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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. Friends 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 Claires 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 cytologyLBCthe 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. Friends 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. Claires 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 excisionthe most common procedureis 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 Ministers 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. Jos Trust was mentioned. If my hon. Friend feels that that is important, I would want to include any work that Jos 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, Claires family are involved and Claire had committed to continue to campaignif 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.
That this House, at its rising on Thursday 18 December, do adjourn till Monday 12 January 2009.