Cervical Cancer Screening

Debate between Steve Rotheram and Alison McGovern

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—

Rail Infrastructure (Merseyside)

Debate between Steve Rotheram and Alison McGovern

Tuesday 12th June 2012 Westminster Hall

[Alison McGovern]

I thank my hon. Friend for his intervention. He and I have tried to work closely together on these issues, for the reasons that he mentions. People do not respect administrative boundaries when it comes to getting a job. We must ensure that people in residential areas, a lot of whom need work, have access to big businesses such as the ones that he mentioned. I hope that I can suggest exactly how we might do so.

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

Hopefully, my hon. Friend will agree that many people separate, isolate or segregate transport as just a means of moving goods or individuals from one place to another. Does she agree that there are also massive economic, health and well-being and social benefits to infrastructure, and that it creates the sorts of job and employment opportunity that she will know are all too needed on Merseyside?

[Alison McGovern]

I thank my hon. Friend for his intervention. He is quite right. If we consider the body of evidence produced by, for example, the Thameslink and Crossrail projects in London, we find exactly what he suggests. Transport infrastructure underpins economic development, but it also gives access to employment, and to the personal dignity involved, to those who currently do not have it. With that point in mind—

Finance (No. 3) Bill

Debate between Steve Rotheram and Alison McGovern

Tuesday 3rd May 2011 Commons Chamber

[Alison McGovern]

Thank you, Mr Hoyle. It would be testing your patience not to stick to the amendment, as I shall endeavour to do for the rest of my remarks.

All Members will realise that the average family, the average couple and the average pensioner are facing a more and more difficult situation as the money coming in has to be stretched even further, and with prices going up in the shops. That is people’s experience. The impact of taxation on fuel prices and its role in driving up inflation and driving down living standards requires investigation and careful thought. This is not just my view or that of just some economist: when I looked into the possible causes of rising inflation in the UK, the first person I thought might have the answer was the Governor of the Bank of England, who, in his letter to the Chancellor about why the Bank had not met the inflation target, cited the VAT rise as one of the inflationary pressures facing the country.

As I said, I am not some inflation hawk who holds to a 1980s antediluvian economic philosophy that inflation is necessarily bad. Some countries have had relatively high inflation as well as growth. However, the important thing about taxation and fuel prices, and their role in inflation, is that it is possible to build in inflationary expectations in the long term through some of these measures. I wonder whether the Government have really thought about what they are doing in not combating some of the issues related to rising prices that we have seen.

There is also an obvious link with people’s worry about the lack of investment at this time. There is no doubt that investment means jobs today and productivity tomorrow, and therefore a more effective economy that enables people to have a better standard of living at less cost. That has to be the aim. At the moment, the Government are balancing the books using VAT and extremely flat taxes that do not pay regard to people’s income. They are asking people in my constituency on relatively modest incomes to pay the same higher prices at the fuel pumps as people in the Chancellor’s constituency down the road in Tatton, who by and large—not universally—are a bit wealthier. That is not fair.

We have to consider carefully whether the increased taxation on fuel resulting from the VAT rise is having a negative impact on the economy in a wide-ranging sense. It is not only about whether fuel prices are up—obviously that could be the result of several things—but, most especially, about what that is doing to inflationary expectations. We need to consider whether it is having a damaging impact on the broader economy, and whether it is a disincentive to growth and productivity improvements in the UK. We also need to consider what it is doing to the living standards of people such as those whom I represent in Wirral and Merseyside who have seen living standards fall severely in the past two years.

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

I am sure that my hon. Friend would agree with the old adage, “You can’t fool all the people all the time”, but that is exactly what the Chancellor tried to do with his 1p tax cut to fuel duty. However, is it not the case that since the Budget, petrol prices have gone up several times more than that 1p tax bribe, and that the VAT increase in fuel duty is causing damage to motorists and businesses—