Lung Cancer

James Brokenshire Excerpts

Thursday 26th April 2018 Commons Chamber

[James Brokenshire (Old Bexley and Sidcup) (Con)]

I am very grateful to you, Mr Speaker, for your kind wishes and kind comments and the support that you have given to me as I renew my acquaintance with the ways and processes of the Back Benches. I very much appreciate your kind words and support.

A week ago today, I had the privilege to speak in the brain tumour debate inspired by the incredible work of Baroness Tessa Jowell. It was one of those very special moments in this House, which was made even more poignant by Tessa being present to hear the debate and to hear the tributes to her courage, her spirit and her determination to bring about positive change for people to live well with cancer for longer. The abiding theme through all that debate was a message of hope—hope for the future, hope for others, and hope in the face of personal physical adversity. There was also the overriding power of human kindness, compassion and love, and I want to return to some of those themes later on.

At the end of August last year, I was out in Northern Ireland for a family weekend. It was a Saturday afternoon and we had had some fun exploring somewhere new with the kids and we were about to have some lunch. I had just sat down when I realised that I needed to clear something from my throat, thinking that it must be a bit of food or perhaps some phlegm. The next think I remember is looking down and realising that my tissue had a bright red blob of blood in it. I felt my heart pounding and a knot at the very pit of my stomach at the shock. That is the thing about cancer: half of us will get it, and it can strike just when we least expect it.

Of course, I could have left it; we blokes are pretty good at doing that. I felt fit and full of energy and I did not have any pain. It actually never happened again. I could have said, “It’s a one off; it’ll just sort itself out.” I did not, because deep down I knew that something really was not right. I trusted my instincts. I did not delay in going to see my GP. I trusted his advice in seeing a consultant when my initial X-ray was clear

“because we probably shouldn’t just leave it there.”

I trusted my consultant’s advice to have a bronchoscopy—a tube down my throat to have a poke around in my lungs—after my CT scan showed a small area of inflammation

“because we probably shouldn’t leave it there.”

At each stage, I could have left it there. I was too busy with work, too busy with Brexit and too busy with the Northern Ireland political talks, but I did not leave it there and that saved my life. I was lucky because my cancer was caught early. I was able to receive curative treatment—surgery to remove the upper part of my right lung—but, sadly, too often that does not happen. Too often people find out that they have cancer too late, and that is what we need to change.

Every year around 36,000 people will die from lung cancer. That is more than breast, prostate and pancreatic cancer combined. It is the UK’s biggest cancer killer and survival rates remain stubbornly poor. One of the main reasons for this is that it is detected at a point when curative treatment is no longer an option. Two thirds of lung cancers are diagnosed when the disease is at an advanced stage. Let me give hon. Members a sense of what this means. Some 83% of lung cancer patients diagnosed at stage 1, when the cancer has not spread, survive their cancer for at least a year. This drops to just 17% at stage 4, when the cancer has spread to another organ. But this is not a numbers game. It is real life—and death.

The Roy Castle Lung Cancer Foundation, which does such excellent work, gave me just one example of this stark reality. Steph lost her dad to lung cancer in December last year. He died 12 weeks after diagnosis. She said:

“I think the worst thing was my dad wasn’t given the opportunity to really fight it.”

We are talking about mothers, fathers, brothers, sisters, friends, loved ones and colleagues. Lives are cut short because we do not pick up on the signs and symptoms. We just do not get it picked up quickly enough.

Symptoms could include a persistent cough that just will not go away; feeling breathless but just not knowing why; hoarseness in the voice; unexplained tiredness or lack of energy; weight loss that cannot be understood; coughing up blood. Yet, according to opinion research commissioned by the British Lung Foundation and BritainThinks, one in five people in the UK are unable to name any symptoms of lung disease at all. Smoking is a clear risk factor, but many people who have never smoked develop lung cancer. I was one of them. Around 15% of lung cancers are in non-smokers. Given that 46,000 people are diagnosed each year, that is a big number in its own right.

I have been struck by the number of people who have asked me, “Did you smoke?” And that is how I have come to appreciate that stigma and misperceptions can be a barrier to getting people the help they need. Rightly, we have made huge steps forward in smoking cessation programmes. We have firmly cemented in people’s minds that lung cancer and other lung diseases are caused by smoking. But there are unintended consequences. Lung cancer can be caused by a number of factors, not just smoking, yet British Lung Foundation opinion research suggests that as many as a quarter of us assume that everyone with a lung condition is a smoker. This was brought home to me when I was contacted by someone with cystic fibrosis—a genetic condition—who told me that even he had been asked if he had smoked. There is even the suggestion that lung conditions are considered less sympathetically.

If someone links lung cancer so strongly to smoking and they have never smoked, they might simply ignore symptoms. Equally, if someone has obvious symptoms but is struggling with feelings of guilt or blame because they do smoke, they might not seek help. We need to challenge perceptions and ensure that stigma does not get in the way. We need to see that people with lung cancer receive the support and treatment they need, whether or not they have smoked.

[Mr Jim Cunningham (Coventry South) (Lab)]

It is good to see the right hon. Gentleman back, hale and hearty, as we say in Scotland. I wish him well for the future. He is quite right that not everybody who gets lung cancer is a smoker. Attention is often not drawn to health and safety at work, but people should be very careful. Workers who deal with deadly industrial processes are not always aware that this could have quite an effect on their health. Medical science is now gradually starting to make some breakthroughs, which gives us all a little bit of hope. I hope that he will touch on that.

[James Brokenshire]

The hon. Gentleman is prescient, because I was about to say that I believe there is real reason to be positive about what we can achieve.

Since my diagnosis, I have met leading experts in the field in the charitable sector and within our NHS. I have experienced incredible care by amazing NHS professionals on the frontline and spoken to experts in the field working on ground-breaking programmes. I have heard about new immunotherapies that are offering new hope even when surgery is not possible. I have even donated a small sample from my own tumour to an amazing Cancer Research UK programme to help understand cancer better by getting to the heart of its DNA to get to grips with its specific genetic make-up, help us find its weaknesses, and destroy it.

I commend the work of the NHS England clinical expert group for lung cancer, chaired by Professor David Baldwin, in seeing that speedier routes to diagnosis and other good practice can be applied across the country. The 10 new one-stop shop rapid diagnostic and assessment centres announced this month to speed up cancer diagnosis where there are vague or non-specific symptoms are another exciting new initiative. There is the work of the cancer taskforce in delivering the Government’s cancer strategy. There is the work of the taskforce for lung health to develop a five-year plan to improve lung health and prevent lung disease more generally. We should be hopeful, we should be positive, and we should be ambitious about what we can achieve and focus on how we can make the biggest impact.

From everything I have seen and experienced, early diagnosis and treatment lies at the heart of this. That is why I believe that a national screening programme for lung cancer is needed, as we have for breast cancer and bowel cancer. We are not starting from scratch. I commend NHS England for its announcement in November of a lung health check programme. It drew on the success of the Manchester scanner scheme, where mobile CT scanners detected four out of five cases of lung cancer in the early stages. In 12 months, the mobile scanning trucks picked up one cancer for every 33 patients scanned. Following this announcement, new lung screening pilots are about to get under way in various parts of the country.

But we risk each pilot doing its work in varying ways—not being joined up and with a fragmented approach to data collection preventing us from making comparisons and harnessing the lessons learned. There also remains some reticence to see this work progress to a national screening programme, with a desire to wait and see the results of the NELSON trial from Holland and Belgium. Yet we have already seen the huge benefits of CT scanning in the United States, and we have already dealt with issues such as false positives in other screening programmes.

There is a real human cost to delay. We should reflect on how many lives could be saved and how many lives are being lost while we wait. One example of this is Bill, whose lung cancer was picked up early through screening. He shared his story with the Roy Castle Lung Cancer Foundation, saying:

“If I hadn’t gone through that scan I could have been dead in a year’s time. The doctor when I went said it’s probably given you ten more years of your life.”

It is because of an overriding desire to see more people enjoy more years of life that I believe we should act now rather than wait. We should commit to a national screening programme and use the pilot programmes to support its implementation. If we want to see a step change in survival rates—to see people living through rather than dying from lung cancer—now is the time to be bold.

The last few months have been hard, knowing that in resigning from Government, my illness would be very public, and knowing that because of the need for a public announcement, many friends and family would be hearing about it on the TV or radio rather than hearing from me directly. When you go through something like this, it puts things in perspective and reminds you of what is really important—most especially, your family and those you love. In so many ways, it is even harder on them than it is on you. I want to thank my wife Cathy and my children Sophie, Jemma and Ben for the love and support they have given me and how they kept me going and kept me positive at some of my darkest moments.

I thank the incredible NHS professionals who have looked after me. They are very special people and without them I would not be giving this speech today. I have also got to know and appreciate even more the work of amazing organisations such as the Roy Castle Lung Cancer Foundation, Cancer Research UK, Macmillan Cancer Support and the British Lung Foundation. I have been humbled and overwhelmed by the kind messages of support, prayers and letters of encouragement from so many people, the contact I have had from people who have gone through or are going through a similar experience and the good advice I have received from key friends. It reminds you of the power of basic human kindness.

I have been very touched by the concern, kindness and support of colleagues from right across the House, some from people I might have expected, and some from people I did not. It has meant a great deal to me at a very difficult time. I hope that we can harness that spirit of good will and the skills, knowledge and experience of Members across the House, so that we can work together to shift the dial on cancer survival and above all deliver on the message of hope that I started with—hope for people receiving a lung cancer diagnosis just like me, hope for the future, hope for a continued life well led and hope for ourselves—and see that more of us are living well with cancer, and living well beyond it.

--- Later in debate ---

[Jackie Doyle-Price]

It has always been a mystery to me why we spend £200 a year on an MOT for our car but do not do the same for our own health. But I will come to the issue of screening in a moment.

I first want to tackle some of the specific points about lung cancer that my right hon. Friend the Member for Old Bexley and Sidcup raised. As he said, it is one of the most common and serious types of cancer, with 44,500 people diagnosed every year in the UK. Early diagnosis is key but, as he said, in the early stages there are not necessarily signs or symptoms, which is why diagnosis can often come too late. We need to raise public awareness and people need to be vigilant.

The issue of smoking is a very important one. It says here in my brief that smoking is the leading cause of avoidable cancers, particularly lung cancer—that is true, but because it is true it has led to a stigma around the disease, and because of its close association to smoking, many people, even if only subconsciously, view it as a self-inflicted disease. As we can see, that was not the case for my right hon. Friend, but it is very unfair to reach such prejudiced judgments about what is a very unpleasant disease.

As was the case with my right hon. Friend, 15% of lung cancer patients are non-smokers, yet an international survey by the Global Lung Cancer Coalition revealed that a quarter of people in the UK had less sympathy for people with that illness than for those with other forms of cancer. It is clear that lung cancer is not just a smoker’s disease, yet some people believe that that stigma is one of the reasons that lung cancer does not receive the level of research funding that other cancers enjoy. When it comes to cancer research, we know that as well as Government funding there is lots of voluntary funding, and for as long as that prejudice exists, lung cancer will not attract as much investment.

It is important, however, that we continue to spend money on research because, as my right hon. Friend has pointed out, lung cancer survival rates are poor and, although overall cancer survival rates are at an all-time high, some cancers have a five-year survival rate of less than 20%. That is why the Government are supporting the less survivable cancers taskforce, which the Under-Secretary of State for Health, my hon. Friend the Member for Winchester (Steve Brine), launched last year and which will look specifically at lung cancer, but also liver cancer—which I suspect suffers from the same stigma—brain, pancreatic and stomach cancer. It will focus on encouraging more research into less survivable cancers. My right hon. Friend also referred to the Roy Castle Lung Cancer Foundation, which does fantastic work to raise awareness of the disease, and I thank it for its work.

By way of an aside, if people are diagnosed with lung cancer, that tends to be all people see. I had a relative who died of emphysema, but he was a smoker. His death certificate pointed out that the cause of death was emphysema due to smoking. It ignored the fact that he had spent most of his working life in mills, where he would have inhaled various things. That is something that the hon. Member for Coventry South (Mr Cunningham) touched on, and it is close to my heart because of my own experience, as well as that of my right hon. Friend.

On screening, the United Kingdom national screening committee advises Ministers and the NHS in all four nations about screening policy. At the moment, systematic population screening for lung cancer is not recommended, owing to a lack of evidence that it will save lives. There is a considerable amount of research worldwide on CT screening for high-risk groups, such as smokers and ex-smokers. In the Manchester pilots, NHS England offered free health checks and on-the-spot scans to smokers and ex-smokers in Manchester, as my right hon. Friend has explained, as a result of which 46 cases of cancer were discovered. There is evidence that we can achieve things by intervening, and that is something that we should look at. NHS England is encouraged by the results. As my right hon. Friend the Member for Wantage (Mr Vaizey) has said, by reaching diagnosis early, we take cost out of the NHS. What is not to like about that? We will look at it further.

I am running out of time, but the Floor belongs to my right hon. Friend the Member for Old Bexley and Sidcup, who is now trying to intervene on me.

[James Brokenshire]

I think my hon. Friend has a few minutes left, because we started just after 5 o’clock. I commit to working with her and her ministerial colleagues to advance screening. I know that there is a lot of discussion about how to do so in the expert working groups. The pilots were not so much about screening as they were about carrying out scans, so the set-up is slightly different. None the less, it is important that they inform our working together. As I have made clear, CT scanning has the clear benefit of ensuring that we can pick up cancers sooner and enabling patients to get the treatment that they need to live full and long lives.

[Jackie Doyle-Price]

My right hon. Friend has made a generous offer. I will address the point that he has made in two ways. The Under-Secretary of State, my hon. Friend the Member for Winchester, is responsible for cancer screening programmes. Our current advice is that national uniform screening would not be productive, but we know about that route. I come back to my right hon. Friend’s experience because he had the wherewithal and courage to face up to a health issue that he had identified and take things forward. I think that the best way of getting improved outcomes is to empower patients to look after and manage their own care, and to have mature conversations with medical professionals so that full investigations can be made. Such conversations would lead to earlier screening. I would be delighted to work with my right hon. Friend to achieve that. We educate the public by sharing real life examples, and that is how we give them the tools to look after themselves. I look forward to working with him on that.

In the time I have left, I re-emphasise that we are making good progress and remain on track to deliver each of the 96 recommendations in the cancer strategy. That will help us to transform cancer services in England, to the benefit of all cancer patients including those with lung cancer. I cannot thank my right hon. Friend enough for securing this debate. I wish him continued success with his own health and send my best wishes to his family, who have gone with him through a very painful and traumatic journey. I thank him again for all the work that he is doing to raise awareness of the disease.