Tim
Luff, Peter
Mackay, rh Mr. Andrew
Mackinlay, Andrew
Maclean, rh David
MacNeil, Mr. Angus
Main, Anne
Mason, John
May, rh Mrs. Theresa
McIntosh, Miss Anne
McLoughlin, rh Mr. Patrick
Miller, Mrs. Maria
Milton, Anne
Mitchell, Mr. Andrew
Moore, Mr. Michael
Moss, Mr. Malcolm
Mulholland, Greg
Mundell, David
Murrison, Dr. Andrew
Neill, Robert
Newmark, Mr. Brooks
O'Brien, Mr. Stephen
Oaten, Mr. Mark
Öpik, Lembit
Osborne, Mr. George
Ottaway, Richard
Paice, Mr. James
Paterson, Mr. Owen
Pelling, Mr. Andrew
Penrose, John
Price, Adam
Pritchard, Mark
Pugh, Dr. John
Randall, Mr. John
Reid, Mr. Alan
Rennie, Willie
Robathan, Mr. Andrew
Robertson, Angus
Robertson, Hugh
Robinson, rh Mr. Peter
Rogerson, Dan
Russell, Bob
Sanders, Mr. Adrian
Scott, Mr. Lee
Selous, Andrew
Shapps, Grant
Shepherd, Mr. Richard
Simmonds, Mark
Simpson, David
Simpson, Mr. Keith
Skinner, Mr. Dennis
Smith, Sir Robert
Spelman, Mrs. Caroline
Spicer, Sir Michael
Spink, Bob
Stanley, rh Sir John
Streeter, Mr. Gary
Stuart, Mr. Graham
Stunell, Andrew
Swayne, Mr. Desmond
Swire, Mr. Hugo
Syms, Mr. Robert
Tapsell, Sir Peter
Taylor, Matthew
Taylor, Dr. Richard
Teather, Sarah
Tredinnick, David
Turner, Mr. Andrew
Vara, Mr. Shailesh
Viggers, Sir Peter
Villiers, Mrs. Theresa
Walker, Mr. Charles
Wallace, Mr. Ben
Waterson, Mr. Nigel
Watkinson, Angela
Webb, Steve
Weir, Mr. Mike
Whittingdale, Mr. John
Willetts, Mr. David
Williams, Hywel
Williams, Mr. Roger
Williams, Stephen
Willott, Jenny
Wilson, Mr. Rob
Wilson, Sammy
Winterton, Ann
Winterton, Sir Nicholas
Wright, Jeremy
Young, rh Sir George
Question accordingly agreed to.
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