Prostate Cancer Screening Debate
Full Debate: Read Full DebateNigel Huddleston
Main Page: Nigel Huddleston (Conservative - Droitwich and Evesham)Department Debates - View all Nigel Huddleston's debates with the Department of Health and Social Care
(3 days, 15 hours ago)
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Gregory Stafford
I thank my hon. Friend for the work of her constituents in that important area. I must also recognise the previous Government’s work, particularly that of my right hon. Friend the Member for Richmond and Northallerton (Rishi Sunak)—whose commitment has continued beyond his time in office, as we have seen today—and that of my noble Friend Lord Cameron of Chipping Norton and my right hon. Friend the Member for Braintree (Sir James Cleverly). With Prostate Cancer UK, we as the Conservative Government committed £42 million to launch Transform, the largest prostate cancer screening trial in the world.
I welcome some of what the current Government have done, but important questions remain about access to testing, identifying men at highest risk and how evidence will translate into policy. First, on PSA testing guidance, as raised by my hon. Friends the Members for Hinckley and Bosworth (Dr Evans) and for Huntingdon (Ben Obese-Jecty), the guidance setting out the right of men over 50 to request a PSA test was withdrawn earlier this year. The Government say that policy has not changed and attribute the concerns to “misinformed media coverage”, yet a written answer in September confirmed that no impact assessment was undertaken because there was
“no change in policy to assess.”
If the policy had not changed, why was the guidance withdrawn? And how was it established that the change had no impact without an assessment? On 21 October, the Government said that
“officials continue to work with NICE”,
which does not clarify whether the changes to the clinical knowledge summary were discussed. Prostate Cancer Research has asked the Department to confirm that higher-risk men can still access a PSA test once informed of its risks and benefits. As of 14 October, it has had no reply. Will the Minister confirm clearly that those men can access testing?
Secondly, on support for those at the highest risk, I of course respect the committee’s independence while it reviews the evidence, but the Government can take practical steps in the meantime. Prostate Cancer UK has called for GPs to inform black men and men with a family history of their elevated risk and to offer them a PSA test. What will the Government do to improve access for such men now, rather than leaving them to wait years for the wider review?
Thirdly, on identifying BRCA2 carriers, an estimated 13,000 men carry that variant, yet most have never been tested and do not know. The Telegraph reported that only about 1,500 men will be invited for testing next year. How will the programme reach the wider population whom it is meant to benefit? The committee’s consultation document stated:
“DHSC analysts are undertaking an exercise to estimate the cost of identifying new BRCA variant carriers.”
Has that work been completed? Will it be published? What will the Government do to identify men who carry the variant without knowing it?
Fourthly, on Transform and the NSC model, the committee will work with SCHARR—the Sheffield centre for health and related research—to update its modelling in the light of the trial’s findings, in particular for black men. It will also examine risk algorithms and biomarkers, including the Stockholm3 test, and whether family history can be more tightly defined. That work of course matters, but its impact depends on how quickly findings inform decisions and whether the public can see what is happening.
Will the Minister commit to publishing by January of next year a dated programme for updating the model, covering the biomarker review and family history work, and reporting to this House every six months? Will she set a named decision point for black men, tied to the results of Transform’s first stage so that reconsideration does not default to the next scheduled review in 2029? What evidence will trigger a change to that model, and will independent experts be given access to it on terms similar to those NICE offers for medicines so that the assumptions can be tested?
Finally, I have some questions about how the value of screening is judged. Since April, NICE has been able to approve a medicine for advanced prostate cancer at up to £35,000 per quality-adjusted life year—a threshold raised as part of the trade deal with the United States. The screening committee judged earlier detection against a figure of £20,000. Why does the NHS now appear to value treating late-stage prostate cancer more highly than preventing it? Will the committee’s forthcoming methods guide bring the two thresholds into line?
In conclusion, I recognise the committee’s concerns about the harms of population-wide PSA screening, including overdiagnosis and treatment, and the uncertainties in the evidence for black men.
We have heard several times today about the importance of making informed decisions, but we cannot make informed decisions unless we are properly informed in the first place. Therefore, while there are some valid concerns about risk, the most important duty we and the Government have is to do everything we can to raise awareness so that people can make important, informed decisions. That is our duty, and I commit to doing so on behalf of my 357 constituents who signed the petition.