Cervical Cancer Screening

Alison McGovern Excerpts

Thursday 1st May 2014 Commons Chamber

[Steve Rotheram (Liverpool, Walton) (Lab)]

I beg to move,

That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.

I am grateful for the opportunity to bring this important debate to the Floor of the House, although I wish it was not under such tragic circumstances. The number of MPs present does not necessarily reflect the wider public interest in the issue. Perhaps that shows that many MPs have lots of competing interests and that many who would have liked to have been here today are, unfortunately, unable to attend.

I want to place on record my thanks to members of the Backbench Business Committee, skilfully chaired by my hon. Friend the Member for North East Derbyshire (Natascha Engel), for listening to the voices of the tens of thousands of people who wanted this issue debated, and to the Leader of the House for recognising the considerable national interest in it. I also thank the Liverpool Echo, the Daily Mirror and the Daily Mail for their continued coverage of Sophie’s case and the steps they have taken to raise awareness of this debate and, more importantly, the issue of screening and the early identification of symptoms, which I will go into in more detail during my contribution.

I want to place on record my gratitude to Sophie’s mum, Peri, and to each and every one of the 321,925 people who signed the online petition following the heartbreaking death of her daughter earlier this year. They made history in the process by accumulating the largest ever number of signatories to a Government e-petition.

There has been a lot of speculation and conjecture about what is actually being requested today, but my motion, seconded by my hon. Friend the Member for Wirral West—

[Alison McGovern (Wirral South) (Lab)]

South!

[Steve Rotheram]

Sorry—she will kill me for that!

The motion is clear in its intent. I am not calling for the introduction of routine cervical screening for all women and young girls under 25, but I am calling on the Government to issue guidance that stipulates that all women should be able to request a cervical smear regardless of their age. Put simply, young women and teenage girls who present to their GP with possible symptoms of cervical cancer should have the choice, if they so desire, to have a smear test, but that must of course go hand in hand with extensive consultation with their GP to ensure that they are informed of all the potential consequences of the procedure. Given the limited number of cervical cancer cases in women under the age of 25—just 47 in England in 2011, according to Department of Health figures—such an option would not open the floodgates to thousands of unnecessary, costly or possibly damaging tests for young girls.

The motion is an attempt to promote the issue, and to encourage the medical profession to take up the provision that is already available to doctors of granting screening tests to females of any age in exceptional circumstances. It must be said that some of the medical profession are clearly not exercising that power, and that has proven fatal in cases such as Sophie’s. Indeed, at the heart of the motion is one simple premise—that a woman of any age over 16 should, through written departmental guidance, have the right to make an informed choice for themselves.

I will highlight areas in which I believe the Government could take immediate action to educate and inform both patients and medical professionals better about the symptoms and diagnosis of cervical cancer in young women and teenage girls, but I want to make it clear that I am very much of the opinion that any changes to age restrictions must be evidence-based.

Sophie Jones was a much-loved and popular 19-year-old girl from the Wirral who had her whole life ahead of her. She had fashioned a successful career in modelling, and was described by her twin sister Ashleigh as

“the life and soul of everything”.

In 2013, after experiencing constant stomach cramps for more than a year, Sophie visited her GP. She advised her doctor of her symptoms and asked for a smear test. Sophie knew that something was seriously wrong, but she was continually refused a test solely on the basis of her age. Instead, Sophie’s GP incorrectly diagnosed her with Crohn’s disease. Last November, Sophie was forced to enter hospital permanently, due to the deterioration in her health and the escalation of her condition. Despite that, numerous doctors still failed to recognise her symptoms or to diagnose her illness accurately.

Eventually, Sophie and her family’s worst nightmares were confirmed when she was diagnosed with cancer of the cervix. Tragically, by the time doctors were able to make an affirmative diagnosis, it was too late. The cancer had spread to other parts of her body, and by then she was terminally ill. For four months, Sophie fought against her devastating disease and, with her family and friends alongside her at her hospital bed, fought bravely to the end. On 15 March, after four long and excruciating months, Sophie’s defences were overwhelmed by her condition and she lost her struggle for life.

There was a time in Britain when a cancer diagnosis struck the fear of God into people, but thanks to advances in medical treatments and preventive measures, early diagnosis ensures that cancer patients survive in more than half of cases. Cancer is no longer a death sentence if caught early enough. Sophie’s diagnosis came too late for treatment to be successful, but it should never have been that way. That is what makes her case so painful for her family and friends.

I know that I speak on behalf of my hon. Friends the Members for Wirral South and for Liverpool, Wavertree (Luciana Berger) when I pay tribute to Sophie’s family and friends for the dignity that they have shown, and for their determination to highlight Sophie’s story to prevent anyone else from ever having to go through what they have been through. Sophie was failed by the current system, and that should not be allowed to happen to anyone again.

Moreover, I am confident that Sophie’s case is not an isolated incident. I am aware of other cases, and other Members will speak about cases that have been brought to their attention. Those cases include that of Maryanne Makepeace, who was told that she had a water infection, before she was finally diagnosed with terminal cancer.

Just last week, the BBC in Wales reported the case of 20-year-old Jessica Bradford, who was also told by her GP that she was too young for cancer. Initially, she was diagnosed with thrush, with the doctor believing that she had a sexually transmitted disease, but Jessica was eventually diagnosed with cancer of the cervix. She has been told that she is now infertile, having undergone radiotherapy and chemotherapy. That is one example of how a woman exercising her right to a test resulted in her being given treatment, which I hope will lead to a full and complete recovery.

Cervical cancer is the second most common cancer worldwide. It is the 11th most common cause of cancer-related deaths in the UK, amounting to about three in every 100,000 women, according to the crude mortality rate of Cancer Research UK. There are, on average, just short of 1,000 deaths from cervical cancer each year in the UK. Three women are diagnosed with the disease every day.

As Jo’s Cervical Cancer Trust points out, almost all cases of cervical cancer are caused by the persistent high-risk human papilloma virus. The NHS guidance on the HPV vaccine indicates that 99% of cervical cancers are caused by an HPV infection, and that four out of five sexually active adults will come into contact with it during their lives. The condition is not one that solely women can get; men also carry the HPV virus. The thing is that many people do not necessarily present with any particular symptoms.

It is worth highlighting the other risk factors that can affect a woman’s propensity to develop cervical cancer. They include smoking, as carcinogens weaken the immune system and leave the individual more likely to attract an infection of the cervix, as well as unprotected sexual activity at an early age, teenage pregnancy, multiple births, decreased immunity in women receiving immunosuppressant drugs and, in some cases, mothers given the DES—diethylstilbestrol—infertility drug when pregnant. Some medical opinion suggests that long-term use of the contraceptive pill, for instance for more than 10 years, can slightly increase the risk of developing cervical cancer, although I am sure there is consensus that the benefits of the pill far outweigh the risks for most women.

The previous Labour Government’s decision to introduce the HPV vaccination programme was extremely apposite. It has saved and will continue to save many thousands of lives across the country. However, we must be relentless in rolling out the vaccination programme in our schools and colleges. Typically, year 8 girls—those aged 12 and 13—are offered the vaccination, and the take-up rate is about 80%. The vaccination offers protection against their developing the condition in later life. A catch-up programme was also introduced by the previous Government in 2009-10, in which almost 1 million girls aged between 12 and 18 were vaccinated. The continued roll-out of vaccination in girls before they become sexually active will greatly decrease the chances of their contracting the infection, and it will increase the chances of cervical cancer survival.

As many as 2,800 women a year are diagnosed with cervical cancer, and more than a third of sufferers die each year because of the failure to catch the cancer through early diagnosis. It is impossible for women on their own to detect abnormalities in cervical cells, but symptoms that seem inconsequential when taken in isolation can amount to a clear indication of cancer of the cervix when assessed cumulatively. Those include abnormal bleeding during or after sexual intercourse or between periods, post-menopausal bleeding if a woman is not on hormone replacement therapy or has stopped it for six weeks, unusual and/or unpleasant vaginal discharge, discomfort or pain during sex, and lower back pain. As the cancer develops, it can cause additional symptoms such as frequent urination, blood in the urine, rectal bleeding, diarrhoea, incontinence and lower-limb lymphoedema.

[Alison McGovern]

My hon. Friend is giving an excellent description of the symptoms that everyone should be aware of. It is refreshing to hear a man talking about the symptoms of women’s cancers. Does he agree that one thing that we can definitely do today is raise the awareness of those symptoms and encourage men and women to understand more about women’s cancers?

[Steve Rotheram]

My hon. Friend makes a powerful point. In all honesty, I did not know an awful lot of this information before I was asked to head up the campaign in the Backbench Business Committee to get this matter debated in the House. I suspect that the same is true of many male colleagues on both sides of the House and many men in the wider public. We must destigmatise the use of words like “period” or “vaginal discharge” by men, because it is important that such things can be spoken about openly. As the father of two daughters, I certainly want them to be aware of the symptoms of this condition, so that they can bring them to my attention and I can help and guide them should they need a consultation with the GP. This is an important matter for us to debate in the Chamber. I am sure that other colleagues will go into the symptoms of this horrible disease.

The danger of highlighting the symptoms is that some women might misdiagnose themselves, causing them unnecessary worry. Conversely, if doing so means that one person with the symptoms is diagnosed with cervical cancer and has her life saved, it is well worth it.

According to the NHS figures, the vast majority of women’s test results come back normal. For about one in 20 women, the test will show some abnormalities in the cells of the cervix. Most of those changes will not lead to cervical cancer and the cells often return to normal on their own. Indeed, that is particularly true of young patients. In some cases, the abnormal cells need to be removed so that they cannot become cancerous.

About 3,000 cases of cervical cancer are diagnosed each year in the UK, which amounts to 2% of all cancers diagnosed in women. As I have stated, cases of cervical cancer in women under 25 years of age are extremely rare. They amount to about 1% of all cervical cancer sufferers in England. However, the relatively small number of occurrences should not be dismissed as statistically negligible. The mission of the NHS cervical screening programme is

“to reduce the number of women who develop cervical cancer and the number of women who die from it.”

The screening programme is credited with saving the lives of about 5,000 cancer patients a year across the board.

In 2004, the last Labour Government increased the age at which young females could have a test from 20 to 25, in accordance with international recommendations from the World Health Organisation. America has adopted the position that a test should happen at 20 years of age or within three years of first sexual activity, whichever comes earlier. To me, that seems an appropriately flexible policy to have. It is estimated that early detection and treatment prevents up to 75% of cervical cancers. The contention centres on the appropriate age at which screening should become routine and on the health consequences for somebody who chooses to have a test before the recommended age of 25.



So that I am not accused of presenting an imbalanced view of the medical thinking on this issue, I should say that there is an opinion among some professionals that smear tests on young women and teenage girls can lead to false positives, unnecessary treatment, anxiety for the patient, infertility or pre-term delivery later in life. There can also be discomfort, embarrassment or, less commonly, pain during the screening test. There is a very small chance of getting incorrect results, which could lead to abnormalities being missed or to unnecessary distress and treatment. There is also a chance of unnecessary treatment occurring if the abnormalities would have corrected themselves naturally. Some of the treatments that are used to remove abnormal cells may increase the risk of premature delivery in pregnancy.

Undoubtedly, there is still extensive debate in the medical profession about whether tests on young women would have the desired impact. In 2009, the British Medical Journal released a paper on the effectiveness of cervical screening with age, which concluded:

“Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on advanced stage tumours in women under age 30. By contrast, screening older women leads to a substantial reduction in incidence of and mortality from cervical cancer.”

For that reason, it is important to reiterate that the motion does not call for routine screening for under-25s.

I believe that it is the duty of any Health Minister to adhere to the medical advice that is presented to the Department. To my knowledge, no new evidence has emerged that is substantial enough to change the Government’s position on screening ages. I believe that, at this juncture, it would be prudent to follow the decision of the Advisory Committee on Cervical Screening in 2009 to reaffirm the policy that the age for routine screening should remain at 25. However, although it is right that politicians should not ride roughshod over medical experts, it is the job of Health Ministers to examine the orthodoxy of the day, to keep matters such as age restrictions under constant review if new evidence emerges and to scrutinise international patterns and comparisons.

I must mention that I am not a medical expert. My opinions are predicated on what I have read and learned about the subject. The debates on either side of the screening argument need to be qualified by further research. I believe that there are steps that the Minister can take right now to address those concerns and the concerns that have been highlighted by Sophie’s death. For me, the Minister should get to work on five things immediately.

First, the Government should address the online advice and guidance that is available to young women and girls who suspect that they have the symptoms of cervical cancer. At present, it is far from adequate. In the course of my research for this debate, I was amazed at the total non-existence of good online advice for young women who suspect that they are displaying the symptoms of cervical cancer. Despite young people having a higher propensity to use the internet to access information than most adults over the age of 30, there is an absence of advice on what steps should be taken by young people who are concerned that they are exhibiting the symptoms and on the support that is available. On the NHS “Your health, your choices” website, there is no mention of what young girls or teenagers should do. Instead, there is a vague information section on smear tests for over-25s. Users of the Public Health England website are forced to wade through pages and pages of material and to follow hyperlink after hyperlink before they finally find the information that they need in the frequently asked questions section. It appears that some of the information online—

--- Later in debate ---

[Mr Baron]

The Minister is nodding—kindly, I think. I thank her for that in one respect.

The solution that the all-party group came up with was to focus on outcomes. We could bombard the NHS with a lot of targets to try to encourage earlier diagnosis, but instead we decided to focus on one outcome measure—the one-year survival rate, broken down by CCG—as a driver towards earlier diagnosis.

[Alison McGovern]

Given some of the specific details that we have heard, does the hon. Gentleman agree that the all-party group’s approach of not setting a lot of targets but instead focusing on outcomes might enable groups of GPs to make themselves more aware of symptoms that have been missed in the case that we have discussed and in similar cases?

[Mr Baron]

That is absolutely right. When it comes to cervical cancer, all the figures suggest that if it is caught early, 95% to 98% of patients can reach the one-year point. That figure falls away significantly if it is not caught early enough. The hon. Lady is right that the idea behind one-year survival rates, broken down by CCG, is to encourage earlier diagnosis. It is intended to encourage CCGs to introduce local initiatives to address the points that the hon. Member for Liverpool, Walton made about late diagnosis. We all know that late diagnosis makes for poor one-year figures, so putting the one-year figures up in lights, broken down by CCG, means that we can see clearly which CCGs are underperforming. The cancer community and politicians can therefore come together and put pressure on those CCGs to raise their game.

As the hon. Member for Wirral South suggests, there could be a range of initiatives, such as better awareness campaigns, whether on cervical or other cancers, better diagnostics in primary care or better GP training—the hon. Member for Liverpool, Walton made the point that the GP in the case in question missed the diagnosis. There could be a range of local measures, and to answer the point that the hon. Member for Wirral South made, it would be up to the CCG to tailor-make those initiatives to address the needs of its individual area. That is what those figures are about and, for the first time, we will have the opportunity to hold underperforming CCGs to account when it comes to late diagnosis. Late diagnosis makes for poor one-year figures, and when those figures are broken down by CCG, we will know which ones are failing to do more to raise their game on early diagnosis.

In conclusion, I have one or two questions for the Minister. First, I managed to secure from the Prime Minister at Prime Minister’s Questions an assurance that the one-year figures will be published in June. I asked that question because those figures were due out in January but then postponed to the spring, I think, and then postponed again. Will the Minister assure the House that we are still on course for their publication in June this year?

Secondly—the Minister knows what is coming— can we throw any more light on how we can hold underperforming CCGs to account? There is no point in having one-year cancer survival figures broken down by CCG if there are no systems in place to ensure that CCGs that underperform are held accountable and encouraged to raise their game. There is no point having the tools in the toolbox if we do nothing with them. Will the Minister enlighten the House about whether there has been any further thought on that issue since we last raised it in this place back in February?

I know that the all-party group’s report, “Cancer Across the Domains”, is on the Minister’s desk at the moment, and I hope she will say a few words about how quickly we will get a response—we look forward to that. In direct relevance to the point made by the hon. Member for Liverpool, Walton about GPs and the challenges of improving earlier diagnosis, will the Minister say whether there are any other initiatives by the Department of Health or NHS England to look at earlier diagnosis, apart from the one-year figures? For example, GPs are recompensed through the quality and outcomes framework system, and I think I am right in suggesting that the QOF system deals with everything when it comes to cancer post-diagnosis, but there is nothing to encourage earlier diagnosis.

Finally, I mention briefly the all-party group’s reception on 8 July, which will highlight the importance of those one-year figures. In summary, for the first time we will have the tools in the toolbox to hold underperforming CCGs accountable when it comes to earlier diagnosis. We must make use of those tools, and the cancer community, politicians, and everyone else must be aware of their importance—I am confident that they will be. If we embrace the concept fully and focus on outcomes and the one-year figures, we have the potential to save, quite literally, thousands of lives a year in this country.

[Alison McGovern (Wirral South) (Lab)]

It is an honour to contribute to this important debate, and I welcome to the House of Commons today Sophie’s mum, Peri, her sisters Chelsea and Ashleigh, and other members of her family. I have been very proud to be involved in this campaign to highlight what happened to Sophie, who was my constituent. I think I am right in saying that this has been the biggest ever e-petition, which I think represents a real change in the way we do our politics in this country. Long gone are the days when only certain people in this place could call on us to hold debates here and only the Government said what we would talk about. In Sophie’s name, her very many friends and family have brought us here to talk about these issues today. That is a massively important change in our politics, alongside the important issue we are discussing.

I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram)—even though he keeps saying that I am the hon. Member for Wirral West, which I am not; I’ll have a row with him about that later—on having initiated this extremely important debate. As I have said before, it is very important for men in Britain, as well as women, to care about women’s cancers, and I will say more about that and about awareness. I make a plea, however, for all my male colleagues, as dads, brothers and friends of women as much as anything else, to ensure that they know the symptoms of cervical cancer and other women’s cancers, and to support their sisters, friends and mums if they have any concerns. That is important.

I begin my contribution by borrowing the words of Peri, Sophie’s mum, which she has allowed me to do. She characterised what Sophie was like in a really brilliant way:

“She was an amazing daughter, sister, girlfriend and friend, a live wire with a huge heart, the glue that held our family together. Her attitude to life was to live it to the best and her positivity shone through to everyone so as you couldn’t help but smile”.

I think those are lovely words about Sophie, and it is in her name that we all come here today. I know I represent all my constituents when I offer their condolences to Sophie’s friends and family, and I feel sure that the many thousands of people who signed the e-petition did so because they wanted to show that they cared about what happened to her. Members might be interested to know that friends and family have also organised fundraising events—they did so before Sophie died—and are taking care of all her family. That is a truly great thing.

Sophie had high aspirations for her life, and she had hopes and plans. She was clearly a vibrant, clever, beautiful young woman with her whole life ahead of her. She attended her GP surgery as she had been suffering for months with symptoms such as stomach pains and various things, and it seems that her request for a smear test was refused on the basis of her age. My hon. Friend the Member for Liverpool, Walton has gone through those issues in some detail. It seems that Sophie was diagnosed with Crohn’s disease, but her health continued to deteriorate until she was eventually diagnosed with cervical cancer and very tragically died in March, just 19 years old.

The disease is rare in younger women, but in this case a smear test would have been important. Sadly, this is not the first case to come to light in which a young woman has died of cervical cancer following such events. Mercedes Curnow died aged 23 in 2011, and reports suggest that she too had requested a smear test. Another young woman, Becky Ryder, was 26. Thankfully, such cases are few and far between, and we are grateful for that; none the less we will all understand the tragic scenario that friends and family face when a young woman faces such a serious disease. Even though the numbers are relatively small, it is important that we take the issue seriously.

Approximately 3,000 cases of cervical cancer are diagnosed in the United Kingdom every year. While there are groups of people such as women under 25 among whom cervical cancer is rare, it does occur. I understand that there are approximately 2.5 cases of cervical cancer for every 100,000 women under 25 years old. It is thankfully rare, but very serious for those people who face it. How can we help GPs to pick up the symptoms of something so rare? A balance has to be struck, but it is important to raise GPs’ awareness of such conditions—rare though they are, they do happen.

There are potential risks in screening women under 25, which have been mentioned. The consequences of unnecessary screening can cause problems in later life, which is why the medical community has had such a discussion about the point at which screening should be done. As politicians, our first regard must be for the medical evidence, and we would never ride roughshod over that, but one thing that we have perhaps not always got right is making information available to people and accepting that people should be trusted with that information. The NHS is very good at giving advice and telling people what they should be doing, but much less good at giving information to help people to make their own informed decisions. The e-petition is about choice and how we ensure that people have the information they need to make the choice for themselves. I understand that Dr Moss of the Advisory Committee on Cervical screening has argued that volunteering to have the test should be an option. If someone does make that request and is turned away, it could cause a very negative response when they are invited for the test later. I know that Sophie was one of the youngest victims of this devastating disease, and such requests would be rare, but people should have the choice.

The debate is an opportunity to talk about the importance of smear tests. We have all had the invitation and thought, “Oh goodness, I’m not really sure I want to go for that.” But it is vitally important that people have the test if invited, and I hope this debate will make people think about the importance of having a smear test. Cervical cancer is a real problem, and the hon. Member for Basildon and Billericay (Mr Baron) rightly talked about early diagnosis and said that that was a problem across various types of cancer. The biggest challenge we face in fighting cancer is getting people to come forward early, and my view is that that is more of a problem in areas of social deprivation. I know from Merseyside, my home patch, that in such areas people are likely to have busy lives, perhaps less awareness, and a bit less confidence and are perhaps working shifts. They may be concerned about symptoms but put their concerns aside, for whatever reason, and the possibility of diagnosis gets later and later.

We need to recognise the differential prevalence of late diagnosis in different areas, and we should ask what we can do to recognise and address the various social and economic factors that can cause late diagnosis.

[Lyn Brown (West Ham) (Lab)]

I am listening to my hon. Friend’s speech with interest and she anticipates many of the points that I want to make. Does she agree that women often put themselves last, behind their family, and there are always other pressing issues to be dealt with rather than a routine cervical smear? Somehow we have to get it across that the smear test is as important as anything else they have to do.

[Alison McGovern]

In my slightly cack-handed way, that is what I was trying to say. Women are incredibly good at putting off things that concern our own health, which is why it is important that our brothers, fathers, husbands and friends encourage us to be concerned about our health and to look after ourselves. It is also important that we make the point today about the importance of smear tests. People should have a choice and be able to talk to their GP about having a test if they need one, and if invited to be screened, they should take up the invitation.

[Mr Baron]

The hon. Lady correctly makes the point that we can do more about the disparity in late diagnosis. By focusing on the one-year cancer survival figures by CCG, we can also come together—whether as cancer charities, the cancer community or as politicians—to focus on the under-performing CCGs and ask why that is happening, in the hope that they will themselves introduce initiatives at the local level to drive forward earlier diagnosis. I hope she recognises that that will be an important element of our battle against late diagnosis.

[Alison McGovern]

I agree with the hon. Gentleman. As I said, Merseyside has a particular issue with cancer, and I feel sure that some of that is to do with late diagnosis that arises from aspects of people’s daily lives. We need to think how we can engage with people in a way that does not depend on their having already some amazing knowledge about the possible symptoms. Many people in my family have had cancer, so we would know, but many people do not know. It can be incredibly stressful to take the first step of going to the GP and saying, “I am really worried. What tests can I have?” We need to encourage CCGs to look at the local conditions and figure out how to get through to the public in their area. The all-party group on cancer has led on that, and I fully support that work.

Another important aspect is broader cultural change. We need a culture change in the NHS in two respects, and Sophie’s case has caused me to reflect on how the NHS works. First, it is important that we talk about women’s health. Women are very good at putting themselves last and putting off the visit to the GP or the smear test that they need. We have seen the great success of breast cancer and other awareness campaigns, and we need to do the same with some of the less well-known cancers, whose symptoms are less well-known. We need a real focus on women’s cancers to try to improve everybody’s knowledge of them. I realise that it is not always easy to talk about periods and so on. Women are very good at hiding such issues and just coping with them, but we need to talk about symptoms. It is also crucial that GPs are aware of possible symptoms. I have learnt from Sophie’s family and friends, and others in Wirral, that the big barrier is ensuring that GPs understand better what they should be looking for and what advice they should be giving to people who come to them with worries or concerns. I know that some excellent GPs are wrestling with that question. People should not be made overly concerned, but if we had more of a culture of giving people information and helping them to make their own decisions, it would help them to feel more empowered.

The second culture change that I would like to see in the NHS is the NHS listening to young women, who are often dismissed in our society. Colleagues have done great work on women’s representation in the media, and I think we have a cultural issue with the place and value of young women that sometimes presents itself in our health service. Too often in the NHS—this is, I am afraid, something I know from my own experience—young women are given advice and told, or at worst instructed, what to do about their health, which is totally disempowering. There are lots of forces in society that are set up to undermine young women, so please let us not have the NHS be one of them. Let us rethink how we identify symptoms early and get people the tests they need. Rather than trying to instruct people, we need to listen to them, respect them, provide them with information and help them to find their own way to the right treatment. In serious cases such as Sophie’s, there are clear worries. More broadly, there is no future for a health service that thinks it can tell people; it has to empower people to make their own decisions.

In conclusion, Sophie’s family and friends started the petition and all signed it, which has brought us to this debate. They have shown tremendous courage at what must be a difficult time. They want to see the change outlined by my hon. Friend the Member for Liverpool, Walton. The public across the country have signed the e-petition—this has been a national campaign—and have brought the issue to the top of the agenda. That shows how important it is and how much cancer affects family life. We are asking for women to be given more choice over their own health, no matter what their age, and for them to feel more empowered. This was a tragic event. We feel the loss of Sophie in our community. It sparked an outpouring of grief and we must do better to make sure it is less likely to happen again.

This is Sophie’s debate and we remember and honour her. In her name, I ask that we resolve to make whatever changes are necessary to make this less likely to happen to anyone else. Cancer is a terrible disease, but we are now more able to diagnose, control and contain it than we have ever been. We can win this fight against cancer, so let us all recommit ourselves to do more, to help others and to make sure that we take care of everybody in our society.

[Several hon. Members]

rose—