Cervical Screening

(Limited Text - Ministerial Extracts only)

Monday 19th July 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Mr Pritchard.

First, as I think everybody else has done, I thank those who initiated this petition in Fiona Mathewson’s memory, and I join others in extending my sympathy to Andrew, to Ivy, to Harry, to Caitlin and to Fiona’s broader family, as well as to the 3,000 individuals in Kelso and across the borders who signed the petition.

Like other hon. Members, for example, the hon. Member for Pontypridd (Alex Davies-Jones), I know how frightening it is to be given this kind of diagnosis, but I can only imagine the impact on Andrew and the loss that he feels. However, if I may say one thing, it is that this debate today is in itself a huge legacy for Fiona, because we are discussing sensibly what we need to do to help women. We are talking, as many people have said, about something that is often seen as a little bit embarrassing. In response to the points by hon. Members that we must improve take-up, I could not agree more. However, we will not achieve that by not talking about some of the challenges that exist.

Cancer screening is crucial and I thank each and every Member who has shown their support for it and contributed to today’s debate. It was eloquently introduced by the hon. Member for Gower (Tonia Antoniazzi), as the Petitions Committee allowed us to have this conversation across the United Kingdom. The simple fact is that screening saves lives and that is why we need to drive uptake. As we have heard, screening can prevent cancer from developing. It can catch cancer earlier and, as we know, the earlier people are diagnosed the better the outcomes, because there is a greater chance that treatment can be successful.

Thanks to the tremendous work of dedicated screening staff up and down the country, the NHS cervical screening programme reaches about 4.6 million women in England every year and currently saves about 5,000 lives. However, we have heard repeatedly that only about 70% of women actually take up the opportunity, for a plethora of reasons. If everybody did attend, that number of lives saved would be closer to 7,000. More lives would be saved, so when a woman receives an invitation to attend a screening appointment, I encourage her to go.

As the hon. Member for Central Ayrshire (Dr Whitford) said, if you notice anything amiss, such as bleeding after sexual intercourse, between periods or during menopause, discuss it with a medical professional. Do not wait—it is your body and just treasure it. I say that because screening is one tool, but that knowledge of yourself is another tool that you have to access treatment quickly. NHS services are open, safe and ready to help you. That is another thing that has come through: I want to reinforce the fact that the NHS is open and the services are safe. You must come forward when your invitation for an appointment.

[Alex Davies-Jones]

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) talked about some of the challenges faced by the lesbian and bisexual community in accessing appointments, but we also need to recognise some of the challenges faced by our trans community, especially trans men, in accessing appointments. Many of them are not sent reminder letters because of administrative policies at GP services. Will the Minister look into that to ensure that everyone with a cervix who is eligible to attend a screening receives a reminder?

[Jo Churchill]

Indeed I will. I would be happy to write to the hon. Lady, because I have looked at that issue. If there is a chance that someone may have abnormal cells, they should get them checked out. The hon. Member for Coventry North West (Taiwo Owatemi) spoke about making sure that we reach those communities who would not necessarily come forward, for a number of reasons.

The hon. Member for Wythenshawe and Sale East (Mike Kane) spoke, as several did, about using technology better, and about the challenges of screening and the health inequality that there is in certain communities for access to screening. I have met NHS England several times about that, to think how we can use that technology and different avenues—I will speak in a minute about the self-sampling sample.

We have to think differently about how we encourage women, because not every woman will come forward in the same way. We have different pressures on our lives at different times. Perhaps we are not as good at the younger end, because people think, as the hon. Member for Pontypridd said so eloquently, “I didn’t think it would happen to me.” Perhaps they have a young family or are busy at work. All those things mean that we have to make it as easy as we possibly can to access screening wherever you are and in whatever form suits you, because there are also cultural barriers for some not only to cervical screening but to breast screening, where they are hesitant to come forward.

[Jim Shannon]

I referred to my wife, who had some difficulty making the appointment. What she did was talk to my mum. I feel women talking to women is much easier. We should not always push to the back of the queue, for instance, a family member having a substantial discussion. Sometimes it starts with a discussion, before they go to the hospital. It very important to have family members around to support and give advice.

--- Later in debate ---

[Jo Churchill]

I could not agree more. We heard earlier that a good group of friends can give someone that nudge when they are feeling a little hesitant. As Members said, it is not the greatest outing of an afternoon, but it can be one of the most important appointments that you may keep, so I urge you to keep it.

I want to assure all women that screening staff are excellently trained to ensure that they feel reassured and comfortable. For those who feel anxious, there is information available online to help them plan their appointment. As many have done, I would like to commend the work of Jo’s Cervical Cancer Trust in raising awareness about what cervical screening entails and how important it is.

Let me turn to the nub of the debate—why screening is not offered on a yearly basis. Currently, cervical screening in England is offered to individuals between 25 and 49 every three years, and between 50 and 64 every five years. For those aged 65 and over, screening is offered if one of the last three results detected any abnormalities. Although health, including how screening is delivered, is a devolved matter, the debate has shown that wherever we are in the country, we need to ensure that health is a priority. We automatically transfer data on a woman’s history to the devolved authorities in Northern Ireland and Wales. I think it was the hon. Member for Gower who raised the question of how we work with devolved authorities: that information goes automatically to Wales and Northern Ireland, but it is still a manual process with Scotland, and work is in progress to make sure we get there.

As I have said, this matter is devolved, but as others have said, we all follow the expert advice of the UK National Screening Committee. The hon. Member for Central Ayrshire pointed out how important it is that we follow the advice of a central body, and in 2015, the UK NSC recommended that a test for HPV be used as the primary screen, because 99.7% of cervical cancers are caused by the high-risk HPV types. I could not agree more with one hon. Member—I apologise; I do not remember who it was—who said that we should talk about HPV in a normal, non-stigmatising way. We should have a conversation: it is important that we talk about those things that affect our bodies, to enable people to seek treatment and do something about them. If HPV is detected, you are referred for further testing. Cells are tested for abnormalities and, if present, you are tested again to see if treatment is necessary. If not, a follow-up appointment is always made for the following year, and if HPV is not detected no action is required, because it is highly unlikely that any abnormal cells are present and the chance of developing a cancer within five years is very small.

That process has been in place since December 2019, and since March 2020 in Scotland. It has made cervical screening more effective, improved detection rates and, crucially, requires women to be screened less frequently: there is a very salient point that the more often something is required, the risk that it is not taken up becomes greater. Making sure that we have the best tests at the best time interval, advised by the experts, is how we will proceed. However, that is not to say that all the technologies aptly described by the hon. Member for Wythenshawe and Sale East, as well as others that are available, are not being looked at all the time in all these areas. If there is a positive from the pandemic, it is that we have moved forward in many areas of technology, and as several Members have said, we need to harness that.

Given the strong link between HPV and cervical cancer, the national HPV immunisation programme is a key way to save lives. Introduced in 2008 and extended to boys in 2019, those vaccines have already led to dramatic reductions in HPV infections in England, and it is hoped that immunisation will eventually eradicate HPV and save hundreds more lives each year. The past year has been a challenging one, but as soon as the pandemic hit, we charged those in charge of the scheme with making sure that they had caught up with HPV vaccinations in schools by this August. They have used schools, community centres, and so on to make sure we do not fall behind on what is such an essential part of the programme—we know about the protection that it gives.

I do, however, acknowledge that screening is not perfect: HPV infection or abnormal cells can be missed, and can develop and turn into cancer between screening tests. That is incredibly rare, and the science supports the hope—I have this hope—that with the introduction of HPV testing and vaccination, many more cancers can be detected and prevented. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) spoke of self-sampling, as did others. I am incredibly interested in this proposal. The YouScreen trial currently taking place in London is sending home-testing kits to some of those who have not taken up the offer of screening, making sure that we offer it to women who might find other environments difficult to be part of—because of time or a whole range of reasons—and who may prefer to do a simple swab test in their own home. That is what this trial is designed to do. It is particularly targeted at disadvantaged groups who may not have attended screenings.

As I say, there are busy lives, there is embarrassment and there are cultural barriers, so making sure we push that forward is important. There are plans for a nationwide trial to offer self-sample kits to women as an alternative to a nurse taking the sample. I have asked my officials to keep me informed of the trials. I eagerly await the UK NSC’s analysis once the trial is complete, and the subsequent recommendations on how self-sampling may be incorporated into the cervical screening programme.

I think we all agree on the need for women to come forward. I thank hon. Members for the tone of the debate and for how everybody expressed their concern that we make sure that we get to those women. I reassure people that, while we did indeed cancel those invitations early on in the pandemic, there is currently no national backlog of people waiting for an invitation to the NHS cervical screening programme. We have been working with and supporting providers to work above pre-pandemic levels to manage diagnostic backlogs. Waiting times for some appointments have increased in some areas, and in those areas specifically we are working with Public Health England’s screening quality assurance service and the relevant clinical commissioning groups. The problem is not everywhere, but I am aware that there is a problem in certain parts of the country.

I thank everyone for their contributions, and I express my sympathy—I know I speak for each and every Member here—to Fiona’s family and friends. The most effective way to prevent deaths from cervical cancer is for as many women as possible to attend their routine appointments, as opposed to yearly screening. Cervical screening undoubtedly saves lives, so once again: when you receive the invitation, please go, and if you notice any worrying symptoms in the meantime, contact your GP. NHS services are open, safe and ready to help you and help keep you safe. You have to help us by attending, so that the screening programme reaches as many as possible and we can drive that rate up into the sort of levels that mean we can prevent each and every woman from having what is, in effect, a preventable cancer.