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Baroness Hayman: My Lords, the noble Baroness is right, but for such a highly contested issue, it is important that we get the research right. An extensive, international analysis of all the available evidence,

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some of which is published and some of which is not, takes time. That time has to be used properly and we will then have data on which we can hopefully all agree.

Baroness Noakes: My Lords, I thank the noble Baroness for that intervention. I wish to imply no criticism of Cancer Research UK. I was merely reiterating what I believe most women feel; namely, that the issue has been raised and they would like some more certainty about it as soon as possible.

I want to touch briefly on research. That being carried out by Cancer Research UK is not funded by the Government and we must thank such organisations for undertaking it. I believe that the Government should be providing the bedrock of funding for this kind of important research. I invite the Minister to say how much government money will go into medical research this year and what proportion of the total amount likely to be spent on medical research they will fund. Will she reflect on whether that is the right proportion, given the huge importance of issues such as breast cancer?

The Question tabled by the noble Lord, Lord Alton, raises the question of how much information should be given to women about potential risks. I believe that patients should be given a balanced explanation of the risks associated with any medical intervention. But a line has to be drawn between giving information on the basis on which informed choices can be made and overloading the patient with information. Information should not be given on the basis of unproven hypothesis. It is into that category that abortion and a breast cancer link falls. Indeed, I believe that it would be positively harmful to concentrate on risks that are not proven.

I wish no disrespect to the honestly held views of the noble Lord, Lord Alton, and my noble friend Lady Knight, but it is difficult to resist the notion that reducing the incidence of breast cancer is not the key concern of those who are behind the use of the so-called "evidence" of a link between abortion and breast cancer. Their target is the reduction in or the elimination of abortion. As many noble Lords have said, many other factors are associated with the incidence of breast cancer—

Baroness Knight of Collingtree: My Lords, I thank my noble friend for giving way and I want to intervene only briefly. What she has said could cause great worry. I cannot speak for the noble Lord, but I can say that nothing I have said today or was trying to do today was intended to do what she has described. I merely want all research examined and details when they emerge to be given frankly to women. That is my aim and that is all.

Baroness Noakes: My Lords, I am pleased that my noble friend has said that because I am sure that all noble Lords around the Chamber feel the same way. But many other factors are associated with the incidence of cancer. Family history is an important one, as are controllable issues such as obesity and the

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decision to take HRT. There are other unproven links through alcohol and even through organo-chlorine insecticides.

However, these are not the targets of the campaigners—and I stress the campaigners outside your Lordships' House—because they have the abolition of abortion in their sights and not the health and well-being of women, which should be our primary concern.

Having taken two interventions, I must be brief. As regards reproductive health in this country, we are fortunate in having contraceptive services and the availability of abortion. There are many issues which we on these Benches do not believe the Government have got right. There are issues about the way in which breast cancer is currently being treated, which we do not believe the Government have got right. Our outcomes are among the worst in Europe; certainly below average. Our waiting times for breast cancer treatment are not improving, even after the reduction in time to first consultant appointment. For example, only 80 per cent then receive treatment within five weeks. And if one wants radiotherapy, one has to be one of the 53 per cent.

We believe that those issues about breast cancer are by far the more important for your Lordships' House to concentrate on, rather than the link between abortion and breast cancer. I look forward to hearing the Minister's reply.

8.29 p.m.

Baroness Andrews: My Lords, I am very grateful to the noble Lord for introducing a debate which has sparked such vital exchanges. I am sure that that was absolutely predictable and understandable, and I am grateful to all noble Lords who have spoken. I am conscious that we do not have enough time to address all the issues. I wish that we had the rest of the evening.

It is a timely debate for all kinds of reasons, and it provides an opportunity to pay tribute to Breakthrough Breast Cancer and Breast Awareness Week and also to the work of the voluntary societies, including the one in which the noble Lord, Lord Alton, himself is involved—the Forget Me Not Appeal. It is timely because breast cancer is a major preoccupation for every woman and is something that we think about for much of the time. If we have friends or members of the family who have suffered from it, there is always the overshadow of fear that we might get it ourselves. It is the second biggest cause of deaths from cancer among women, with 41,000 new cases each year.

It is absolutely right that we are rigorous and determined in identifying risks and, as my noble friend Lady Massey eloquently said, in providing the essential information that women need both to reduce risks and to make informed choices. But it is vital that we do nothing to raise unfounded fears and anxiety. As many noble Lords said, we know that there is a whole range of known risk factors relating to genetics, the environment, lifestyle, obesity and, as recent research has suggested, high alcohol intake. In

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addition, there are reproductive and hormonal factors, such as having children at a late age, early puberty or late menopause.

I want to say at the outset that the Government are entirely committed to ensuring that women are as fully aware as possible of the risk factors. If the weight of expert evidence suggested a causal link between abortion and the risk of breast cancer, we would make that information widely available to women as soon as possible. But, as many noble Lords have said—particularly my noble friend Lady Gould—the weight of evidence is not stacking up. That evidence comes not only from the UK but from the US and now, increasingly, from other countries.

I believe we must be alert to some of the issues raised by the research quoted. For example, the Patrick Carroll study was reviewed by the RCOG. That study was not peer-reviewed, and the RCOG concluded that it failed to establish a causal association between abortion and breast cancer. The study by Joel Brind in 2000 was subject to other analyses. Other researchers analysed the literature and reached the opposite conclusion.

However, in this very brief overview of the great deal of evidence that has been made available thus far, I want to be able to show that there is a wealth of international research. Studies have involved many women of different ages and varying reproductive histories. As the noble Baroness, Lady Thomas, said and as the American College of Obstetricians and Gynaecologists said recently, the results of the early studies were slightly inconsistent. But they were difficult to interpret because of methodological considerations—not least the varying patterns of recall of women and self-referral. That explains some of the inconsistency in those studies. However, more recent and more robust studies, whether they were case-controlled through the control group examining what happened to women who did not have cancer or abortions, or cohort—that is, large population—studies, have found no link between abortion and breast cancer.

I turn to what we in the UK, and the RCOG in particular, are doing. In 1999, the RCOG reviewed all the research evidence available at the time. Many noble Baronesses this evening have referred to the RCOG's guidelines produced in August 2000, which, I understand, were inspired by Dr Brind's study and which, indeed, reassured women who have had an abortion or breast cancer that the research evidence on this question to date is inconclusive. A long quotation was read from that set of guidelines.

However, I can tell the House that, after reviewing the most recent and refereed studies, the RCOG is now even more confident than it was in 1999 that there is no association between abortion and breast cancer. That should be reflected in new guidelines from the RCOG which are in the process of preparation.

Lord Alton of Liverpool: My Lords, perhaps I may intervene before the noble Baroness proceeds. I am grateful to her for giving way. Can she explain why the

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RCOG also said that that evidence cannot be disregarded? Perhaps she can refer to the successful court action last week based on the same evidence, laid before the British Government, in both the United States and previously in Australia, where women have now won their cases for the right to have information.

Baroness Andrews: My Lords, I cannot comment on those cases because I am not aware of them. The RCOG guidelines state that professionals involved in abortion care should be equipped to provide women with information on, among other things, the long-term effects of abortion, which are rare or unproven, including breast cancer. So, it is aware of the need for women to be informed even where there is a remote or inconclusive risk. That is part of the whole scope of the information. I think it would be safer if I write to the noble Lord about the Brind study as I do not have the full RCOG report before me, simply the resume.

We have had additional confirmation from the USA. The November 2003 edition of the International Journal of Gynaecology and Obstetrics includes a committee opinion from the American College of Obstetricians and Gynaecologists (ACOG) which reviewed the same peer review papers as those recently reviewed by the RCOG with one exception and concluded that there was no evidence in this body of medical research to suggest any causal link.

In addition, and cited in the briefing we had from Cancer Research UK, were cohort studies from Germany and Sweden and of large populations in France, Denmark and China. The noble Baroness, Lady Knight, referred to China. I cannot comment on what she said but have in front of me only what was said by the researchers. Those studies, which in one case involved over 1 million women, found either a non-significant increase, no correlation, no increase in risk or even a slight protective effect in some instances where women had had an abortion. I am happy to let noble Lords have that review.

Reference was made to Cancer Research UK's world class review. I am grateful to my noble friend Lady Hayman for her intervention. She knows so much more than I do about such matters. It is a vast and complex study. As she said, it is reviewing not just a potential link between abortion and breast cancer but a whole range of reasons why women contract breast cancer. We are anxious to have the results, but we also recognise that the results must be validated and confident. Therefore, we look forward to them being published as appropriate.

I turn to some of the wider issues raised, in particular by the noble Baroness, Lady Noakes. There is good news about breast cancer research. Research from Cancer Research UK published last year showed that in the past decade British women have had the world's biggest decrease in deaths from breast cancer thanks to better diagnosis and treatment. We want to build on that. It is not good enough and there is a long way to go but we are moving in the right direction and building up a knowledge base. Only last week we announced that the number of patients entering

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clinical trials has doubled over the past three years. That will have a major impact on helping cancer patients to benefit sooner from new development.

As a Government we spend about £190 million on cancer research. Sadly, I cannot tell the noble Baroness what proportion of that goes to breast cancer because it is not broken down by tumour sites. One of our great successes is the expansion of the cancer screening programme. Breast cancer mortality decreased by 21 per cent in 1998. Thirty per cent of that reduction was attributed to breast screening. Quality improvements and the expansion of the programme now to women aged 65 to 70 will make a big difference.

The cancer networks are contributing, as are the cancer collaboratives. We know that there are some problems along the way. Noble Lords did not mention the postcode lottery. Yesterday in another place the Secretary of State addressed that very firmly and stated that the national cancer director has been asked to look at the NHS in every region to ensure that drugs and treatment which have been approved nationally by NICE are available.

The Cancer Plan and the extra £570 million for cancer services are major initiatives to ensure that the money gets to where it is needed. Just as we have tracked it now for two years to ensure that it does, so we shall track it again for another year.

On abortion our policy remains as it has been since 1967. Let me make clear that our aim is to reduce the number of unplanned pregnancies. I am pleased to say that our teenage pregnancy strategy is having an effect. We have had a 10 per cent drop in teenage pregnancies. That is to the great credit of those working in this field.

I must finish. I do so by reiterating that for the vast majority of women who seek to terminate a pregnancy, the decision is not an easy one. Accurate information is absolutely vital, but I cannot state too strongly that ethical and emotional issues should not be compounded by introducing fears about the possible risks of breast cancer in the future on inconclusive evidence. I am very grateful to all noble Lords who have taken part in the debate.

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