CERVICAL CANCER (Hansard, 26 January 1966)

§ Mr. Clifford Williams (Abertillery)
I am very grateful for the opportunity to speak about the cytology service. Cancer is a word which strikes fear into the hearts and minds of everyone. It is an ugly, virulent, painful and deadly disease which, despite all the effort and specialised dedicated work, over many years, of countless qualified and eminent men, and despite all the money which has been poured forth from charitable organisations and the central Government over many years, we have not yet mastered. I express the hope that medical research specialists will, by their devoted work, conquer this disease as they conquered tuberculosis some years ago, to the everlasting benefit of mankind.
I have been privileged to spend 35 years in hospital administration. I remember the days when, with our begging bowls, we collected pennies and halfpennies to keep open the doors of our cottage hospitals in times of extreme poverty. In these later years, in the so-called affluent society, I have been aware of so much more that could have been achieved to relieve the sufferings of many people if the will and determination of the Government of the day had been evident. But, generally speaking, we who were hospital administrators still held out our begging bowls for the expansion and development so urgently required in the hospital services.
The need for more rapid development of the cytology services is shown by the following statistics. About 2,500 women die each year in England and Wales from cancer of the cervix; 2,597 died in 1964—and a further 1,106 from cancer of the body of the womb. Of these, 2,544 were aged 35 or more; and 2,500 represents approximately 1 per cent. of all female deaths. Moreover, deaths from cervical cancer account for about 4 per cent. of all deaths in women under 50. These deaths also account for over 5 per cent. of all female cancers, or more than a quarter of the cancer deaths in women under 50. So the problem is one that 361 affects many women with an otherwise good expectation of life. Statistics show that social and economic circumstances play a significant part. Mortality is higher in the lower income groups.
These are frightening figures, but the terrible tragedy is that if we were in a position immediately to give an adequate service to all women at risk by making available routine screening for cervical cancer, taking smears and examining them, we could in a very short period, by these preventive methods, very nearly completely banish this disease and remove the haunting fears of women.
I am very pleased with the recent developments of the cytology services in Wales. The rate of progress in Wales has been particularly encouraging. Testing has increased from 938 in December, 1964, to 2,615 in June last year. This is a faster rate of growth than in any region in England, and we may hope that the return for December last will show that rapid progress continues. The number of pathologists and technicians trained has risen from three and five respectively in December, 1964, to six and 17 in June last. Three local health authorities—Monmouthshire County Council, Newport Borough Council and Cardiff County Borough—are taking part in the screening. I want to pay full tribute to these authorities and to the Newport and East Monmouthshire Hospital Management Committee for providing hospital laboratory services and technicians to deal with this grave disease. I should also like to pay tribute to their excellent co-operation and the excellent progress they have made.
Mr. Minister, I know that you are very much alive in the field of preventive medicine, and I know that steps have been taken to develop the service, and I also know that it takes time to train men as screeners to a very exacting standard indeed. But I must ask you, Mr. Minister, whether we are doing enough.

§ Mr. Deputy Speaker (Sir Samuel Storey)
Order. The hon. Gentleman must address his remarks to the Chair and not to the Minister.

§ Mr. Williams
I ask whether we are doing enough to meet the menace of cervical cancer. What further measures are needed? Is it possible to double or per- 362 haps treble the number of pathologists and technicians? If there is a shortage of space in existing hospitals to set up these pathology laboratories, will your Department consider mobile testing stations throughout the country?

§ Mr. Deputy Speaker
Order. The hon. Gentleman must address his remarks to the Chair. He must not refer to my Department. This is the Minister's responsibility. The hon. Gentleman can only address the Minister through the Chair.

§ Mr. Williams
I thank you, Mr. Deputy Speaker. Perhaps you will forgive my innocence in these matters, for I have not had very long experience in this House. I think that this is only the second occasion on which I have made a speech and I am grateful for your guidance. If I err again, I hope that I shall receive your correction and continue in the proper manner.
I do not think that enough is being done by publicity. We should do a lot more to make the facilities available known through the Press, radio and television, in simple language and thereby remove the fears and misunderstandings about cervical cancer that so many women dread. We should let them know how they can take advantage of the service that must be provided so that their fears and apprehensions can be removed in our time.
I am informed that the test is simple. But it is important to detect the early stages of womb cancer for it to be treated successfully. If it is treated at an early stage, only a minor operation is necessary, requiring a stay in hospital of only 7 to 10 days for a complete cure.
It is estimated that 15,000 to 20,000 women suffer from womb cancer. These are frightful figures and it is a frightful disease. The problem is desperately urgent and I do not think I can be accused of exaggeration when I say that if, in the near future, we could have full cytology services we would save the lives of 3,000 women. In doing so we should earn the eternal gratitude of everyone concerned. I speak on this subject with some feeling and, indeed, I believe I speak for the whole House in asking for a more rapid development of this service to halt the dreadful disease afflicting so many women.

§ The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)
My hon. Friend the Member for Abertillery (Mr. Clifford Williams) has done the House a service in raising the question of the speedier development of testing for cervical cancer. This is an important development in the National Health Service and one in which the women of the country, through their national and local organisations, have shown and are showing an increasing and special interest.
There can be little quarrel with many of the statistics my hon. Friend has given. He asked whether we can proceed more quickly in the development of this very important service and it is on this, perhaps, that we should focus our attention.
In the time at my disposal I want to try to assure my hon. Friend that we are proceeding with the service as fast as is humanly possible. We have made considerable progress in recent months and our last returns—those for June—showed that the development of the service was accelerating. I am not arguing that progress was so fast that it could be described as spectacular, but I can say that it was striking. The rate of testing, which stood at 39,000 per month at the end of 1964, had risen in the intervening six months to nearly 51,000. This represents an annual rate of more than 600,000 women tested, an increase of close on 30 per cent. I have no doubt that the figures for the end of December, when they are available, will be much better still.
The detailed picture provided by the June returns showed, as one would expect, plenty of variations in the speed of progress over the country as a whole. In some areas routine screening was well under way; in some it was starting; while in others it was still limited to a diagnostic service for patients with symptoms. Varying local circumstances account for this. There are variations in the speed of recruitment and training of laboratory staff; the degree of financial priority hospital authorities are able to give to the service; the extent of co-operation by family doctors and local health authorities; and the local differences in the proportion of women coming forward for testing.
364 While we are very optimistic, the future rate of development is difficult to forecast with any accuracy. Progress so far has been better than anticipated; on the other hand, we cannot blind ourselves to the possibility that unsuspected snags may lie ahead. But the indications are that by the end of this year screening should be locally and readily available to well over half the female population over 35 and we hope that it will be possible then for any women anywhere who specially want the test to obtain it.
Not only the pace but the pattern of development varies from area to area. Cervical cancer testing is a co-operative venture between the three branches of the Health Service and the emphasis differs in different places. We have not sought to impose a uniform pattern and this variety and flexibility are to be welcomed. Everywhere smears are examined in hospital pathology laboratories, but they may be taken in family doctors' surgeries or in hospital, local authority, or voluntary clinics.
However, while most of the smears are still taken in hospital clinics, the proportions taken elsewhere rose from about a quarter at the end of 1964 to a third in June, 1965. The number of smears taken by family doctors almost doubled and those by local health authority clinics trebled. This illustrates the increasing importance of the part being played by family doctors in this service. The House will be interested to know that the subject of the smears has been discussed with the B.M.A. in the current negotiations and we hope as a result of these negotiations to get increasing participation by the doctors in this type of work.
The fact that the family doctors are participating in this work gives us a great deal of hope for the future. The contribution from the local health authorities—and I was glad that my hon. Friend mentioned the local authorities in Wales—deserves the special attention of the House. While the number of councils which had taken powers to participate in screening was only three at the end of 1964 it is now 66; and 26 others have either applied for powers, or expressed interest in doing so.
Altogether, this represents more than half the local health authorities in the 365 country. Local councils are displaying a very commendable interest in this service and my own feeling is that they will play an increasingly important rôle in the development of routine screening.
My hon. Friend will know that the main problem that has faced us is the shortage of laboratory staff trained in cytology. At the end of 1964 hospital laboratories in England and Wales had in post about 200 pathologists and 150 technicians trained in cytology. By the end of June these numbers had risen to 283 pathologists and 383 technicians, with a further 29 pathologists and 131 technicians undergoing training at 5 special centres or under local training arrangements.
The demand for places at the 5 special centres continues to be satisfactory, and we intend to carry on the training programme with all our vigour. These increased numbers of trained laboratory staff are very encouraging and I am certain that with the increasingly solid basis which they provide we can look forward to a steady and continuing expansion of the screening service.
My hon. Friend was quite right when he said that he appreciated that the question of labaratory technicians was the key to the extension of this service. We accept this as axiomatic. We estimate that we should need about 500 whole time equivalent technicians to set up a really extensive national screening service. We have 514 technicians, to whom I have referred. These technicians are not wholly concentrated on this particular service, and they represent only somewhere in the region of 310 whole-time technicians. Even though we have made progress there is still some way to go.
We have recognised the need to increase technicians as being the basis of the service. Unless we can increase the numbers, the service will not expand in the way we want it to. My hon. Friend mentioned the setting up of mobile centres. I do not think that this is "on" at this stage. We have to progress a little more slowly. I do not think it is possible or practicable to introduce a mobile service. We have difficulties in getting technicians and we have tried to meet this problem by recognising the full status of the technicians. The basic 366 grade technicians's salary is now in the range from £805–£1,025 with prospects of promotion to posts with a salary of nearly £2,000.
If we can attract the right kind and number of technicians, we can expect an increasing extension of the service, because we have a situation in which the medical practitioners, the local authorities and the hospitals co-operate to the fullest possible extent—in the main. As in all services, there are the exceptionally good spots. I was pleased that my hon. Friend, being a Welshman, was able to tell the House that Wales again is in the forefront of this aspect of life. There may be very good parts of the country and there may be what might, perhaps, be termed black spots, but we can expand if we can manage to get the technicians that we think we will be able to get because of the great degree of co-operation that exists in the other aspects of the service.
My hon. Friend referred also to publicity. I am not so sure whether it would be wise to go into a wholesale programme of publicity at this juncture. There are times when publicity is of vital importance, but there are other times when, perhaps, it is not quite appropriate. We cannot project our publicity with full and good effect for the money we spend until we are sure that we have the service to take the results of that publicity without inconvenience to those who have been attracted by the publicity.
If there is inconvenience for the people who are attracted by the publicity, it is more likely in the long run to be damaging to the whole service than if we did not indulge in publicity. That is not to say that we do not publicise the service in the women's journals and in other ways, but I do not think that it would be wise to indulge in a radio and Press publicity campaign at this juncture.
My hon. Friend made many references to statistics concerning cervical cancer and its incidence and mortality rate. We recognise the great difficulty with which women are faced and their risk period. We want the time to come when we can have this service extended to all well women, because it is now recognised that provided the problem can be caught in its early stages, the chances of cure are very great and the degree of strain that would be imposed upon the hospital service as a result would be infinitesimal 367 compared with what would happen if the problem went on and was not caught until later.
We want to see the service extended to all well women, but from our statistics so far we think that our aim of extending the service to women of 35 and over and giving them the five-year repeat examination is, perhaps, the best way to deal with the situation in the context of the service that we have been able to create.
My hon. Friend quite rightly asked whether we were satisfied that we were doing all we might do. It is always difficult to say whether one is satisfied or not. In the health field and provision of services of one kind and another, in the short period in which I have held office I have never been really satisfied with any of the services we give, although I recognise that our Health Service is by far the best in the world. I know from day to day experience that there are deficiencies in the service, in every aspect.
It is sometimes a little difficult for anyone with feeling not to have strong feelings about some of the deficiencies, but I am satisfied that in the service for cervical cancer we are doing all we possibly can to provide a service worthy of the Health Service as a whole. We are progressing as fast as we can and there is no impediment of any kind emanating from the Department in the extension of the service. In the progress we have 368 made already, on the figures available for June and which will be available for December, while I shall not perhaps be satisfied that we have a perfect service, I shall be more satisfied with the service which exists then than at present.

§ Mr. Richard Wood (Bridlington)
I did not interrupt the hon. Gentleman earlier, because, obviously, he had some important facts to give to the House, but could he give an assurance that the period between the test and the time when the result is known is cut to the minimum? He will appreciate the national importance of this and also the importance of acting in the result of a positive test as quickly as possible.

§ Mr. Loughlin
I do not want to be dogmatic, or to say things which I cannot prove, but as far as I know speedy action is taken within the confines of the whole service in the locality concerned. It may be that in some localities where there is pressure at a given time for beds a woman cannot be got into hospital quickly enough—