Cervical Cancer Screening

Steve Rotheram Excerpts

Thursday 1st May 2014 Commons Chamber

[Steve Rotheram (Liverpool, Walton) (Lab)]

I beg to move,

That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.

I am grateful for the opportunity to bring this important debate to the Floor of the House, although I wish it was not under such tragic circumstances. The number of MPs present does not necessarily reflect the wider public interest in the issue. Perhaps that shows that many MPs have lots of competing interests and that many who would have liked to have been here today are, unfortunately, unable to attend.

I want to place on record my thanks to members of the Backbench Business Committee, skilfully chaired by my hon. Friend the Member for North East Derbyshire (Natascha Engel), for listening to the voices of the tens of thousands of people who wanted this issue debated, and to the Leader of the House for recognising the considerable national interest in it. I also thank the Liverpool Echo, the Daily Mirror and the Daily Mail for their continued coverage of Sophie’s case and the steps they have taken to raise awareness of this debate and, more importantly, the issue of screening and the early identification of symptoms, which I will go into in more detail during my contribution.

I want to place on record my gratitude to Sophie’s mum, Peri, and to each and every one of the 321,925 people who signed the online petition following the heartbreaking death of her daughter earlier this year. They made history in the process by accumulating the largest ever number of signatories to a Government e-petition.

There has been a lot of speculation and conjecture about what is actually being requested today, but my motion, seconded by my hon. Friend the Member for Wirral West—

[Alison McGovern (Wirral South) (Lab)]

South!

[Steve Rotheram]

Sorry—she will kill me for that!

The motion is clear in its intent. I am not calling for the introduction of routine cervical screening for all women and young girls under 25, but I am calling on the Government to issue guidance that stipulates that all women should be able to request a cervical smear regardless of their age. Put simply, young women and teenage girls who present to their GP with possible symptoms of cervical cancer should have the choice, if they so desire, to have a smear test, but that must of course go hand in hand with extensive consultation with their GP to ensure that they are informed of all the potential consequences of the procedure. Given the limited number of cervical cancer cases in women under the age of 25—just 47 in England in 2011, according to Department of Health figures—such an option would not open the floodgates to thousands of unnecessary, costly or possibly damaging tests for young girls.

The motion is an attempt to promote the issue, and to encourage the medical profession to take up the provision that is already available to doctors of granting screening tests to females of any age in exceptional circumstances. It must be said that some of the medical profession are clearly not exercising that power, and that has proven fatal in cases such as Sophie’s. Indeed, at the heart of the motion is one simple premise—that a woman of any age over 16 should, through written departmental guidance, have the right to make an informed choice for themselves.

I will highlight areas in which I believe the Government could take immediate action to educate and inform both patients and medical professionals better about the symptoms and diagnosis of cervical cancer in young women and teenage girls, but I want to make it clear that I am very much of the opinion that any changes to age restrictions must be evidence-based.

Sophie Jones was a much-loved and popular 19-year-old girl from the Wirral who had her whole life ahead of her. She had fashioned a successful career in modelling, and was described by her twin sister Ashleigh as

“the life and soul of everything”.

In 2013, after experiencing constant stomach cramps for more than a year, Sophie visited her GP. She advised her doctor of her symptoms and asked for a smear test. Sophie knew that something was seriously wrong, but she was continually refused a test solely on the basis of her age. Instead, Sophie’s GP incorrectly diagnosed her with Crohn’s disease. Last November, Sophie was forced to enter hospital permanently, due to the deterioration in her health and the escalation of her condition. Despite that, numerous doctors still failed to recognise her symptoms or to diagnose her illness accurately.

Eventually, Sophie and her family’s worst nightmares were confirmed when she was diagnosed with cancer of the cervix. Tragically, by the time doctors were able to make an affirmative diagnosis, it was too late. The cancer had spread to other parts of her body, and by then she was terminally ill. For four months, Sophie fought against her devastating disease and, with her family and friends alongside her at her hospital bed, fought bravely to the end. On 15 March, after four long and excruciating months, Sophie’s defences were overwhelmed by her condition and she lost her struggle for life.

There was a time in Britain when a cancer diagnosis struck the fear of God into people, but thanks to advances in medical treatments and preventive measures, early diagnosis ensures that cancer patients survive in more than half of cases. Cancer is no longer a death sentence if caught early enough. Sophie’s diagnosis came too late for treatment to be successful, but it should never have been that way. That is what makes her case so painful for her family and friends.

I know that I speak on behalf of my hon. Friends the Members for Wirral South and for Liverpool, Wavertree (Luciana Berger) when I pay tribute to Sophie’s family and friends for the dignity that they have shown, and for their determination to highlight Sophie’s story to prevent anyone else from ever having to go through what they have been through. Sophie was failed by the current system, and that should not be allowed to happen to anyone again.

Moreover, I am confident that Sophie’s case is not an isolated incident. I am aware of other cases, and other Members will speak about cases that have been brought to their attention. Those cases include that of Maryanne Makepeace, who was told that she had a water infection, before she was finally diagnosed with terminal cancer.

Just last week, the BBC in Wales reported the case of 20-year-old Jessica Bradford, who was also told by her GP that she was too young for cancer. Initially, she was diagnosed with thrush, with the doctor believing that she had a sexually transmitted disease, but Jessica was eventually diagnosed with cancer of the cervix. She has been told that she is now infertile, having undergone radiotherapy and chemotherapy. That is one example of how a woman exercising her right to a test resulted in her being given treatment, which I hope will lead to a full and complete recovery.

Cervical cancer is the second most common cancer worldwide. It is the 11th most common cause of cancer-related deaths in the UK, amounting to about three in every 100,000 women, according to the crude mortality rate of Cancer Research UK. There are, on average, just short of 1,000 deaths from cervical cancer each year in the UK. Three women are diagnosed with the disease every day.

As Jo’s Cervical Cancer Trust points out, almost all cases of cervical cancer are caused by the persistent high-risk human papilloma virus. The NHS guidance on the HPV vaccine indicates that 99% of cervical cancers are caused by an HPV infection, and that four out of five sexually active adults will come into contact with it during their lives. The condition is not one that solely women can get; men also carry the HPV virus. The thing is that many people do not necessarily present with any particular symptoms.

It is worth highlighting the other risk factors that can affect a woman’s propensity to develop cervical cancer. They include smoking, as carcinogens weaken the immune system and leave the individual more likely to attract an infection of the cervix, as well as unprotected sexual activity at an early age, teenage pregnancy, multiple births, decreased immunity in women receiving immunosuppressant drugs and, in some cases, mothers given the DES—diethylstilbestrol—infertility drug when pregnant. Some medical opinion suggests that long-term use of the contraceptive pill, for instance for more than 10 years, can slightly increase the risk of developing cervical cancer, although I am sure there is consensus that the benefits of the pill far outweigh the risks for most women.

The previous Labour Government’s decision to introduce the HPV vaccination programme was extremely apposite. It has saved and will continue to save many thousands of lives across the country. However, we must be relentless in rolling out the vaccination programme in our schools and colleges. Typically, year 8 girls—those aged 12 and 13—are offered the vaccination, and the take-up rate is about 80%. The vaccination offers protection against their developing the condition in later life. A catch-up programme was also introduced by the previous Government in 2009-10, in which almost 1 million girls aged between 12 and 18 were vaccinated. The continued roll-out of vaccination in girls before they become sexually active will greatly decrease the chances of their contracting the infection, and it will increase the chances of cervical cancer survival.

As many as 2,800 women a year are diagnosed with cervical cancer, and more than a third of sufferers die each year because of the failure to catch the cancer through early diagnosis. It is impossible for women on their own to detect abnormalities in cervical cells, but symptoms that seem inconsequential when taken in isolation can amount to a clear indication of cancer of the cervix when assessed cumulatively. Those include abnormal bleeding during or after sexual intercourse or between periods, post-menopausal bleeding if a woman is not on hormone replacement therapy or has stopped it for six weeks, unusual and/or unpleasant vaginal discharge, discomfort or pain during sex, and lower back pain. As the cancer develops, it can cause additional symptoms such as frequent urination, blood in the urine, rectal bleeding, diarrhoea, incontinence and lower-limb lymphoedema.

[Alison McGovern]

My hon. Friend is giving an excellent description of the symptoms that everyone should be aware of. It is refreshing to hear a man talking about the symptoms of women’s cancers. Does he agree that one thing that we can definitely do today is raise the awareness of those symptoms and encourage men and women to understand more about women’s cancers?

[Steve Rotheram]

My hon. Friend makes a powerful point. In all honesty, I did not know an awful lot of this information before I was asked to head up the campaign in the Backbench Business Committee to get this matter debated in the House. I suspect that the same is true of many male colleagues on both sides of the House and many men in the wider public. We must destigmatise the use of words like “period” or “vaginal discharge” by men, because it is important that such things can be spoken about openly. As the father of two daughters, I certainly want them to be aware of the symptoms of this condition, so that they can bring them to my attention and I can help and guide them should they need a consultation with the GP. This is an important matter for us to debate in the Chamber. I am sure that other colleagues will go into the symptoms of this horrible disease.

The danger of highlighting the symptoms is that some women might misdiagnose themselves, causing them unnecessary worry. Conversely, if doing so means that one person with the symptoms is diagnosed with cervical cancer and has her life saved, it is well worth it.

According to the NHS figures, the vast majority of women’s test results come back normal. For about one in 20 women, the test will show some abnormalities in the cells of the cervix. Most of those changes will not lead to cervical cancer and the cells often return to normal on their own. Indeed, that is particularly true of young patients. In some cases, the abnormal cells need to be removed so that they cannot become cancerous.

About 3,000 cases of cervical cancer are diagnosed each year in the UK, which amounts to 2% of all cancers diagnosed in women. As I have stated, cases of cervical cancer in women under 25 years of age are extremely rare. They amount to about 1% of all cervical cancer sufferers in England. However, the relatively small number of occurrences should not be dismissed as statistically negligible. The mission of the NHS cervical screening programme is

“to reduce the number of women who develop cervical cancer and the number of women who die from it.”

The screening programme is credited with saving the lives of about 5,000 cancer patients a year across the board.

In 2004, the last Labour Government increased the age at which young females could have a test from 20 to 25, in accordance with international recommendations from the World Health Organisation. America has adopted the position that a test should happen at 20 years of age or within three years of first sexual activity, whichever comes earlier. To me, that seems an appropriately flexible policy to have. It is estimated that early detection and treatment prevents up to 75% of cervical cancers. The contention centres on the appropriate age at which screening should become routine and on the health consequences for somebody who chooses to have a test before the recommended age of 25.



So that I am not accused of presenting an imbalanced view of the medical thinking on this issue, I should say that there is an opinion among some professionals that smear tests on young women and teenage girls can lead to false positives, unnecessary treatment, anxiety for the patient, infertility or pre-term delivery later in life. There can also be discomfort, embarrassment or, less commonly, pain during the screening test. There is a very small chance of getting incorrect results, which could lead to abnormalities being missed or to unnecessary distress and treatment. There is also a chance of unnecessary treatment occurring if the abnormalities would have corrected themselves naturally. Some of the treatments that are used to remove abnormal cells may increase the risk of premature delivery in pregnancy.

Undoubtedly, there is still extensive debate in the medical profession about whether tests on young women would have the desired impact. In 2009, the British Medical Journal released a paper on the effectiveness of cervical screening with age, which concluded:

“Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on advanced stage tumours in women under age 30. By contrast, screening older women leads to a substantial reduction in incidence of and mortality from cervical cancer.”

For that reason, it is important to reiterate that the motion does not call for routine screening for under-25s.

I believe that it is the duty of any Health Minister to adhere to the medical advice that is presented to the Department. To my knowledge, no new evidence has emerged that is substantial enough to change the Government’s position on screening ages. I believe that, at this juncture, it would be prudent to follow the decision of the Advisory Committee on Cervical Screening in 2009 to reaffirm the policy that the age for routine screening should remain at 25. However, although it is right that politicians should not ride roughshod over medical experts, it is the job of Health Ministers to examine the orthodoxy of the day, to keep matters such as age restrictions under constant review if new evidence emerges and to scrutinise international patterns and comparisons.

I must mention that I am not a medical expert. My opinions are predicated on what I have read and learned about the subject. The debates on either side of the screening argument need to be qualified by further research. I believe that there are steps that the Minister can take right now to address those concerns and the concerns that have been highlighted by Sophie’s death. For me, the Minister should get to work on five things immediately.

First, the Government should address the online advice and guidance that is available to young women and girls who suspect that they have the symptoms of cervical cancer. At present, it is far from adequate. In the course of my research for this debate, I was amazed at the total non-existence of good online advice for young women who suspect that they are displaying the symptoms of cervical cancer. Despite young people having a higher propensity to use the internet to access information than most adults over the age of 30, there is an absence of advice on what steps should be taken by young people who are concerned that they are exhibiting the symptoms and on the support that is available. On the NHS “Your health, your choices” website, there is no mention of what young girls or teenagers should do. Instead, there is a vague information section on smear tests for over-25s. Users of the Public Health England website are forced to wade through pages and pages of material and to follow hyperlink after hyperlink before they finally find the information that they need in the frequently asked questions section. It appears that some of the information online—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I was very reluctant to interrupt the hon. Gentleman, but he has been going on for over 23 minutes. Other Members wish to speak and there are other debates today. The guidance is that Members should speak for 10 to 15 minutes, so I have given him a lot of latitude. I would be grateful if he thought about speeding through his points so that we can move on to another speaker.

[Steve Rotheram]

That is not as I was informed, Madam Deputy Speaker, so apologies if I have overrun my time limit. I was told absolutely the opposite. I will try to conclude, and I will contact the Minister in writing with any points that I miss out.

Whatever is said and decided today, this debate needs to be the beginning of the process, not the end. I said when I made my application to the Backbench Business Committee on 8 April that I was there as a spokesperson for the 320,000 signatories to the “Sophie’s choice” petition. Today, I have presented their case, which is a case for women’s right to choose, for clearer medical guidance for patients and professionals, for improvements to the sex and relationships education system—I will inform the Minister about that in writing—and for immediate action to tackle the blind spot that exists in the vaccination programme for 19 to 24-year-olds.

We must not forget that it was the people who put this debate on the Floor of the House today, and now it is time for the Government to listen to the British public and act. In their name, let us ensure that Sophie’s legacy is a life-saving one, so that her family and friends can take comfort from the fact that despite failings of the highest order in her case, Sophie did not die in vain.

--- Later in debate ---

[Steve Rotheram]

I thank all Members who have taken part in today’s debate, especially the Minister and the shadow Minister. As I said to the Backbench Business Committee, Parliament is often accused of debating only issues that stimulate interest in the Westminster bubble and that do not resonate with the wider public. That accusation cannot be levelled at us today. My hon. Friends the Members for Wirral South (Alison McGovern) and for Liverpool, Wavertree (Luciana Berger) have met Sophie’s family, and their contributions today were examples of how moved they have been by this case and reaffirmed my belief that we should do everything we can as parliamentarians to use Parliament as a mechanism to put this issue on the national media agenda.

I thank the hon. Member for Basildon and Billericay (Mr Baron) for his insightful speech, much of which I agreed with, in particular his excellently made point about the need to focus on outcomes rather than targets. The right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Cheltenham (Martin Horwood) rightly highlighted the conflicting advice by some in the medical profession about the dangers of smear tests for young women, and the recent Sasieni research, which calls into question the guidance from 2009.

My hon. Friend the Member for West Ham (Lyn Brown) spoke about the work of Sir Robin Wales and Newham council, and I pay tribute to both. I thank my hon. Friend the Member for North Ayrshire and Arran (Katy Clark) for raising the case of her constituent Suzanne Fernando, and for the work that she is doing to support Suzanne’s work. It is a first-class example of how MPs can play their part in raising awareness. I also thank the hon. Member for Strangford (Jim Shannon), who spoke of his support for the HPV vaccination programme.

The purpose of this debate was to put cervical cancer, its symptoms and the anomalies that exist in its detection on the agenda, and I believe that with the support of more than 320,000 signatories, we have achieved that. I am positive that through the dedication of her family and friends that she left behind, this debate will go some way to ensuring that Sophie’s legacy is a life-saving one for many young women in the future, and I hope her family can at least draw some comfort from that.

Question put and agreed to.

Resolved,

That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.

[Sadiq Khan (Tooting) (Lab)]

On a point of order, Mr Deputy Speaker. You will be aware that we on the Labour Benches have on a number of occasions expressed concern about the Government’s policy on legal aid and its consequences. This morning His Honour Judge Leonard QC sitting at Southwark Crown Court stayed proceedings in the Crown v. Crawley and others, a £4.5 million fraud trial, after he heard representations from one of the country’s leading and most respected QCs that the case should not proceed, as a fair trial was not possible because of the consequences of the legal aid changes introduced by the Lord Chancellor.

This case alone has cost the taxpayer tens of thousand of pounds and justice has not been done, but it is extremely serious for the criminal justice system in this country, which has not just been brought into disrepute, but is now rendered ineffective by a Lord Chancellor who is out of his depth. [Interruption.] I understand that there are at least eight other complex criminal cases, including—