Bowel Cancer Screening

Harriett Baldwin Excerpts

Wednesday 23rd November 2011 Commons Chamber

[Guy Opperman (Hexham) (Con)]

Thank you, Mr Deputy Speaker, for giving me the opportunity to raise this matter in the House. Bowel cancer affects men and women, and it is the second-highest killer after lung cancer. The debate is, I suggest, both timely and genuinely needed.

I have personal experience of the NHS that is probably too long to list. When I was a jockey, I was saved by a gastro-surgeon at Warwick hospital. I hoped I was riding the winner at Stratford races, but we turned over and the horse ruptured my spleen, perforated my left kidney and broke nine bones in my ribs. I can assure the House that it hurt a great deal. The surgeon saved my life on that occasion. Subsequently, it is well known that I had a meningioma in April and was recently given the all clear by Mr Neil Kitchen and the amazing staff at Queen Square hospital in north London.

My grandmother was an NHS matron and I have had bowel cancer screening. Certain family members have had this cancer, so I had the colonoscopy that was medically advised in those circumstances. I would certainly not be an MP were it not for the campaigns I waged on behalf of Savernake hospital in Wiltshire, where I was born; that hospital also saved my mum’s life.

I would like to declare an interest as a taxpayer. The NHS’s approach to individual screening is surely an issue in which we should all be interested—from the point of view of prevention of loss of life and the maintenance of good health, but also in respect of how NHS funding, which is clearly finite, is spent on preventing future problems.

I pay tribute to the Beating Bowel Cancer regime, to Cancer Research UK, to the British Society of Gastroenterology, and to Professor Wendy Atkin, her funders and the 170,000 volunteers who took part in her definitive study of flexible sigmoidoscopy, which is known as a flexi-scope. I also pay tribute to Imperial College London, University College London, the University of East Anglia and St Mark’s hospital, and to the variety of doctors, constituents, charities and members of the public who have worked so hard to combat this problem and have helped me to prepare for the debate—including the clinicians, particularly Dr Colin Rees.

As a Member of Parliament representing a constituency in the north-east, I am proud to say that the north-east leads the way in bowel cancer screening. It was the first to complete coverage of an entire region in April 2010.

Before I embark on the substance of my argument, I also make an apology on behalf of my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who sponsored the Beating Bowel Cancer reception in the House last year. Much to his regret, he cannot be here tonight. He is a good friend of mine, but he is well known in the House—and, indeed, throughout the world—for having worn the Beating Bowel Cancer tie, which I am now wearing, in the Chamber after that reception. My hon. Friend, who has quite a generous build, was attempting to restrain that generous build with his suit when he accidentally touched a button on the tie, setting off a melody that lasted for nearly two minutes. Madam Deputy Speaker virtually extracted him from the Chamber. I understand that the incident was reported in 25 countries, and did more for the screening of bowel cancer worldwide than anything that anyone has said since.

I have no future as a surgeon, and I assure the House that I have removed the bottom half of my own tie so that there is no possibility of my being extracted from the Chamber for being too musical.

Let me now make some serious points about the clinical position. Traditional bowel cancer screening involves the faecal occult blood test, known as the FOB. In the last few years 11 million people in the country have been offered the test, 6 million have accepted it, 120,000 scopes have followed, and 12,000 diagnostic findings of cancer have resulted. It is clear from the statistics that lives have been saved. Previously those screened were aged between 60 and 69, but screening has now been extended to those aged between 60 and 74. It should be noted that the north-east—leading the way, as it does so often in a medical context—was the first region to extend the age group.

Tragically, take-up of that vital free NHS screening is only 54%, whereas take-up of breast cancer screening is 74% and take-up of cervical cancer screening is 79%. However, the situation is changing. Professor Wendy Atkin and her team have brought flexible sigmoidoscopy to the forefront of bowel cancer screening. The results of their 16-year study were definitive. Their randomised trial, which followed 170,432 people, established that the flexi-scope examination reduces the incidence of bowel cancer in those aged between 55 and 64 by a third. Mortality was 43% lower among that group than it was in members of the control group.

The flexi-scope test works by detecting and removing growths on the bowel wall, known as polyps, which can become cancerous if left untreated. It can prevent cancer from developing by removing polyps before they become cancerous, and provides long-lasting protection from bowel cancer.

[Harriett Baldwin (West Worcestershire) (Con)]

I congratulate my hon. Friend on securing this very important debate. Does he agree that screening for certain kinds of hereditary cancers, such as non-polypsosis colorectal cancer, should begin at a much earlier age, and should take place relatively frequently throughout the lives of those who are screened?

[Guy Opperman]

I do indeed. I welcome the fact that the guidelines from the National Institute for Health and Clinical Excellence have changed to allow screening to become considerably more frequent in such cases. I am sure that the Minister will comment on that.

Flexi-scope screening will undoubtedly save thousands of lives. FOB screening saved 700 to 1,000 lives a year, and flexi-scope screening will save about 3,000 lives a year. To confirm that, the Government implemented a pathfinder project in three areas. Unsurprisingly, two of those areas were in the north-east, this country’s leading medical region. The three areas were South of Tyne and Wear and Tees, along with Derby. The pathfinder findings are with the Department of Health and have not yet been published, but I can assure the House that, in broad terms, they accord with Professor Atkin’s findings. Last October, the Prime Minister announced a proposal to pilot the scheme nationally in 2012, but there are clinical and funding issues that need to be addressed.

First, when is the Department of Health going to invite bids for the follow-on pilot process, given that that was supposed to be done in 2011 and it is now 23 November?

Secondly, clinicians raise the specific concern that the flexi-scope system is only manageable if we have a sufficiency of trained nurse endoscopists, so where are we in respect of this crucial training? Even with the most amazing piece of equipment, if we do not have the people to operate and interpret it, it is useless. Under this scheme, several hundreds of thousands of endoscopies will have to be carried out, with colonoscopies to follow in about 10% of cases. Therefore, everything will depend on training.

Thirdly, how does the Department of Health plan to assess its age groups? My understanding is that the current group of 60 to 74-year-olds will have FOB testing, and those aged 55 will have a flexi-scope. That is relatively clear, but what will happen for gentlemen and ladies in the 56-to-60 age group is not at all clear. Will they be offered the flexi-scope as well, or is that to be based solely on GP referral? Trusts need guidance on what they are to do with such a large and unknown number of people, as they need to plan budgets, staffing and much more besides.

Fourthly, we need to assess what we are going to do with those who have a flexi-scope at 55 and receive the all-clear and then reach the age of 60. Will we rescreen? Anyone who has ever worked in the health industry will know that there is “health speak”, and in this case the following question would be asked: “What is the parallel screening modality for the future?” As always, “health speak” is gibberish, but the simple question here is: are we going to rescreen people who are fine at 55?