Bowel Cancer Screening Age

Tuesday 8th March 2016 Westminster Hall

16:03

[Caroline Ansell (Eastbourne) (Con)]

I beg to move,

That this House has considered bowel cancer screening age.

Bowel cancer is second only to lung cancer for the number of lives it takes. Across the country, 165,457 people have signed a petition to bring down the bowel cancer screening age in the UK in a bid to hit this devastating disease.

[Margaret Ferrier (Rutherglen and Hamilton West) (SNP)]

It is extremely unfortunate that bowel cancer— screening is available only in England, Wales and Northern Ireland from the age of 60. Would the hon. Lady’s welcome the Scottish Government’s approach of screening people from the age of 50 being taken up across the rest of the UK? That would surely give many individuals an early diagnosis and a higher chance of survival.

[Caroline Ansell]

I thank the hon. Lady for her intervention. I recognise that earlier screening in Scotland and would certainly welcome it.

The petition that I mentioned has been well supported; in fact, it has had 500 new signatories this very day. The originator of the petition, Lauren Backler, has travelled from Eastbourne to be with us today in Westminster. May I at this point pay tribute to her courage and endeavour? For anyone hearing the news that they or a loved one have been diagnosed with bowel cancer, it will be simply earth-shattering, as Lauren knows. She writes:

“On 2nd December 2014, my Mum Fiona Backler was diagnosed with bowel cancer, at Eastbourne DGH’s”—

Eastbourne District General Hospital’s—

“Accident and Emergency and was told a few days later that the cancer was terminal. She started palliative chemotherapy within a week, but despite us being told that potentially she could have up to 2 years to live, she passed away on 28th March 2015, just under 4 months after diagnosis and a week after her 56th birthday. Before she was diagnosed, she had been back and forth to her GP with vague symptoms, and had even had an endoscopy about a year and a half beforehand, which she had been told was all clear. When she was diagnosed, her consultant told us that the cancer had possibly been missed at that stage.

Bowel cancer screening can often pick up abnormalities in people who have no symptoms at all, and so I believe that if the screening age was lowered to 50 it would give thousands of people a fighting chance of beating the disease.”

[Rebecca Pow (Taunton Deane) (Con)]

My hon. Friend knows that I have come to the debate for personal reasons. My husband was diagnosed with bowel cancer in December 2014, when we were right in the middle of fighting the campaign, and it was I who spotted the unusual signs and dragged him to the GP, where, like many men, he would never have gone, or at least not for a very long time. Ironically, he received a letter some months later saying, “Come for the screening,” when he would have been 55. Had he had that letter at 50, the polyps would have been recognised and removed and they would, potentially, not have turned into cancer. As it was, he did have cancer, and we had to go through that earth-shattering experience that the poor lady whom my hon. Friend talks about has also been through. I sympathise with her, and I urge support for my hon. Friend’s motion. We need to continue to explain why the matter is so important.

[Caroline Ansell]

I thank my hon. Friend for her moving contribution. Personal testimony highlights just why earlier intervention is vital—it can be life-saving.

[Glyn Davies (Montgomeryshire) (Con)]

My hon. Friend makes reference to personal experience. I would not be here today without an early diagnosis of the bowel cancer I suffered. I had an operation that left me with a stoma, and I am living proof that someone can make a 100% recovery and even become a Member of Parliament, if they work hard.

I hope my hon. Friend agrees that one of the big benefits of screening is not only the identification of blood as a possible sign of bowel cancer, but the raising of awareness. The truth is that it came as a huge shock to me, and I imagine that it comes as a huge shock to people who think they are invulnerable and do not believe that they could possibly be suffering from bowel cancer.

[Caroline Ansell]

My hon. Friend makes an apposite point, and I hope that, in a small way, this debate, underpinned as it is by personal testimony, plays a part in raising awareness. As I said at the beginning of my speech, the disease takes the second highest number of lives of all cancers.

[Julian Knight (Solihull) (Con)]

I congratulate my hon. Friend on securing this important debate. As someone who lost both of his grandfathers to bowel cancer, I think that early diagnosis is absolutely key. However, it is not just a case of screening at a specific age; it is about spotting the signs. I have friends who have developed this dreadful disease in their 30s. It is all about spotting the key signs. One of those friends went on, after recovery, to carry the Olympic torch and is now a champion for young people with bowel cancer. Will my hon. Friend go on to talk about spotting the signs and not just about screening?

[Caroline Ansell]

My hon. Friend makes a very worthy point. He brings glad tidings, too, that bowel cancer can be beaten and that those who have suffered from this terrible condition can go on to lead rich and fulfilling lives—which, in some cases, bring them to Parliament.

[Mr Andrew Smith (Oxford East) (Lab)]

The hon. Lady is being very generous in giving way. I commend her excellent speech, the petitioners and her remarks about her brave constituent. With the national rate of screening at 58%—it is only slightly higher in Oxfordshire—does she agree that, as well as raising awareness and pushing for an earlier age of screening, which I fully endorse, still more needs to be done to increase take-up, notwithstanding the adverts and the reminder letters that are already sent?

[Caroline Ansell]

The right hon. Gentleman is right in identifying that as a key way to move forward. In fact, screening uptake has not really moved in more than a decade, so we do need to be in the business of raising awareness of the condition, its symptoms and the opportunities for screening, at whatever age it is set.

[Chris Davies (Brecon and Radnorshire) (Con)]

While we are on the personal stories, cancer—bowel cancer in particular—touches all families. I sadly lost my sister this time last year through it and my father is in a hospice at the moment for that exact reason. I am someone who is going through the investigative treatment, just as the husband of my hon. Friend the Member for Taunton Deane (Rebecca Pow) did, and everything is fine so far. As uncomfortable as it is, it is particularly difficult for men to be brave enough to go out and have the investigative actions take place. I am 48, so reducing the age would not necessarily have covered me. My sister, sadly, was 50 when she passed away. But bringing the age down will certainly give other people a chance, and that is the most important thing. I congratulate my hon. Friend on bringing the debate forward.

[Caroline Ansell]

I thank my hon. Friend for his contribution.

[Kevin Foster (Torbay) (Con)]

I welcome the fact that my hon. Friend has secured this debate. My mother was diagnosed with bowel cancer at 56 and, ironically, my father, who was 60 at the time, had received the screening kit five months previously. Does my hon. Friend agree that that shows the need to review the age at which people are screened?

[Caroline Ansell]

I agree, and I hope we can put that need forward today. I know that the Minister and her Department are working hard in this area and that they are all the time seeking to secure better outcomes. I hope that they might just revisit the screening age as part of that.

It has been really moving to hear from right hon. and hon. Members about their own experiences and about the losses they have suffered. Lauren is here today, having lost her mum. What a terrible tragedy that is. It feels especially poignant that we are here so soon after celebrating mother’s day.

With today’s advances in life expectancy, 56—the age at which Lauren’s mother died— is incredibly young, yet if Lauren’s mother had lived in Scotland, she would have been screened three times before the age at which she was diagnosed, increasing the chances of early detection and therefore survival. Learning that must have been a bitter blow. England has, however, led in this area. In 2006, we became the first home nation and one of the first countries in the world to offer routine screening for bowel cancer, with the faecal occult blood test, or FOBT, being sent every two years to those aged 60 to 69—later extended to 74. However, a year later Scotland implemented the same screening, with the crucial difference that it would begin from the age of 50.

The national screening committee, which ran FOBT pilots in the early 2000s, felt that 50 was the right age at which to begin to screen. It noted a lower take-up of the test in 50 to 60-year-olds compared with those over the age of 60, but recommended that the Government take measures to address that. However, when deciding on final implementation it was recognised that, due to a shortage of endoscopy equipment and with substantially higher incidence rates over the age of 60, screening would begin with that age group. It is conceded that more than 80% of those diagnosed with bowel cancer are over the age of 60.

A University of Sheffield study recommended that offering both bowel scope screening and the FOBT from the age of 60 would maximise survival rates and have the important trade-off of being cost-effective. Yet the same study also found that the FOBT would substantially lower the number of deaths by as much as 23% if it was run for 50 to 69-year-olds, whereas running it from the age of 60 only would reduce the number of deaths by only 14%. It is hard to talk about percentages but, just to bring the debate back to the personal level, that significant 9% would have included Lauren’s mum, and perhaps other people we know.

We know that there is a clear upward incidence of bowel cancer over the age of 50. The rate of bowel cancer roughly triples between one’s 40s and one’s 50s, before doubling again in one’s 60s. We all should be aware of the signs and take precautions in our diet and lifestyle to prevent and detect bowel cancer—and, yes, perhaps we ought to shed the very British attitude that we must keep calm and carry on, and seek out our GP. More must be done to improve screening uptake rates. Bowel cancer screening rates remain disappointingly low nationwide, having barely moved above those achieved in the pilot 16 years ago.

[Rebecca Pow]

Spotting the signs is absolutely crucial, and we have had some great receptions in Parliament about just that point with the bowel cancer organisations, but I want to put a positive spin on things. Let us not be negative. If we spot bowel cancer early, which is exactly what my hon. Friend is talking about, it is fully possible to recover. It is one of the ones that has a positive outcome. We have got some great medical teams in this country, and I think we should praise them. In particular, I praise the team at Musgrove Park hospital. It has one of the best support teams in this area. I know Lauren has had a terrible time, but for other people there is an awful lot of positivity, which is why my hon. Friend secured the debate.

[Caroline Ansell]

Indeed, there is a lot of positivity. Lauren brings that positivity: she wants not only to reduce the screening ages, but to advance awareness of bowel cancer across the piece. I know that she is particularly concerned about those who are at risk and are already carrying the condition in their 20s and their 30s. So much more needs to be done, and that includes us talking about our symptoms and taking that forward. As we have heard, there is a good prognosis if we can strike out for that early intervention.

[Sir David Amess (Southend West) (Con)]

On that positive note, my mother had a scare at 90. She ended up with a colostomy and she is shortly to be 104. There are good outcomes. Does my hon. Friend share my disappointment that the national average for take-up is 58%? In Southend, it is 52%. Our excellent Minister will be keen to ensure that there is a much higher take-up rate.

[Caroline Ansell]

Indeed. I am looking forward to hearing more from the Minister about the excellent work the Government are doing. I know that they have plans and prospects for hitting that low take-up. I fear that that low take-up might be a very British sort of thing, and we need to break through that if we are to strive to see the same survival rates as some of our European counterparts.

On early diagnosis, those diagnosed with stage 1 bowel cancer have a 97% chance of survival, which is hugely positive. That compares with a chance of survival of just 7% when the cancer is more advanced. Early diagnosis not only provides patients with a much better chance of survival, but would cost the NHS far less, saving an estimated £34 million according to the charity Beating Bowel Cancer. That is because treatment for the earlier stages of cancer is often less intensive and invasive than treatment for more advanced diseases.

Sadly we also know that we are lagging behind other countries on survival rates. A 2013 study for the London School of Hygiene and Tropical Medicine, which was part-funded by the European Commission, found that in Britain we diagnose bowel cancer later than other countries, while our survival rate overall for bowel cancer was only 51.8%. That is lower than the European average of 57% and lower than Germany’s survival rate of 62%. That is not where we want to be. I am looking forward to hearing from the Minister about her Department’s sterling work, but my question today is: could the age of screening be revisited? Is there scope to further personalise and target testing in those younger years?

[Mr Philip Hollobone (in the Chair)]

For the Minister’s benefit, the debate will conclude at 4.57 pm.

16:03

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. The quite extraordinary level of participation in this half-hour debate speaks volumes about the level of interest in and engagement with this issue from parliamentarians. I congratulate my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing the debate. I am grateful that I had the opportunity to speak to Lauren at the Beating Bowel Cancer reception here in the House in January and to have heard her story in person. My officials and I enjoyed that conversation. As my hon. Friend said, she is a remarkable young woman.

Bowel cancer is one of the most common types of cancer. The statistics around the number of people who die from it each year have been eloquently explained. We accept that we as a country want to do better. That is why, looking at cancer in the round, NHS England set up the independent cancer taskforce, which produced the new strategy “Achieving world-class cancer outcomes”. That was widely welcomed when it was published last July. The Government are committed to implementing the recommendations of the taskforce, and that will see improvements right across the cancer pathway, including in screening. The strategy sets a clear ambition for a further improvement in survival rates. They have improved, as my hon. Friend said, but we want to go further.

Today’s focus is very much on screening, which is a crucial part of diagnosing bowel cancer early. We know that outcomes are significantly better for people diagnosed at stages 1 and 2 as compared with stages 3 and 4. When deciding whether to undertake bowel cancer screening, we have to remember that it is a choice for each individual, so it is important that people are provided with the information they need to make an informed decision. I will go on to talk a little about how many people either decide not to do it or do not get round to doing it. Screening is a significant challenge, and I welcome attention being given to it.

On the advice of the UK National Screening Committee, the expert body that advises Ministers and the NHS in the four UK countries about all aspects of screening policy, bowel cancer screening using the faecal occult blood self-sampling test is offered in England. The bowel cancer screening programme offers screening using the kits every two years to men and women aged 60 to 74 who are registered with a GP. Men and women aged over 74 can self-refer for screening every two years if they wish. People eligible for screening receive an invitation letter explaining the programme, along with an information leaflet explaining the benefits and risks of bowel cancer screening. By the end of January 2016, nearly 29 million men and women in England had been sent a home testing kit and more than 17.5 million had returned a kit and been screened. More than 24,000 cancers have been detected, and nearly 70,000 patients have been managed for high or intermediate-risk adenomas, or polyps, including polyp removal.

The age issue has been the focus of much of the comment today. The NHS bowel cancer screening programme began in 2006, with full roll-out completed in 2010. The programme initially offered screening to men and women aged 60 to 69 because the risk of bowel cancer increases with age. More than 80% of bowel cancers are diagnosed in people aged 60 or over. In the pilot, which was conducted in Coventry and Warwickshire and in Scotland in the late 1990s and early 2000s, more than three times as many cancers were detected in people aged over 60 than in those aged under 60, and people in their 60s were most likely to use a testing kit. Only 47% of men aged 50 to 54 completed a kit, compared with 57% of men aged 60 to 64.

There are also issues of capacity, particularly for endoscopy services, as has been mentioned. The roll-out of screening required that the NHS bowel cancer screening programme take into account and help balance the increasing workloads and pressures placed upon services providing diagnosis and treatment to all people with bowel cancer, not just those found through the screening programme. I emphasise that point to the House, because it is important. The latest routes to diagnosis figures from Public Health England show that in 2013, only 9% of bowel cancers were diagnosed through screening. That 9% is important, but it compares with the more than 50% of bowel cancers that were diagnosed following a GP referral. Sadly, 25% were diagnosed via emergency routes, and those have very poor survival rates because the cancers tend to be at a later stage. The programme has to be able to respond. The skills and the clinicians we need to respond to those GP referrals have to be available, so there is always a difficult balance in terms of the resource we need.

The programme was also required to consider possible changes to it. One such change—this is an important point that has not quite come out in the debate so far—is bowel scope screening, also known as flexible sigmoidoscopy, for people in their 50s. It is a one-off examination that is an alternative and complementary bowel screening methodology to the self-testing kit. It aims to find polyps before they turn into cancer, so it actually prevents cancer ever developing. Evidence has shown that men and women aged 55 to 64 attending a one-off bowel scope screening test could reduce their individual mortality from the disease by 43% and their individual incidence of bowel cancer by 33%.

In 2011, the UK National Screening Committee recommended offering bowel scope screening for bowel cancer. The NHS bowel cancer screening programme is currently rolling it out to men and women around their 55th birthday. They will be invited to take part in the self-testing part of the programme from age 60. Although Scotland is piloting bowel scope screening for some people in its programme, England is the only UK country committed to a full roll-out. Some 77% of bowel scope screening centres in England are currently operational. The Secretary of State is committed to rolling out bowel scope screening to all screening centres in England by the end of 2016, and we are on track to deliver that commitment.

As of the end of January, more than 230,000 invitations had been issued and more than 85,000 bowel scope screening procedures performed. Although that is very good, Members who can do the maths quickly will realise that uptake is currently running at 44%, compared with nearly 60% for the self-sampling part of the programme. If, on the back of this debate, Members can do anything to raise awareness in their constituencies and to empower men and women to make informed decisions about taking up these free tests, I encourage them to do so.

[Margaret Ferrier]

Will the Minister give way?

[Jane Ellison]

I am afraid that I cannot take any interventions because there were so many in the opening speech. I do apologise, but I really want to get through my response.

So far, nearly 3,500 people have attended colonoscopy following bowel scope screening, with 125 cancers detected, and 1,688 people with high or intermediate-risk polyps and 1,270 people with low-risk polyps have had them detected and managed or removed.

Delivering the bowel scope screening programme will obviously place huge demands on endoscopy services, but it can be safely delivered by members of the hospital team other than trained doctors, such as nurses. That is why we announced in September last year that Health Education England is developing a new national training programme for an additional 200 non-medical staff to get the skills and expertise to carry out endoscopies by 2018. The first cohort began training at the end of January. In addition, NHS England’s sustainable improvement team is working intensively with trusts that have significant endoscopy waiting lists, in order to improve performance. That learning will then be shared widely. NHS England is also exploring ways to improve endoscopy performance through pricing changes.

I have already mentioned low uptake rates. We know uptake is lower in more disadvantaged groups, in men—as has been referred to—and in some black and minority ethnic groups. Public Health England is providing support and technical advice to its partners in the NHS on reducing the variation in coverage and uptake. Local screening providers are working with commissioners to address that, which is really important, because some of the variation in these important programmes is astonishing. Again, if any Member can do anything to reduce the variation, it would be greatly appreciated.

The Independent Cancer Taskforce has also recommended an ambition for 75% of people to participate in bowel screening by 2020. To facilitate that change, it recommended a change to a new test, the faecal immunochemical test—FIT—which is more accurate and easier to use than the current FOB test and also improves uptake. I encourage Members with an interest to compare the two tests and try to understand how different they are and why they are likely to have such different effects.

My hon. Friend the Member for Eastbourne will be aware that in November last year the UK National Screening Committee recommended that the FIT test should be used as the primary test for bowel cancer screening instead of FOB. We are currently considering that important recommendation. If it is accepted, it is worth remembering that it will be a major change to a programme that saves hundreds of lives, so we will have to ensure that it is rolled out in a safe and sustainable way, which will include the procurement of cost-effective kits and IT systems.

In any debate about cancer screening it is important to underline the difference between population screening programmes and people going to see their GP with the symptoms of cancer. Information for the public on the signs and symptoms of bowel cancer is available on the NHS Choices website. The Department advises people who are concerned about their risks to speak to their GP. Many of the cancers we have heard about in the debate were found at a very late stage. It is probable that there were some symptoms that could have led to a GP referral.

Since 2010-11, the Department and Public Health England have run 10 national “Be Clear on Cancer” public awareness campaigns, including two national campaigns to promote the early diagnosis of bowel cancer. The first campaign ran from January to March 2012, raising awareness of blood in poo as a sign of bowel cancer. It was the first ever national TV campaign to raise awareness of the symptoms of this cancer and to encourage people with relevant symptoms to go to their doctor without delay. A second campaign ran later that year.

The National Institute for Health and Care Excellence has guidelines on the recognition and referral of suspected cancer, which were updated in June 2015. That is important because in updating them NICE urged GPs to lower the referral threshold when they are assessing whether a referral is appropriate and to think of cancer sooner when examining patients. Switching the way we think and lowering the referral threshold is a critical change that NICE estimates will save many thousands of lives. Of course, professional advice is also available through the various expert bodies.

I emphasise that all screening programmes are kept under review, and the UK National Screening Committee will always look at new evidence. I will of course make sure that our expert advisers are aware of the significant parliamentary interest that has been demonstrated today. In responding to this short debate, I have been trying to illustrate the interaction between the two different parts of the programme—bowel scope screening and the original screening. I have also been trying to underline the point about take-up. Of course it is about individuals making an informed decision, but beyond rolling screening out to different ages, we must ensure that people in the highest risk groups, particularly the over-60s, are aware that they can choose to be screened. Many lives could be saved, so it is really important that we get that message across. We can do more.

In conclusion, I thank my hon. Friend the Member for Eastbourne again for securing this debate and drawing the important issue of bowel cancer screening to the attention of the House. I assure her and the families of all those affected—including, of course, Lauren, who started the petition—that preventing premature death from cancer is of the utmost priority for the Government. I hope I have set out how we are responding to that vital challenge.

Question put and agreed to.