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Cancer Screening

I am delighted to have the opportunity to introduce a debate on cancer screening, which is a continuation of an interest that I have had ever since I entered the House. I had debates on cervical cancer screening in 2001 and on screening in general in 2003. As the Minister may have guessed if she has had an opportunity to see the record, I want to use this debate to take forward the questions that I was raising at that stage. I have two reasons for wanting to do so. First, I am conscious that this issue is of very great concern to my constituents, particularly women. I discovered in 2001 that there was a major campaign in my constituency and 5,000 women wrote to me, specifically requesting that I raise in Parliament the issue of how to improve cervical cancer screening, as new technology was becoming available that would reduce the risk of omissions from the screening process. As I explained in the previous debate, I also have a personal motivation: I lost my wife to breast cancer. She was diagnosed aged 43 and I have always been haunted by thoughts of whether, if screening had taken place for women in their 40s as opposed to 50s and 60s, her cancer would have been picked up at an earlier stage and she would have been saved. In general, cancer screening is one of the great success stories of the NHS. It is more advanced than in almost every other developed country. It has been done on a mass scale, certainly for cervical cancer and breast cancer, for many years and many lives have been saved as a consequence, so it is a positive story, and big advances have been made in the past 10 years in respect of the big three cancers to which screening applies. I want to acknowledge that, while asking questions about the process. It clearly appeals to elementary common sense to suggest that if we have screening, conditions can be picked up at an earlier stage, avoiding not just premature death but unnecessary surgery. I recognise, of course, that there are limits to that process. There are limits to screening technology, which mean, for example, that it is not applied in the case of some cancers. Prostate cancer is one for which there is not sufficient precision. I also recognise that there has to be a test of cost and benefits. We cannot just have indiscriminate screening of all age groups for all conditions. Initially, I shall ask a few questions and pursue the issue of cervical cancer screening, in respect of which there have been major advances. There is a long history in Britain, through the smear test, of saving very large numbers of women from that condition. Some of the progress is recognised in the fact that we screen 3.5 million women annually; I understand that there is 80 per cent. coverage. Roughly 4,500 lives a year are saved as a result of the screening process, and I think that deaths have now come down to fewer than 1,000 a year. That is a major success story, with continually falling death rates since about 1990. The big transformation in recent years has been the introduction of the liquid-based cytology tests, which are much more accurate and avoid the 20 per cent. failure rate that occurred under the old testing system. If the Minister does not have the answers to my questions to hand, I hope that she will write to me. First, since the new LBC system was successfully introduced in Scotland—I think that that was completed by 2004—why has it taken so long to spread it through England? Can she give us some clarity about when the roll-out is expected to be completed? I understand that we are talking about next year, but is it the beginning or end of next year? Is that known? Secondly, there are substantial disparities between the home countries in respect of the age groups covered by the smear testing arrangements as enhanced by the LBC test. The age group is 20 to 60 in Scotland, 20 to 65 in Wales and 25 to 64 in England. There is nothing wrong with that at all—indeed, there is much to be said for experimentation and trying different approaches—but what lessons have been learned from those different age profiles? Does one work better than another? Can we learn from Wales and Scotland? Are there any proposals to adapt the age profile? Thirdly, can the Minister confirm the worry that some cancer charities have expressed? One in particular, called Jo’s Trust, has written to me and I met representatives at a reception in the House of Commons. It is particularly concerned with young women and has pointed to the fact that there appears to be a serious tailing off in the number of young women in their late 20s who are going for the screening. Have the Government analysed that? Do they know the reasons for it and do they have any answers to it? My final set of questions about cervical cancer screening relates to the new technology that is becoming available as a result of the understanding that, unlike other cancers, cervical cancer is caused by a virus—a sexually transmitted virus. I think that the science was developed in the mid-1990s, and out of the understanding of the human papilloma virus come various potentialities. The first is whether the knowledge of HPV is being incorporated in screening: is it being used as part of the new screening process with LBC? Secondly, the technology now makes it possible to vaccinate against cervical cancer. The Government were right and, indeed, quite courageous to bring in the new programme, which involves vaccinating girls before they leave school. It is hoped that that will greatly reduce the incidence of the disease at an early stage in its transmission. However, the cancer charities that are following this issue have raised various supplementary questions about that and perhaps the Minister will reflect on them. First, it appears that the next school year will be missed. I do not know whether that is correct; perhaps the Minister will confirm it. If it will be missed because of the difficulties of introducing vaccination across the board, what will happen to that age group? Will there be a follow-up, with encouragement and support in getting GP referrals to catch up? What plans do the Government have to deal with what we might call the missing age group? I am referring to those young women who are too old to have caught the new vaccination programme at school, but who are too young to have the smear test, because they will not get it until they are 25. There is a 10-year group of young women who are missing altogether. What are the plans to deal with that? Is there a system of enhanced GP referral, for example, which would enable them to be captured? I also have some questions for the Minister about the progress being made in the breast cancer screening programme. That, too, is a major success story for the NHS. It has been going for a very long time, particularly for women aged 50 to 64, and the age group has now been expanded by five years, which is a very welcome step. The analysis shows that about 1,400 lives a year are being saved. As with cervical cancer, there is clinical evidence of a substantial disparity between the survival rate for those who are screened, which is about 95 per cent. over five years, and the survival rate for those who are not screened. The difference, however, is that breast cancer numbers are rising substantially, whereas cervical cancer numbers are falling, and I wonder whether that might have something to do with the difference in the take-up of screening. One thing that I find difficult to understand is why the take-up of breast cancer screening is significantly lower than the take-up of cervical cancer screening. After all, we are talking not about young women, but about mature women, who are presumably very conscious of their health. We are also talking about the same obstacles in terms of information and literacy. Why, then, should the take-up for breast cancer mammographic screening be significantly lower than for cervical cancer screening? The figure for breast cancer screening is about 75 per cent. on average, as against 80 per cent. for cervical cancer screening. In my area, as the Minister will know because she lives close by and represents a constituency next to mine, breast screening take-up is well below the national average, even though people are generally fairly prosperous and well educated. I have asked the primary care trust to address some of the technical problems, such as the location of the screening site and so on, but the figure is still low, and I wonder how much work has gone into understanding why take-up rates are low and whether they can be improved. The big issue on breast cancer screening is age, and as I explained to the Minister, I have a personal interest in pursuing this. Everybody welcomes the extension of screening to older women, but the outstanding question is whether there would be value in extending it down the age range to women between 45 and 50 or between 40 and 50. When I last asked that question four years ago, the Government felt that the evidence was not compelling. There have been some pilot studies since then, and I wondered whether there had been any rethink about the desirability of extending the age range to catch younger middle-aged women, substantial numbers of whom get cancer. My final point on breast cancer screening is that, as with all cancers, screening is only as good as the subsequent cures and treatments. There is no point screening people if they are not promptly dealt with and there is a long-standing issue about the speed of treatment for breast cancer patients. Are the Minister and her officials aware of an article that appeared in the British Medical Journal in recent months, which was based on a case study in Bristol and pointed to the difficulties with the so-called two-week rule? Apparently, GPs are putting a lot of women in the non-urgent category, where cancer diagnosis is growing rapidly, so something is not working with the two-week rule and the other principles designed to get people quickly into treatment. The third and final category about which I wish to ask the Minister is bowel cancer screening. It is a big step forward and very welcome that the Government have accepted that there is value in screening for bowel cancer, which is of course different from cervical cancer and breast cancer in that it affects men as least as much as—indeed, probably more than—women. There is a large number of fatalities—about 16,000 a year, or about half of those who are diagnosed—and the number is growing rapidly. An estimated 2,500 people a year could be saved if screening were effective, so it is very welcome that the Government have taken a step forward. I speak on the issue with some local interest because one of the leading charities—Beating Bowel Cancer—is located in St. Margaret’s in my constituency. It is a strong advocate of the screening process, and some of us participate annually in its loud tie day, which is one of its gimmicks to make the subject more attractive. For obvious physical reasons, bowel cancer is not something that people particularly want to talk about, and the charity has done a brilliant job of overcoming some of that psychological resistance. The screening programme is now being rolled out, which is very welcome, and the primary care trust in my area was one of the first in London to adopt it. However, I have some questions about how the process is working. First, the roll-out has been going on for a year, so do the Government have any preliminary conclusions? If so, when will they publish them? Secondly, some of the feedback from the work that has been done suggests that uptake is quite low and that only half of those who are tested return the kits, as they are required to do. Is anything being done to raise that problem and deal with it? Thirdly, do the Government have the funding to complete the envisaged three-year roll-out? Finally, are interesting conclusions being drawn as a result of different age ranges being applied in Scotland, Wales and England? My final point about bowel cancer is that, as with other forms of cancer, the success of the Government’s programme depends entirely on whether those who are screened can get treatment. As the Minister will know, difficult and emotive issues have been raised as regards the drugs that are made available to bowel cancer patients once they have been screened and diagnosed. A constituent called Adam Griffin, who is only 30, has run up against the barrier that was created by the National Institute for Health and Clinical Excellence when it ruled that Erbitux and another bowel cancer drug, Avastin, could be made available only in exceptional circumstances, and several young people in their 20s and 30s in London are being denied those drugs because of that new ruling. I know the difficulties involved, and these drugs are expensive, but I wonder whether the Government take account of age in interpreting the phrase ““in exceptional circumstances””. Common sense suggests that if people can be saved from premature death in their 20s and 30s, they would, quite apart from any humanitarian consideration, have a much longer life to live, so the value of the treatment would be much greater. How much flexibility is there in that respect? A lot of emotion has, rightly, been generated around Herceptin, but there are some equally dramatic and difficult issues around bowel cancer drugs. That rather broader question takes us a bit away from screening, but I wonder whether the Government are responding to the rather critical study by the Swedish Karolinska institute. The study suggested that despite Britain’s screening record, which is second to none in the developed world, we rank among the worst in terms of the availability of cancer drugs. The study partly attributed the relatively low cancer survival rate in the UK to that limited availability. My final point—I have just exceeded my 15 minutes, so it is my final point—is that some cancer conditions cannot be dealt with through screening because the science is insufficiently precise, and we are always told that prostate cancer is one of those conditions. It is increasing rapidly among men, which is not necessarily as insidious as it seems, because it is a condition of very elderly men, who have many other problems. I was recently invited to an MPs’ health check and I was very struck by the fact that I was offered a prostate cancer test, thereby becoming one of the 6 per cent. of men who are tested. I therefore have one simple question: if such tests are good enough for MPs and for 6 per cent. of the population, why can the other 94 per cent. not enjoy them?