World Cancer Day

Philippa Whitford Excerpts

Wednesday 30th January 2019 Westminster Hall

[John Lamont]

The hon. Gentleman makes an excellent point, and raises a very good example. My brother’s father-in-law sadly died a couple of weeks ago. His treatment was provided by Leeds hospital, so I know the tremendous amount of resource and expertise they have in that particular hospital.

For breast cancer in Scotland, the mortality rate was 53 per 100,000 women in 1992. That has fallen to 32 per 100,000, despite the incidence of breast cancer increasing. In short, we are much better than we used to be at both identifying and treating cancer. That is because the UK has taken the steps that World Cancer Day promotes—in particular, tackling tobacco use and obesity levels and rolling out national cancer strategies.

Big issues clearly remain; pretty much all the cancer charities I have spoken to ahead of today’s debate agree with that. We need to get better at early diagnosis, because we know how much of a difference it can make. For example, if bowel cancer is diagnosed early, nine in 10 people will survive, but with a late diagnosis, the survival rate is only one in 10.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Does the hon. Gentleman agree that research shows that the awareness around breast cancer means that women come forward quickly, but with bowel cancer people do not? Research done in the west of Scotland showed that the biggest delay was in going to the GP. We need to get people to talk about it, be open about it and go and get help.

[John Lamont]

I could not agree more. There is an awareness issue. Often, when people develop some symptoms that they are unsure of, they are nervous about going to the doctor. People need to be encouraged to step forward and go to their GP, to ensure that if there is an opportunity to get an early diagnosis, that is achieved, because the results are clearly much more positive if that is the case.

That is why we have early diagnosis targets across the UK, and why it is so serious that in Scotland, more than 20% of patients are waiting for longer than the six-week standard for diagnostic tests. Too many people are waiting too long for treatment. NHS boards north of the border are meant to take no more than two months to start treatment, but that target is being missed for every type of cancer. In some health boards, one in five patients did not meet that target. I am sure we have all received emails from patients who are faced with an agonising wait for treatment, knowing that they have cancer. While the missed targets are by no means unique to Scotland, I hope that we can all come together here—Scottish National party colleagues included—to call on the Scottish Government to make clear that that needs to get better.

I should also be interested to hear the Minister’s views on whether any consideration has been given to reviewing treatment target times with a view to introducing faster treatment targets for certain types of cancer. It strikes me as odd that across the UK our targets are the same for all cancers, regardless of type.

One significant reason for the time taken to diagnose and treat is problems to do with workforce. Demand for tests is only going to increase, due to a growing and ageing population, but we already do not have enough staff in a range of areas.

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[John Lamont]

I am grateful to the hon. Lady for sharing her experience. This all needs to be looked at. As I said, DLA and PIP should at the very least be backdated to the date of diagnosis. Additional support, particularly for parents like those in my constituency who have to travel such long distances to access treatment, should be factored into the calculation of how much they might be entitled to. We need to ensure that the system at least recognises those extra financial pressures.

[Dr Whitford]

I utterly agree with the hon. Member for High Peak (Ruth George) on financial support. Macmillan Cancer Support estimates that having cancer costs £570 a month, which is very difficult for some families. Will the hon. Gentleman suggest to the Minister that removing the expensive parking charges at hospitals in England would make a little difference? At the moment, a parent being stuck in hospital for eight hours and then paying through the nose for parking adds insult to injury.

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[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) for securing this important debate.

It is staggering that about 4,600 women and more than 20 men in Scotland are diagnosed with breast cancer each year. Sadly, few people, particularly males, realise that men can also be affected. My researcher was diagnosed with breast cancer nearly 16 years ago and remains eternally grateful for the care and support she received from the national health service. Her paternal grandmother and great-aunt were of a different, less fortunate generation and lost their lives to breast cancer shortly after diagnosis, although a delay in seeking assistance was undoubtedly a factor in their demise.

Regrettably, previous generations were often reticent to seek assistance, perhaps due to a lack of knowledge or embarrassment. Encouraging openness and interaction, as World Cancer Day does, and media campaigns from the national health service and various cancer charities are vital if we are to empower people through education and advocacy, including peer support, to improve their quality of life and life expectancy following a cancer diagnosis.

[Dr Whitford]

I welcome the mention of embarrassment. Does the hon. Gentleman not think that we have a particular job to do with men to get beyond the embarrassment of talking about bowels, bowel motions and other bodily functions? If people cannot talk about it with their families, they will struggle to talk about it with a GP.

[Bill Grant]

I totally agree; I am of the embarrassed generation. It is challenging for males—I concede that it is men in particular—to go to the general practitioner, but we need to educate them about making that first contact and being conscious of the risk. It is particularly my generation; the generation following are a bit less self-conscious and more eager to go to the GP, where they will find that help.

As a member of the Select Committee on Science and Technology, I have become acutely aware of the importance and benefits of research. In 2014, the city of Glasgow, not far from my constituency, hosted the European breast cancer conference. Such conferences bring together experts in their respective fields to share knowledge and experience for the benefit of patients and to consider preventive measures for the future, such as developments in immunotherapy that harness the body’s immune system to target cancer cells. As I understand it, such developments may be able to complement, if not replace, radiotherapy and chemotherapy, the side effects of which many breast cancer patients find more challenging than the cancer itself.

Treatment has very much improved, recognising the importance of body image in an era when the media often seek to portray the perfect person. The charity Breast Cancer Care stages regular fashion shows in which those who take to the catwalk have themselves been cancer patients. The male and female models, resplendent in their latest outfits, send a very clear message that they have beaten or are robustly fighting cancer.

Tamoxifen, a common medication for breast cancer treatment, is now just one of a range of drugs available to patients. It was heartening to learn of the Scottish Medicines Consortium’s decision to approve the life-extending drug Perjeta for routine use in treating secondary breast cancer on Scotland’s national health service. Compared with existing treatments, the drug apparently has the potential to offer valuable time to those with incurable HER2-positive secondary breast cancer.

Nowadays, cancer is treated by multi-disciplinary teams that include GPs, surgeons, oncologists, radiographers, radiologists and clinical nurse specialists. It is crucial that we have appropriate succession planning so that we can replace those vital experts as they reach retirement age or change career for whatever reason. It is quite concerning that 20% of breast radiologists in Scotland are predicted to retire before 2025, according to the charity Breast Cancer Now. We need to get the wheels in motion to replace those very important individuals.

Cancer is a challenge to our society. It changes people’s lives in different ways, and sadly some go on to develop lymphoedema. However, collectively we can meet that challenge. Some countries have a lesser incidence, so it may be prudent, as an aspect of self-help, to reflect on diet and lifestyle choices in the UK that may have a bearing on development or outcomes. The potential effects of obesity, cigarettes and alcohol need to be seriously addressed. That apart, we need to focus on the future needs of the researchers and medical professionals to protect the population who are at risk of cancer.

Finally, my constituents and I thank the national health service professionals, the volunteer drivers, the penguins of Dundee, the marathon runners from the borders and the charities. They all make the challenge of living and dealing with cancer that wee bit easier.

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[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is great to have this debate on the 20th World Cancer Day and I, too, congratulate the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont)—we need shorter constituency names—on securing it.

Obviously, it is very clear in my record and from my previous speeches that I have been a breast cancer surgeon for over 30 years. When I graduated in the 1980s, the survival rate from breast cancer at five years was approximately 53%; we are now in the high 80s and approaching 90%. However, breast cancer is not just about survival. In those days, treatment was incredibly destructive. Women lost their breasts through mastectomy and had very harsh radiotherapy, the side effects of which were awful, and there was very little in the way of other forms of treatment.

Now, we practice much less destructive surgery; we have computed tomography-planned radiotherapy; and our drugs are designed and developed, such as the immunotherapy that the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned. So the treatment has moved on, the survival rate has moved on and the impact on patients has moved on.

Critical to that movement, as is said over and over, is early diagnosis; that is the importance of screening. However, what we are seeing in many screening programmes, particularly in breast cancer screening programmes, is a gradual fall-off. So it is important that we encourage people to attend the screening that they are suitable for, whether that is cervical screening or breast cancer screening, or—as I say—people putting poo in the post once they reach that age, examining themselves, and not being embarrassed to go and see a doctor.

We have raised this issue in previous discussions, but we are lucky enough in Scotland that bowel screening—the poo in the post programme—starts at 50, and because the endoscopy that results from a positive test does not just treat cancer but gives us the opportunity to remove a polyp, the incidence of bowel cancer in men in Scotland has fallen by 18%. So bowel cancer screening is not just finding cancer early; it is a chance to prevent the cancer from developing. The Government said last August that they would also move to that earlier screening age instead of 60, and I would be grateful to know from the Minister roughly when that change will happen.

However, what challenges screening, as Members have already talked about, is workforce. Radiology is not just an issue in Scotland; radiology is an issue right across the UK. I am co-chair of the all-party parliamentary group on breast cancer and our report last year—“A Mixed Picture”—showed very clearly that as three radiologists retire, they are likely to be replaced by only two.

The other group is endoscopers. If we are running screening, and if screening in England is going to start earlier, that will generate more endoscopies. The NHS is not buildings and machines; it is people. That is a challenge for all of us and I have to say that unfortunately I think Brexit will make workforce more difficult as we go forward.

The number of cancers increases as we get older, as does the complexity of treatment. We are discovering new drugs by design, genetics and cell biology rather than just by accident, as many drugs in the past were found. We have to turn that around. We talk about access to a new drug that might be £100,000 a treatment, but how much cheaper to try to prevent the cancer in the first place? Most members of the public know that smoking is the No. 1 cause, but smoking has been going down, particularly since the smoking ban in the mid-2000s. In fact, lung cancer incidence in men is down by just over 17%. That means 17% of men not getting lung cancer, not having a big operation and not dying from it. There is absolutely no treatment that will achieve that.

What many people do not know is that obesity is the second commonest cause. We have discussed things such as childhood obesity strategies, and the need for a watershed on advertising, high-quality school meals and active transport, so that it is easier for people to maintain a healthy weight and to remain fit. We live in an obesogenic society; it is really hard for people to resist things when they are bombarded from every direction. Low-quality carbohydrate food is still much cheaper than fresh vegetables and protein. That always means people are slanted in the wrong direction.

Alcohol is also a cause of cancer. I am proud that, after five years of being dragged through the courts, the Scottish Government have managed to introduce minimum unit pricing, particularly to tackle white ciders—the really poor-quality alcohol at the lower end of the spectrum.

To tackle cancer, the best strategy is to prevent it. That requires a health-in-all-policies approach right across every Department and Government. As well as preventing cancer, that would prevent many of the chronic illnesses that cause debility in older life. As well as preventing cancer, it would prevent other suffering; we would improve the quality of life of our senior citizens. That is something we should all aspire to.