---

Cervical Cancer (Minimum Age for Screening)

I rise briefly to oppose this Bill. I do not do so out of any personal animosity towards the hon. Member for Braintree (Mr. Newmark), whom I know well from our work on the Health Committee, but because I think that the premise on which it is based is entirely flawed. I was not sure what the hon. Gentleman was going to say, but what he said made me more convinced of the need to put on record the scientific evidence for the approach taken by the Government. I do not lightly defend what the Government are doing, but I think that they have been absolutely right about both the screening programme and the introduction of a vaccination programme. I want the House to consider the nature of a screening programme, and to show hon. Members that the way in which it is being done in England is appropriate. In addition, I want to show that the reference that the hon. Member for Braintree made to the vaccination programme was flawed. A good screening test must be both sensitive and specific—"sensitive" in the sense that it must pick up as many as possible of the things that is designed to find, and "specific" in the sense that it should not pick up what it is not supposed to find. The problem of false positives leading to treatment is a real one, and there are two difficulties with screening at a young age. First, the condition being sought is rarer in the young, and there is good evidence that the lesions that are suffered do not progress as quickly as is the case when the person is older. Secondly, early screening can lead to over-treatment, the risks of which—especially given the possible impact on fertility—are greater among younger women. When talking about the use of public money, it is not good enough to say that a non-evidence-based screening programme that is neither sensitive enough nor specific enough will be introduced, and then to leave it to people to make the choice. The funding spent on such a programme could be spent on other interventions to treat established disease or to screen in other areas of ill health where the evidence is better. It is not good enough to say that the matter can be left to individuals to make the choice, because the spending decisions involved have to be made responsibly. It is certainly not logical—I am afraid that it is totally illogical—to talk about the existence of a gap between the ages of 18 and 25. The hon. Member for Braintree said that the catch-up programme ended at 18 and that the screening programme started at 25, but it is not an either/or matter. People who are vaccinated will go on to get screened. The fact that the catch-up programme ends at 18 makes it an independent variable, and there will be no more catch-up after the programme has taken place. The gap will widen as more people are vaccinated, but the hon. Gentleman's statement was both meaningless and misleading. When we look at whom to trust on these matters, it is important not to listen to politicians or even—dare I say it?—to journalists. The hon. Member for Braintree cited evidence from The Sun, so I want to refer to a recent edition of the British Medical Journal, which I mentioned to him earlier in the summer. In the BMJ edition of 8 August 2009, a study by Sasieni and colleagues asked:""Does the association between cervical screening and a subsequent decrease in the incidence of cervical cancer vary with age?"" The summary answer was:""Cervical screening at ages 35-64 is effective at preventing cervical cancer. It is less effective at ages 25-34 and has no effect at ages 20-24."" That is a pretty clear judgment, so it is not as if there is a benefit to be set against the risks; on the basis of the study, there does not appear to be a benefit. I always caution hon. Members against listening to the results of one study, because one study may not be representative of the field. Usefully for us, the BMJ commissioned an editorial commenting on that study and a number of others. The editorial, by Guglielmo Ronco of Turin, summarised the study and said that, according to the study, screening is effective only from the age of 35. It said that""effectiveness in preventing cancers in the five years after screening is limited below age 25"." It commented:""The large sample size allowed analysis of the cancers by stage"," and there was no finding, when the cancers were stratified by stage, that undermined the conclusions made. The editorial went on to say:""The question is whether to screen younger women, and if so, how? In many developed countries the low incidence of invasive cervical cancer and the lack of effectiveness of screening in young women indicate that screening should not start before the age of 25. For women aged 25-34, screening with HPV testing alone is much more sensitive than screening with cytology, but it is also less specific."" That is a reference to another technique that could be used for screening, which it would be useful to debate. We might debate whether we should test for the presence of the human papillomavirus, because that test has greater sensitivity. However, one would find people with the virus who did not have any lesions and were therefore clearly not likely to develop cancer at that point. There is an argument that we should look into that, and I hope that the Government will continue to examine that area. The hon. Gentleman mentioned the cervical cancer or HPV vaccination programme, and it is important to say a word in defence of it. There is very good evidence that it will save lives, because of the very high effectiveness of the vaccine at preventing infection with HPV, which has been demonstrated to be the cause of many cervical cancers. There is clear evidence of benefit, and I urge parents—as do the Government and, more importantly, medical experts—to ensure that their children are vaccinated. Of course, it is impossible to say that any vaccine is entirely safe. That is not something that should be said, or that can be said. However, it is a matter of balancing benefits against risks. There is great known benefit to the programme, and if there is a risk, it is known to be small. I very much regret, as I hope that the hon. Gentleman does, the coverage of the issue in The Sunday Times two weeks ago. In an article asking, "What has cervical cancer drug done to our girls?" it cited the case of Natalie Mort, who died after having the vaccine, but who, post mortem, was found to have a tumour in her chest. The pathologist said that it was""so severe that death could have arisen at any point"." It is extremely disappointing that the article went on to quote a parent—