Cervical Cancer Screening

Luciana Berger Excerpts

Thursday 1st May 2014 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) and the other hon. Members who supported the application for this debate to ensure that the House can discuss such an important issue. I also thank hon. Members for their thoughtful contributions throughout the debate, which are a testament to how much the case of Sophie Jones has moved Members on both sides of the House. Not only across this House, but across the country people have reacted with shock and sadness at the death of a young woman that might have been prevented. We need only consider the number of people who signed the petition calling for the Government to look again at cervical cancer screening to appreciate the depth of feeling surrounding this issue. As we heard, 321,956 people signed it, which is more than three times the number required for it to be considered for a debate in this House. As my hon. Friend the Member for Liverpool, Walton said, that is the largest number for any of these petitions.

I would like to take this opportunity to pay tribute to Sophie Jones’s family and friends for their courage, spirit and strength in driving forward this campaign and for their determination to ensure that what happened to Sophie does not happen to another young woman. I am speaking in this debate not just as shadow public health Minister, but as a constituency MP representing Liverpool, Wavertree. My constituency is close to that of my hon. Friend the Member for Wirral South (Alison McGovern), where Sophie Jones lived, and this tragic case has affected people right across Merseyside. I have heard from a number of constituents who have read about Sophie’s story and were very keen for me to participate in this debate.

I was very privileged to meet Sophie’s family with my hon. Friend the Member for Wirral South and hear from them about what a remarkable young woman Sophie was. She was active, well-liked and so positive, and I was so moved hearing about her bravery and positive outlook, even as her cancer took hold—it really is a true inspiration to us all. I am glad that the House has had the opportunity to hear about Sophie’s case, to examine policy on cervical cancer screening and to debate ways in which we can do so much more to ensure that such a tragedy does not happen again.

Cervical cancer is the most common cancer in women under 35 in the UK and although deaths from cervical cancer have plummeted over the past 30 years, about 970 women died from it in 2011 in the UK—that is more than two women every day. Cervical cancer is not normally associated with younger women—as we have heard from a number of hon. Members, it is extremely rare in under-25s. There were 47 cases in women aged under 25 in England in 2011, which was less than 2% of all cases. The House has heard today many good reasons why routine cancer screening is offered when women turn 25. I will not go through them in detail but I will touch on them briefly.

We have heard today, including from my hon. Friend the Member for Liverpool, Walton, about evidence showing that screening all women under the age of 25 can lead to some harmful investigations and treatments. I listened to what the hon. Member for Cheltenham (Martin Horwood) said and I will be interested to hear the Minister’s response and whether she believes that that evidence needs to be reviewed. I am grateful for the opportunity I have had to speak to experts in this field, including at the Liverpool women’s hospital, in preparation for today’s debate. I have heard that there are problems involved in screening under-25s and that young women often undergo natural and harmless changes in the cervix that a smear test would identify as abnormalities. Screening young women would involve putting these women through further tests and investigations they would not otherwise have gone through when, in most cases, the abnormalities would have sorted themselves out without any need for treatment. I understand that the decision for routine cervical screening to begin at 25 was taken after a thorough review of the evidence by expert clinicians and scientists. That decision was reviewed in 2009 by the Advisory Committee on Cervical Screening, which at the time voted unanimously to keep the age at which screening starts at 25, reaffirming the earlier conclusion that the harms of screening women under 25 outweighed the benefits.

The point in the cases of Sophie Jones and of all the other people we have heard about today is that there is heartbreaking proof that, though rare, cervical cancer in the under-25s can happen. We must get better at spotting the signs of the disease and diagnosing it earlier.

I wish to cover three main areas for improvement to which I hope the Minister will respond. First, we must increase awareness of the symptoms not just among women so that they can spot the signs and go to their doctor at an early stage, but among doctors and nurses so that they understand that young women can develop cervical cancer. Secondly, we must ensure that once cancer is diagnosed, women are swiftly referred for treatment. Finally, we must do more to prevent cervical cancer from happening in the first place. We can do that by ensuring high levels of coverage among girls of the human papillomavirus vaccination programme and that eligible women attend their cervical screening appointment.

The cervical screening programme is highly effective at detecting early stages of cancer or pre-cancer, but it is not the best tool for diagnosing cervical cancer once symptoms are apparent, as they were in the case of Sophie. We know that detecting cancer early can make a real difference. The earlier that cervical cancer is diagnosed, the better the outcomes are likely to be. As we heard from the chair of the all-party group on cancer, the hon. Member for Basildon and Billericay (Mr Baron), it is so important that women are made aware of the signs and symptoms of the disease.

I echo the point made by my hon. Friend the Member for Wirral South; it was refreshing to hear a man—my hon. Friend the Member for Liverpool, Walton—listing the different symptoms experienced by women. I will not read them out again, but encouraging women to visit their GP if they have any concern or are showing any of the symptoms is such a simple message that could make a really big difference. Men, as fathers, partners and siblings, can also play a part, by being aware of the symptoms.

The tragedy in Sophie’s case was that she did visit the doctor on a number of occasions, but tragically was not diagnosed accurately. The Government must do more to ensure that GPs are getting the support and the training they need to help them identify cancer signs and symptoms, and that needs to be done during initial training and ongoing professional development. Clinical commissioning groups have a role to play, too. Crucially, we must make doctors aware that, although rare, young women can suffer from cervical cancer.

As much as these improvements at the first point of contact are needed, they are not enough if, once cancer is suspected, people are not seen quickly enough by specialists. We have heard from Members about how important early diagnosis and treatment are. NHS England’s figures on cancer targets for the last three months of 2013 reveal that 4,500 people waited more than two months for treatment after an urgent GP referral, which was in breach of the Government’s own target. That is not good enough, and the Government must urgently get to grips with the failing.

If we are to win the battle against cervical cancer, we must do everything possible to prevent it from occurring in the first place. I am proud of the fact that it was the previous Government who, in 2008, introduced the HPV vaccine, which immunises teenage girls against the majority of the high-risk strains of HPV that are associated with cervical cancer. My hon. Friend the Member for Liverpool, Walton highlighted the very high risks connected with the HPV virus and cervical cancer. All 12 and 13-year-old girls are now being offered the vaccine through their secondary schools. From September 2012 to September 2013, 86.1% of 12 to 13-year-old girls in England went on to receive all three doses of the vaccine. There is room for improvement here, and the Government must do more to encourage girls aged 12 and 13 to participate in the HPV vaccination programme.

As my hon. Friend the Member for West Ham (Lyn Brown) outlined in her contribution, the HPV vaccination alone will not prevent every case of cervical cancer. Alongside the HPV vaccine, the best preventative measure is for eligible women to attend their routine cervical screening appointment. We know that cervical screening saves around 5,000 lives every year in the UK, but, despite that, around 3.7 million women are currently overdue for a smear test. Shockingly, that has increased to 11% since 2009-10.

One challenge is around access to GPs. A YouGov survey for Jo’s Cervical Cancer Trust found that of the women of screening age who have missed or delayed appointments, almost a third of them said that it was hard to book a screening at a convenient time, and 35% said that if GP surgery opening times had been more flexible it would have encouraged them to attend their appointments. As my hon. Friend the Member for Wirral South said, we should do all that we can to encourage and provide the opportunity for women to take up their invitation for a smear test.

I wish to finish by coming back to Sophie and her family. As Sophie's mother, Peri Cawley, said:

“If we can do something to make sure this doesn’t happen to someone else, then Sophie's death will not have been in vain.”

The petition under discussion had hundreds of thousands of signatures, which shows that people across the country support that goal. As today’s debate has shown, Members of this House are clear about what needs to be done. We must increase awareness of the symptoms among not just women, but men and all GPs to ensure that they understand that younger women can develop cervical cancer and are able to spot the signs. We must also ensure that we do more to prevent cervical cancer from occurring in the first place by encouraging girls to have the HPV vaccine and women to attend their cervical screening appointments. We now look to the Government to take the action that is needed to make progress on those counts and to ensure that there is no repeat of the tragedy that happened to Sophie Jones. I look forward to the Minister’s response.