Provision of Cervical Screening

David Mowat Excerpts

Friday 27th January 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Thank you for those comments, Madam Deputy Speaker. I thank the hon. Member for Dewsbury (Paula Sherriff) for her constructive speech, which was challenging towards the end. She raised four important points, which I will try to address in my remarks.

I also thank the hon. Lady for her work with the all-party parliamentary group on women’s health to lead the charge on cervical screening. On Jo’s Cervical Cancer Trust and the #SmearForSmear campaign, during her remarks I was able to check with both my Parliamentary Private Secretary, my hon. Friend the Member for Kingston and Surbiton (James Berry), and the Whip, my hon. Friend the Member for Daventry (Chris Heaton-Harris), and we will be delighted to take a selfie with her that we can use for #SmearForSmear. This debate is about asking challenging questions, but it is also about awareness. We will do anything we can to help a charity such as Jo’s Cervical Cancer Trust do its job better. Perhaps we can take the selfie together after we finish.

As the hon. Member for Dewsbury said, nine women a day are being diagnosed with cervical cancer and two to three women a day are dying. It is a cancer that is almost entirely preventable through screening although, as she said, the symptoms are hard to detect, which I will cover. She said that the cancer strategy, which is being led by Cally Palmer, covers screening in some detail, including how we will proceed, and addresses the need right across the cancers for clinical commissioning groups to take a consistent approach to survival rates, early diagnosis, 62 day referral-to-treatment times and the whole cancer experience.

One of the things that I always say when we in this place have a debate about cancer is that we spend too much time—I am as guilty, or have been in the past, as any other Member—discussing the bricks and mortar of the health service and not enough thinking about some things that probably matter more to our constituents, such as one-year survival rates for cancer. We should be evaluating and holding our CCGs to account much more often over differential one-year survival rates, because, in the end, they probably matter to more people and have more impact on their lives than perhaps some of the accident and emergency reconfigurations that we discuss.

There is a cervical cancer screening programme, and the hon. Lady made some good points about take-up. She did not talk about the campaign that has been waged in some areas on screening under the age of 25. I do not think that that is something that Jo’s Cervical Cancer Trust wants, but I will cover it and the reasons we do not do it.

The hon. Lady mentioned the importance of the enhanced HPV screen that is coming in, asking a question about the IT systems to support that. We are planning that that will be in place—I have confirmed that; I think written questions have been tabled on the issue—by April 2019, when it will be rolled out. That will be in place. I can give her that assurance.

I want to talk a little about the point the hon. Lady made about GP awareness and clinical practice, because, as she said, there is not enough awareness of the symptoms of cervical cancer. It is hard to detect the symptoms, such as abdominal bleeding and its many causes. I will also cover the fact, which she rightly referred to, that the UK is doing a lot in the area of vaccination, which is probably what will achieve the most progress in the future and make the biggest difference in getting rid of this disease, which is, as you said, Madam Deputy Speaker, quite preventable.

On screening, I will start with the good news: we have screened 3 million women a year between the ages of 25 and 49. Every three years, a screening is available. After that, to the age of 64, it is every five years. The view is that, if that screening were not being done, there would be about 5,000 more deaths a year, rather than the 700 to 800 that are happening now.

Although there are few areas of cancer treatment, performance and survival rates on which the UK could say that it is a world leader, the screening figures from the OECD show that we are No. 4 of the 30 OECD countries. We do more screening than countries such as Germany, Denmark and Austria. However, the hon. Lady raised the point, and she is right, that screening rates are going down. They are going down across the world and we do not wholly understand why. We need to do more to get them up, as about 25% of women who are entitled to be screened are not being screened, and that percentage increases for women coming for their first screen at the age of 25 to 29. That is arguably the most important one, but the percentage of those not coming is about 33%.

As the hon. Lady said, the incidence of that is higher among ethnic minority women and among women with learning disabilities. There is a correlation with social deprivation as well. Perhaps that is predictable, but it is nevertheless true.

On the reasons for that, the hon. Lady talked about, perhaps, embarrassment. I think Jo’s Cervical Cancer Trust has done some work on that. Some people say that they have no time to go to their GP, or they are scared about what the procedure involves or they think it is not important. We need to do what we can to improve that.

The hon. Lady raised some interesting points about the letter people receive, and she quoted from it. I am told that that correspondence is being reviewed, but it strikes me—she made the point in her speech—that we are all on the same side in this regard. One way forward might be for her and Jo’s Cervical Cancer Trust to come and speak to me about some of those suggestions, because they would be pushing at an open door. We can do that in the next few weeks.

We are trying to make the information more accessible, particularly for women with learning difficulties, because there are specific issues there—there are specific issues with their health in general, but particularly with regard to this issue. As the hon. Lady said, a lot of work is going on to target those GP practice areas and understand why they have such high incidence of no-shows. It is somewhat correlated with ethnic minorities, and it might involve some behavioural norms, for the reasons that were mentioned. I should say at this point that the Chancellor gave £650,000 from the tampon tax to Jo’s Cervical Cancer Trust, which has used that money to try to understand, behaviourally, why a quarter of women are still not coming forward for screening in spite of a second reminder, and to increase awareness. None of that is to say, though, that there is not more to do. I am happy to speak to her and Jo’s Cervical Cancer Trust about it.

From time to time there have been petitions and discussions about lowering the age limit for screening. I was pleased that the hon. Lady did not mention that, because it has been looked at again by the UK National Screening Committee, the World Health Organisation and, indeed, Jo’s Cervical Cancer Trust, and there is agreement that earlier screening would do more harm than good because it is particularly likely to lead to false positives, which would create a pressure for biopsies that are not necessary. Notwithstanding the tragic case of Amber Cliff, the view is that screening that cohort of women earlier not only would not be beneficial—it is not a question of it not being cost-effective—but would actually make things worse. In that cohort of women, about five a year die, so it is particularly important that they understand the symptoms and go to their GP as quickly as possible. I should emphasise that there is no EU or other UK country that screens women under the age of 25. I shall discuss vaccination in more detail in a moment, but it is one of the things that will make a difference to women in that age group, and it will help with the screening no-shows, because we are getting much better uptake numbers for vaccination.

The hon. Lady talked about HPV as a significant indicator of risk. One thing that is being introduced on the back of the normal, historical screening is screening for the virus on the first occasion. If it is present, the woman will be monitored much more closely going forward, because it is a very good indicator of the likelihood of cervical cancer developing. As I said, that programme will be rolled out nationally from April 2019. We are at the forefront of countries that are doing that around the world. I used to work with IT systems, and the hon. Lady is right to continue to ask about this one. The referral system and database will be ready to make that roll-out happen.

The hon. Lady rightly discussed the need for a GP outcomes framework. NHS England has done work to ensure that GP awareness is as high as it should be and that women, particularly those with mid-period bleeding, understand that it is serious and should be investigated and, if necessary, that they should be sent to a gynaecologist.

HPV, which is the indicator of this and other cancers, lends itself to vaccination, and we are one of the first countries in the world to bring in a very high volume of vaccinations of girls aged between 12 and 13. I am pleased to say that, last year, 85% of year 9 girls received the vaccination, which almost entirely takes away the likelihood of cervical cancer developing. That 85% is a higher number than the screening number, and it will help us to catch the people and the areas that have traditionally been hard to reach. Indeed, it is one means that we will use to address the issue of those hard-to-reach groups.

As HPV leads to other cancers, it has been suggested that the vaccination should also be given to boys. That is under discussion now, and we will be making a decision in the next few months. At the moment, only girls are vaccinated.

Let me finish by thanking again the hon. Member for Dewsbury for the points she raised, and for the way in which she did so. This is not a party issue—all of us are against cervical cancer. However, it is right that we challenge the postcode lottery that she mentioned and discuss ways to improve the take up of screening. If the five of us who are in the Chamber can do a selfie at the end of this debate and give it to Jo’s Cervical Cancer Trust it will perhaps show that, at least, the awareness part has been achieved.

Question put and agreed to.