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Cancer Treatment

rose to call attention to the availability of positron emission tomography (PET) scanners and associated equipment in the treatment of cancer within the National Health Service; and to move for Papers. The noble Lord said: My Lords, without wishing to detain the House, I will start with a little background information. In doing so, I recognise that those listed to speak include an eminent medical consultant, a GP, a radiographer and my noble friend Lord Warner, all of whom are well versed in these matters. However, I think that people outside the House who are following the debate will want to hear a little more detail. Positron emission tomography (PET) is a form of medical imaging. It has been used in the research setting for more than 20 years and in routine clinical practice over the past 10 years. My interest in the subject derives from my experience as a parent who followed in great detail the treatment regime for my son, who was a cancer patient under Professor Andrew Lister at Barts. I learnt during the course of his treatment that PET scanners are critical to the accurate diagnosis of cancer conditions. Sadly, I lost my son. However, for many patients the PET scanner can save a life by indicating the need for surgery or avoiding needless surgery. It was in the light of that experience that I set out to research the issue. A patient who has a PET scan is injected with a small amount of radioactive tracer. After the injection, the patient waits for the radioactive tracer to be taken up by different cells within the body. An FDG radioactive substance in the tracer is attracted to cells such as cancer cells. The distribution of radioactivity in the body is measured by the PET scanner, and an image of uptake across the body is produced. Scanning takes about 30 minutes to perform. PET scanners are considered to have many advantages over conventional methods of diagnosing and assessing lung cancer, lymphoma and several other types of cancer. Although primarily used in the diagnosis and staging of cancer, PET scans are also used in cases of cardiac disease and neurological disease. PET also has potential specific applications in Parkinson’s disease, stroke, epilepsy and Alzheimer’s disease. In cardiology, a PET scan is one of the most accurate tests to detect coronary artery disease. PET has also now successfully been employed in fighting HIV/AIDS. The scans can pick out areas where the AIDS virus is active, allowing doctors to plan new treatments for the infection. In some situations, PET can pick up disease changes earlier than more conventional scanning techniques, such as CT or MRI. Thus, in those situations, PET is more accurate than CT or MRI. For best results, PET is often used in conjunction with a CT scan. The newest scanners are combined PET/CT scanners. In the area of lung cancer, PET is invaluable in assessing whether lung tumours are benign or malignant. These scans are therefore invaluable for those lung cancer patients for whom conventional testing has not been able to differentiate and the biopsy is inconclusive. With survival rates for lung cancer at less than 10   per cent for both men and women, PET can be used in the staging of lung cancer to assess whether or not the cancer is suitable for surgery. It can help to define the extent of the tumour within the chest, including the lymph glands, and can detect unsuspected spread outside the primary tumour in around 10 per cent of patients. PET scanners can therefore save patients from futile surgery. Any major surgery has associated risks and physical side-effects and, if unnecessary, will add to the emotional stress of a lung-cancer patient’s final months. One study showed that the addition of PET scanning to ““conventional work-up”” of lung cancer patients can actually halve the number of ““futile”” chest operations. I myself had a tumour on the lung in 1996. Unfortunately, I am not one of those who would have benefited from a PET scan as my surgery, a thoracotomy which resulted in the loss of half my lung capacity, was unavoidable. Conversely, PET scanners will also recognise the patients who can be operated on where previously other investigations have deemed them surgically incurable. In an area where survival from lung cancer has shown little improvement for more than 20 years, that must be a benefit. According to the Intercollegiate Standing Committee on Nuclear Medicine report of 2003, Positron Emission Tomography: A strategy for provision in the UK, this service has a potential role in 25 per cent of patients. As there are more than 28,000 new cases of lung cancer each year in the United Kingdom, that means that around 10,000 people could be helped. That does not even take into account the need for PET in many other types of cancer, as well as cardiology and other applications throughout the National Health Service. Formal evaluation of the cost-effectiveness of diagnostic techniques such as PET are notoriously difficult, and reports by a variety of health technology assessments are now out of date. However, as the Department of Health’s own consultation on the PET framework last year said:"““It is now widely accepted that the evidence of benefit is now sufficiently robust to support the establishment of PET facilities across the country, so that all appropriate patients can have access to the technology””." Of other research, the Pietermanstudy showed that 62 out of 102 patients with lung cancer being assessed for major surgery had their management changed after having a PET scan. A 2002 study published in Thorax showed that, in a series of 164 patients with lung cancer, the addition of PET scanning to conventional techniques resulted in major changes in treatment in 78   cases. Those statistics show the relevance of the equipment to diagnosis and treatment. The PLUS study in The Lancet also showed that PET scanning prevented unnecessary surgery in one out of five patients with suspected non-small-cell lung cancer. Results showed that PET lung scanning with FDG has an accuracy rate of 85 to 90 per cent in differentiating malignant from benign nodules. We have PET scanners in England. There are six fixed-location PET scanners routinely available for National Health Service patients in England—four PET and two PET/CT combined scanners—all of which are located in London and the south-east. There are a further two fixed-location private scanners in London and three privately managed mobile scanners, which provide some services for NHS patients across the United Kingdom. In addition, at present three institutions with PET facilities are dedicated to research in Cambridge, Manchester and Hammersmith. Those numbers compare very unfavourably with the rest of Europe, where there are more than 120 sites. France has recently announced plans to increase its number of PET scanners from more than 30 to 75 by 2007. In the USA, there are more than 160 PET sites, and US Centers for Medicare and Medicaid Services (CMS) reimburses PET scans in a very wide range of cancers, as well as some other specific areas of cardiology and neurology. The Department of Health acknowledged that the provision of PET facilities in the United Kingdom compares unfavourably with that of most other western European countries. Last year’s consultation, A framework for the development of Positron Emission Tomography (PET) Services in England, states:"““Five European countries already have at least one scanner per 2 million population, compared with around one per 5 million in the UK (including private scanners, but excluding research scanners)””." In February last year, the European Journal of Nuclear   Medicine and Molecular Imaging published a comparative table on PET scanners in western European countries. It looked at the number of scanners needed in each country for all uses. It concluded that we need an extra 42 PET scanners to cover the scanning requirement of the United Kingdom. In sharp contrast, Germany has a scanning requirement of 56 scanners, yet it already has 80 PET scanners in place. My question is very simple. What are Her Majesty’s Government going to do to address the lack of PET scanners in the United Kingdom? The department’s framework consultation last year on the future provision of PET scanning in England looked at which tumour groups would benefit from PET scanning, the likely demand, and the implications for the optimal configuration and location of PET scanners. While this document highlighted the costs associated with the roll-out of a PET scanning service, it also stated that a network of cyclotrons will need to be established across the country to produce the FDG material required for PET scanning and that:"““Consideration should be given to the establishment of cyclotron services functioning on commercial principles to supply several PET scanning facilities””." Like all radioactive products, the amount of radioactivity decreases with time, and the deterioration of the FDG product means that a number of facilities will have to be built, each relatively close to the PET scanner, because of the difficulty over the problem of time. The Department of Health has conservatively estimated that the capital cost of installing a PET/CT scanner, including the associated building costs, is likely to be around £2 million. A cyclotron facility is likely to cost a similar amount. The total cost, including VAT, of installing 15 or 16 PET/CT scanners and five or six cyclotrons is therefore likely to be around £50 million. With the private sector having already shown a commitment to invest in FDG manufacturing in the United Kingdom, does my noble friend agree that it would be prudent for the National Health Service to invest in the provision of PET scanners and let the private sector get on with investing in FDG manufacturing sites in a kind of public/private partnership? The consultation also looked at PET scanning provision within a window over the next three to five   years. Does my noble friend agree that if we are to compare favourably with our European counterparts in the future, we should be looking beyond that three to five year window? Will my noble friend indicate whether he intends to accept the recommendation made by the Intercollegiate Standing Committee on Nuclear Medicine, which stated that state-of-the-art dedicated PET camera facilities should be established in at least 15 sites within the UK in the next three to five years””? What about the NICE guidance on lung cancer recommendation, which states:"““Every cancer network should have a system of rapid access to FDG-PET scanning for eligible patients””?" With the consultation on the draft having ended in October 2004, will the Minister take this opportunity to let the House know when he intends to publish the final framework, to which he recently referred in correspondence to me? Finally, I draw my noble friend’s attention to Early Day Motion 646, Provision of Scanners in the NHS, in the name of Mr George Mudie MP, tabled in the House of Commons last night. It reads:"““That this House believes that the Department of Health should announce the roll-out of a national programme of PET and CT scanners to assist in the diagnosis and detection of cancer and cardiac and neurological conditions, including Alzheimer’s, Parkinson’s, epilepsy and HIV/AIDS; and further believes that the United Kingdom should meet levels of provision already being planned for in other members states of the European Union””." Last night, on the day that the Motion was tabled, there were two signatories. I hope that by Christmas we will have 200. I beg to move for Papers.