BREAST CANCER (Hansard, 4 February 1972)

§ Dr. Tom Stuttaford (Norwich, South)
rose—

Several Hon. Members
rose—

§ Mr. Robert Maclennan (Caithness and Sutherland)
On a point of order, Mr. Deputy Speaker. In the hubbub which has occurred you appear to have given a Ruling. It would be useful if you could clarify your Ruling.

Mr. Deputy Speaker
I seem to have given a number of Rulings. To which of my Rulings does the hon. Gentleman refer?

§ Mr. Maclennan
That given in reply to my hon. Friend the Member for Greenock (Dr. Dickson Mabon).

Mr. Deputy Speaker
The Adjournment debate as listed on the Order Paper lasts for 30 minutes from the time it starts.

§ Mr. Mikardo
Further to the point of order raised by my hon. Friend the Member for Greenock (Dr. Dickson Mabon), Mr. Deputy Speaker. As the House decided not to adjourn, it is sitting. Am I not right in thinking that, as the House is sitting, it is the master of its own business and of its own Order Paper? You told us—I am sure rightly—that the Motion for the Second Reading of the Hare Coursing (Abolition) Bill lapsed at Four o'clock. I seek your guidance. Would it be in order for an hon. Gentleman to move again, That the Bill be now read a Second time?

Mr. Deputy Speaker
That would not be in order.

§ Mr. Patrick Cormack (Cannock)
On a point of order, Mr. Deputy Speaker. The subject for debate on the Adjournment of the House is one of absolute importance concerning millions of women. Does it not bring the House into disrepute to have this charade when the debate should be taking place?

§ Mr. Robert Hughes (Aberdeen, North)
On a point of order, Mr. Deputy Speaker. As a comparatively new Member of the House, I seek your guidance arising from the technical position whereby the Motion for the Adjournment of the House failed. 936 In which circumstances is it in order for the Whip who again moved the Adjournment to do so after such a short time? The House having decided not to adjourn, should we not be able to another two hours, say, to allow the House to discuss topics it may wish to discuss, including the Hare Coursing (Abolition) Bill? [HON. MEMBERS: "Get on with it!"] I shall put my point of order. I shall request information in as succinct a manner as I can. Interruptions by hon. Members opposite will simply delay the proceedings. Is it not necessary, before the Adjournment can again be moved, for there to be a Closure Motion? Can we not carry on discussing matters until such time as the debate is closured?

Mr. Deputy Speaker
It is perfectly in order for the Adjournment to be moved again, as indeed it has been. Dr. Stuttaford.

§ Dr. Stuttaford
Before Lloyd George—

§ Mr. McNamara
On a point of order, Mr. Deputy Speaker. It will be within the recollection of the House that at what appeared to be the conclusion of the debate on the Hare Coursing (Abolition) Bill you called—"Second Reading, what day?", to which the reply was given by my hon. Friend the sponsor of the Bill, "Today, Sir". As I understand it, that was accepted; and, the Adjournment not having been moved, surely the business of the House, as agreed to by the House without any opposition, is that today we are discussing the abolition of hare coursing.

Mr. Deputy Speaker
The answer to that point of order is that a debate cannot be continued after it has been interrupted by Standing Orders.

§ Dr. Stuttaford
Further to that point of order, Mr. Deputy Speaker. As 10,000 women a year die of cancer of the breasts—a far greater number than the number of hares killed by coursing—should not the House now proceed to the Adjournment debate?

Mr. Deputy Speaker
That is hardly a point of order, but I call the hon. Gentleman to speak.

§ Dr. Stuttaford
Before Lloyd George—

§ Mr. Marcus Lipton (Brixton)
On a point of order, Mr. Deputy Speaker. By what right, or under what Standing Order, when the Motion for the Adjournment was put for the second time by an hon. Member opposite, did you deny the House the opportunity of voting on that Motion?

Mr. Deputy Speaker
I have done no such thing. The House is doing itself very little credit by raising points of order which are becoming frivolous, having regard to the answers from the Chair, and which are preventing a very important subject from being discussed.

§ Mr. William Price
On a point of order, Mr. Deputy Speaker. May I make it clear that I regard that Adjournment debate as very important, too, and in many respects far more important than the other issue which we are discussing. If the hon. Member for Norwich, South (Dr. Stuttaford) wants me to say that, then I gladly say it. I do not want to disrupt his business. But I understood that it was one of the customs of the House that if an hon. Member lost an Adjournment debate through no fault of his own, the matter was put right the following week, and I assure the hon. Gentleman that I shall be here to listen to him.

Mr. Deputy Speaker
That is not a matter for me.

§ Mr. Hamling
Further to that point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker
There cannot be a "further" to something that is not a matter for me.

§ Mr. Hamling
On a point of order, Mr. Deputy Speaker. If the hon. Member for Norwich, South (Dr. Stuttaford) loses his Adjournment debate, that is not the fault of the Opposition.

Mr. Deputy Speaker
Order. That is a statement which is very interesting, and it may or may not be true. But it is not a point of order. Dr. Stuttaford—

§ Dr. Stuttaford
I want to discuss today—

§ Mr. Peter Archer (Rowley Regis and Tipton)
On a point of order, Mr. Deputy Speaker. It may assist hon. Members if you will clarify our minds as to the posi- 938 tion which the House has now reached. No one wishes the hon. Member for Norwich, South (Dr. Stuttaford) to lose his Adjournment debate. I understand that technically he will be addressing the House on the Motion, That this House do now adjourn. What some of us are a little unclear about is what it is that the House decided a few minutes ago.

Mr. Deputy Speaker
After the debate on the first subject matter had been interrupted there was a Division on a Motion for the Adjournment. That was a technical matter of the adjournment of the debate, and there is now before the House another Motion to adjourn.

§ Mr. Nigel Spearing (Acton)
On a point of order, Mr. Deputy Speaker. I wish to make it clear that I speak in no sense of frivolity, nor do I regard the Adjournment debate of the hon. Member for Norwich, South (Dr. Stuttaford) as unimportant. None of us would dream of doing so. But the procedure of the House is of great importance and, speaking as a relative newcomer, I seek your guidance on this point. I understand that the Adjournment Motion has been moved by an hon. Member on the Government Front Bench, which he has every right to do. I did not hear you put that Motion to the House and I did not hear you collect the voices. Under which Standing Order did you state that that Adjournment Motion had been carried without so doing?

Mr. Deputy Speaker
I did not. I put the new Motion to the House and called the hon. Member for Norwich, South to speak to it. That he has been trying to do for a very long time.

§ Dr. Stuttaford
Mr. Deputy Speaker—

§ Mr. English
On a point of order, Mr. Deputy Speaker. May I ask you what exactly happened after the interruption of business. The hon. Member for Norwich, South (Dr. Stuttaford) was not speaking on the previous Adjournment Motion or you would not have put the Question to the vote. Therefore, is it the case that your calling of the hon. Gentleman has anything to do with this Adjournment debate? When hon. Members lose their Adjournment debates through no fault of their own, there is 939 one course of action available. But the hon. Gentleman was not speaking to the Adjournment Motion that was to have given the opportunity for his Adjournment debate. That has been decided upon, presumably in his absence. I suggest that this is a totally different Adjournment debate.

Mr. Deputy Speaker
The hon. Gentleman has answered his own question. This is a totally different Adjournment debate and an hon. Member has been called for it. I call him again now—Dr. Stuttaford.

§ Dr. Tom Stuttaford (Norfolk, South)
Thank you very much. Mr. Deputy Speaker. I offer you my commiseration together with my fellow feeling, on a very difficult half hour.
I am raising on the Adjournment a matter of considerable importance. In this country, 10,000 women die every year from cancer of the breast. The treatment for this is very effective if it is undertaken early. It is true that it is effective but it is also true that surgeons have quarrelled over the years about the best way of treatment. Be that as it may, there can be no doubt that early treatment for the disease is what is needed. Over the last 35 years, the death rate from most causes has been falling, particularly in the lower age groups, but this is not true of cancer of the breast. For the last two generations, there has been little change in the mortality from this cause.
So, we have a unique situation, because Dr. Stracks and his colleagues in New York have shown a way in which mortality may be reduced, by mammography, a clinical examination by which early diagnosis can be achieved. If it is achieved, the death rate may be halved. Dr. Stracks has undertaken a study of 62,000 New York women taken at random from every social class and every ethnic group. They were all between the ages of 40 and 64. He has shown that these women will double their chances of surviving cancer of the breast if it is found in good time. He has shown, too, that although mammography, the X-ray examination of the breast, is important it is not the only important factor. Clinical examination is important too. Neither by itself is sufficient. There must be the two alternative methods—clinical examination and examination by X-ray. 940 It is true to say that by X-ray of the breast by mammography, one can detect a growth in any woman's breast before it can be detected even by a surgeon. This allows us for the first time to treat these cases at a very early stage.
The treatment is becoming established not only in the United States but also on the Continent, where there is an internationally renowned centre at Strasbourg, and in Scandinavia, Finland in particular. It is disappointing to find that this country, which has so long prided itself on the National Health Service as the envy of the world, is lagging behind. We are not entirely lagging behind, however, because we have three centres which have been doing this screening for early cancer of the breast. I regret that none of these centres has been paid for out of Department of Health funds. They have been privately, independently, paid for.
There is a centre in Newcastle, to which I give due credit. It has found that out of the last 850 patients examined by Mammography with soft tissue X-ray, 13 had early cancer. Perhaps our premier hospital for cancer, the Royal Marsden Hospital, has had a unit—the Well Woman Clinic—operating for some years. The unit has been finding 7 or 8 cases of cancer of the breast per 1,000 women examined.
At the B.U.P.A. medical centre—and I declare some interest because I work there although my income, I am glad to say in no way depends on the number of patients I collect—the figures are interesting. Until 1970, 4,000 people were examined and 19 cases were found. That was until the installation of the Sennograph. Once the X-ray machine had been installed, in June, 23 positive cases were found out of 633 women examined. These units have admirably demonstrated that our figures could be similar to those of Strack's figures for New York if we had this procedure available to the general public, because we could detect a disease at a stage when we could offer women a greater chance of recovery.
The figures are so impressive that we can now have no argument about their validity or significance. The Department of Health will I trust admit that they show there is a need and a demand for us to do something about this. Since we have the National Health Service we must look after the demand as expressed 941 by the general public. We in Government have assumed the rôle of the father of the family of the pre-Lloyd George era. We are responsible for seeing that the advantages of medicine, from whichever part of the world they come, are adopted here and fully exploited for all classes and income groups.
We look forward to hearing today not about research projects and pilot schemes which will confirm the facts we already know, but about the establishment of new units which will form the pilot centres which can be expanded to give us a preventive service which will go round to the factories and the various communities rather as the mass X-ray units did in the past, when women may have their breasts X-rayed, preferably annually when they are at the maximum-risk age. Then we may see a fall for the first time in two generations in the death rate from cancer of the breast.
From discussions I have had with the manufacturers of this machine I know that 12 have been sold to the N.H.S. in the last year. I should like to know how many will be used for the screening of women who hitherto thought they were well, and how many will go to the diagnostic units attached to the surgical departments of our teaching or other hospitals. It is important that we should realise, if we are to develop the service, that we must do so so that the women will have the advantage of these diagnoses before they are aware clinically that they are ill. It has been said, not I trust by the Under-Secretary, that we would never have the skilled personnel available to man a comprehensive system.
This is not true. At the end of the war when we began our mass X-ray units we heard the same arguments. This is even easier. I know the difficulties of reading chest X-rays and I can assure my hon. Friend that these X-rays are simpler to read. Any doctor with special training can soon pick it up. Just as the mass X-ray unit had to use G.Ps. with clerical assistance to read the films so we have to use other doctors to read these things. We can use other staff for such units. Any competent and intelligent nurse can be taught by the correct people the right way to examine a breast so that she will detect any growth that might have been missed by the X-ray machine. She can also quickly learn the correct way to put 942 a woman on the X-ray platform so that she gets a good view of the breast.
If we train a special team we will get better results. The bad results where they have occurred have occurred when radiographers were more interested in detecting the obvious disease than in screening those who are currently helping. We must realise that the N.H.S. has made a belated start. So that we may catch up with the service provided in other countries I ask the Minister to continue the present schemes in operation, to provide finance and to exploit those which are not yet being exploited.
I particularly mention the Royal Marsden Hospital which has a unit working. It is now finding in its Well Woman Clinic 12 cases of cancer for every 1,000 women examined. Yet this unit is starved of funds and resources, so much so that it has had to close its waiting list. It is a waiting list which, at 1st January, was six months long.
That shows very clearly that another argument previously advanced, that women would not come forward, is untrue. Women are intelligent—believe it or not in view of last Friday's debate—and there is no doubt whatever that, given the opportunity, they will come forward in droves to be examined. We want to hear today that the Royal Marsden is to keep its Well Woman Clinic, that it will have the funds and that it will have the room and resources to continue its invaluable services to women of all classes in that part of London.
I would mention my own clinic where we are providing a service for those paying, but the unit would be very happy to throw itself open to the general public for two or three sessions a week so that National Health Service patients may benefit from the expertise which has been acquired through private medicine. This is how it should be. Private medicine should be a leader very often, but it must never be the preserve only of those who can afford to pay. It must show the way and allow others to follow, and open its doors to anyone who comes with the appropriate medical authority.
This is a very valuable pilot study. Both places have found that they can align themselves with general practitioners and so got a random cross-section of people, not pre-selected by some surgical unit because of suspected 943 disease, but women who themselves want to be examined, not because they are ill.
I want to refute another oft-expressed argument, that we are going to frighten the community. We heard this about the E.C.G. system and about the antenatal work. It is constantly the excuse that we shall produce a race of neurotics, a race of people totally obsessed with their health. Is it not true. From that unit 1 per cent. will come away knowing that disease has been found in time to help them; the other 99 per cent. will come away reassured, freed from the dread which hangs over all women, whether they admit it not, young or in early middle-age, of carcinoma of the breast. Thus 99 per cent. will be assured or reassured and there will be hope for the 1 per cent. The scheme is worth pursuing and perservering with.
I briefly turn to the question, how many people will come forward, what the demand will be. From my own experience and the experience at the B.U.P.A. clinic, and the publicity in a recent article in the Observer by Paul Ferris, we know that there is enormous public interest and that the demand will be there. If we are to do this, we must have some very definite replies today. We must know what is to happen, how many units we shall establish in this country, and whether they will be based on hospitals or on health centres or on local authority clinics. We must know of any plan for integration of the existing three units and we must have an assurance that the sennographs ordered by the National Health Service—they can be ordered at fairly trivial cost—will be for the use of the women of this country, whatever their income group may be, so that they also may receive a service which at present is offered to women in New York, in Strasbourg, and in Finland.
I leave the matter there now. I fear that my presentation of the case been somewhat disturbed by our proceedings at 4 o'clock, but I hope that it will receive a satisfactory answer.

§ Mrs. Joyce Butler (Wood Green)
The House is grateful to the hon. Member for Norwich, South (Dr. Stuttaford) for having raised this important topic, and I am especially grateful for the oppor- 944 Utility to say a few words as I am an officially designated founder of the Women's National Cancer Control Campaign. The Campaign changed its name recently and extended its scope from exclusive concern with cervical cancer screening because of the number of deaths from breast cancer. I support what the hon. Gentleman has said and urge the Minister, on three grounds, to take action.
I readily defer to the hon. Gentleman's medical knowledge when he says that we now know the answer, but, as I understand it, there is still some doubt in the minds of many people about the respective merits of mammography and thermography, and some experiments are still being done with blood and urine tests which also may be important. I urge the Minister to make sure that adequate funds are available for the continuation of research even at this late stage. Funds for research and facilities for early detection are still urgently needed.
Second, will the Minister make funds available to the Marsden Clinic so that it may become fully operational once again? It is a tragedy that it has a six-months waiting list and that the Cancer Control Campaign and other bodies formerly able to refer patients to the Marsden Clinic cannot now do so. This is something which the Minister has within his power.
Third, will the Minister consider making public funds available for the suggested clinics in Gateshead, Edinburgh and Guy's Hospital? All this is most necessary.
I cannot entirely agree with the hon. Gentleman when he says that women will come forward in droves. Experience has shown that they need some encouragement to do so, and this is where the Campaign for which I speak today comes in. It is only too willing and anxious to co-operate in a medically supported campaign if the Department will give the go-ahead, accept the suggestions which the hon. Gentleman has made, and get such a campaign launched.
All those who have lost relatives because of breast cancer and who give money for cancer research will, I am sure, support all that has been said in this short debate in urging the Department to put its full weight behind further effort to end this terrible scourge for women.

§ Mr. Laurie Pavitt (Willesden, West)
I add my voice in urging the Minister to take action. There is a precedent showing what can be done. The figures given for breast cancer are immensely larger than those for carcinoma of the cervix. Yet, 10 years ago, there was great concern when the chief medical officer reported that 2,500 women a year were dying unnecessarily from cancer of the neck of the womb. As a result, a campaign was set on foot, exfoliate cytologists were trained, and we had a great screening programme which has been an immense success.
I urge the hon. Gentleman to ensure that resources are transferred to selective screening. If we have preventive medicine, we can save the National Health Service millions of pounds. As I said on other occasions, the whole apparatus which the Department has for mass radiography, which is now not of such importance, could be adapted for selective screening of the kind described by the hon. Member for Norwich, South (Dr. Stuttaford). The Minister has the weapon already to hand. If he cares to use it, it will be of tremendous help in preventing the occupation of hospital beds, preventing people from dying, and preventing the use of valuable surgical 946 resources, and at the same time doing a lot for the nation.

§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
Might I have your guidance, Mr. Deputy Speaker? Do I take it that the Adjournment debate must end at five minutes to five o'clock?

Mr. Deputy Speaker
In a very short time.

§ Mr. Alison
I deliberately did not seek to intervene when the hon. Lady the Member for Wood Green (Mrs. Joyce Butler) and the hon. Member for Willesden, West (Mr. Pavitt) rose to add their contributions to that already made by my hon. Friend the Member for Norwich South (Dr. Stuttaford) because I felt that it would be impossible for me in so short a time—because of the peculiar events a little earlier—to do justice to the—