Cervical Cancer (Testing and Treatment) (Hansard, 1 March 1988)

§ Mr. Jimmy Wray (Glasgow, Provan)
I beg to move, That leave be given to bring in a Bill to establish a body known as the National Cervical Cancer Service, which will be responsible within the National Health Service, for managing a national system for making cervical cancer tests available once every three years to all women aged between 20 and 65 years, and for supervising the provision of treatment for cervical cancer; to provide for the making of tests by doctors acceptable to the women concerned; to provide through the National Cervical Cancer Service for action to make women aware of the need for such tests; and for purposes connected therewith. The Bill would require the establishment of a nationally managed computer-based system of testing for, and the subsequent swift treatment of, cervical cancer for all women between the ages of 20 and 65, for all women to be tested once every three years, and for that service to be adequately and fully funded by the DHSS.
The Bill is simple, but it could virtually eliminate 2,000 needless deaths of women throughout the United Kingdom every year. I know that women in my constituency are dying needlessly of cervical cancer. It is certain that women are dying needlessly in every constituency in the United Kingdom, as 2,000 women every year die of cervical cancer, although, detected in its early stages, it can almost always be cured completely.
The smear test is simple, only slightly uncomfortable for the women concerned and can be carried out by a GP or a trained nurse. The resultant smear is captured on a glass slide and sent for analysis to a cytopathology laboratory. Examination there can reveal that a patient has nothing to worry about or that she should report to the appropriate hospital for straightforward treatment that almost always results in a complete cure.
It is a public scandal that women have to wait five months for colposcopy clinical tests and nine months for laser tests for that treatment. Despite that comparatively simple cycle of test and treatment, some 2,000 women die of cervical cancer every year in Britain.
Investigation shows that more than 60 per cent. of those who die have never had a cervical smear test. Obviously, the current system is not working, although the Government aim for the testing of every woman in the United Kingdom between the ages of 20 and 65 once every five years. The cost of carrying that out effectively is estimated at some £30 million, and it should give 70 per cent. protection to those at risk. However, testing the same age range of women once every three years would give 90 per cent. protection and would cost only £20 million more.
That is a small cost, by comparison with a weapons system, which we should hardly begrudge a vital area of preventive medicine. Such a screening policy almost certainly could be implemented within the existing National Health Service budget if the screening programme were to effectively managed on a national scale, supported by compatible computer sytems in doctors's surgeries and in FPCs and cytopathology laboratories equipped with specifically designed information technology systems.
Currently, the British programme is not effective because the majority of smears have been taken from women in the lower-risk categories. That is because most 832 smears are taken during obstetric and contraceptive consultations which normally arise in the cases of women under the age of 40, the age group least at risk.
The five-year gap between screenings, the poor management of call-recall systems, the reliance upon manual records instead of computerised systems, the reluctance of many GPs to carry out preventive medicine, the natural fear of women faced with the word "cancer" and poor eductional programmes, all lead to women neglecting or forgetting to obtain a smear test.
However, the computerisation of family practitioner committee lists and of some GPs' patient records means that an operational database is being built up, but it is taking place in a piecemeal, undirected fashion which negates its potential. For the scheme to work successfully, there needs to be a nationwide scheme based upon compatible computer systems with common operating standards and management procedures.
There is also a need to equip cytopathology laboratories in every health authority with specific computer systems that will handle all data arising out of the prevention of cervical pre-cancer and will embrace fine needle aspiration cytology, endoscopic "brushes" and general cytology such as sputum and other body fluid samples. Such a computer system should be capable of being extended to handle breast data. Those systems should interact with the FPC computer systems.
So far, less than 25 per cent. of Britain's 200 cytopathology laboratories are equipped with adequate computer systems. That lack of provision seriously hampers the successful operation of Britain's national screening programme and contributes significantly to the figure of 2,000 women dying needlessly every year.
The Government appear to believe that they have done all that is necessary by at long last computerising FPCs. However, because of the Government's negative attitude towards funding, FPCs have been unable to recruit and maintain staff of a standard high enough to deal effectively with the vast data handling. Existing patient records have a serious error rate of 30 per cent. Data entry is likely to be slow and to require constant revalidation. FPCs are commending call programmes without reference to existing GP-based systems in their areas. That causes repetition of testing and alarm to women recently tested by their GPs.
Furthermore, the FPC computer systems have not been designed to handle interaction with a cytopathology laboratory computer system. In due time, and with improved management, all those barriers to a successful call-recall system may be overcome, but it could take several years—an unacceptable delay, considering those 2,000 needless deaths every year.
Current cytopathology laboratory computer systems, such as the one already operating at Southampton's general hospital can handle call-recall systems via GPs and, keep FPCs informed so that records can be updated. They can do that in addition to their laboratory-related work.
In order to increase the productivity of all United Kingdom cytopathology laboratories so that none fails to meet the Government guideline of turning round smear screenings in under a month, and so that significant improvements in the call-recall system can be achieved prior to the eventual tardy implementation of the national FPC system, the Government should establish a body entitled the national cervical cancer testing service.
833 That body should be established under the authority of the Department of Health and Social Security, which will have responsibility for establishing, managing and implementing a nationwide common system for the testing for cervical cancer once every three years of all women between the ages of 20 and 65. That service would be responsible for ensuring that all women whose health was found to be at risk would receive adequate and timely treatment.
That body would be charged with meeting the following basic requirements: the provision of adequate resources for taking, examining and reporting on cervical smears and the provision of adequate, computer-based clerical systems for the making and keeping of examination appointments.
In Scandinavia, it is national policy to treat all symptoms of illness detected during screening for cervical cancer even if they are not cancerous conditions. That has raised the general health level of women considerably.
The Government have given guidance in their new DHSS health circular issued on 12 January 1988 that their objective is to reduce mortality from cervical cancer by regularly screening all women at risk to identify and treat conditions that might otherwise develop into cancer. It goes on to ask district and regional health authorities to implement the circular's provisions.
As usual, the Government are long on exhortation and short on properly financed action. I remind those Ministers responsible that each of the 2,000 needless deaths of women each year costs the United Kingdom some £15,000. That sum does not take into account the considerable additional costs that arise in state support—

§ Mr. Speaker
Order. Will the hon. Gentleman now bring his remarks to an end?

§ Mr. Wray
If humanitarian grounds do not move the Administration, perhaps the prospect of financial savings will. I beg my colleagues to support the Bill.
834 Question put and agreed to. Bill ordered to be brought in by Mr. Jimmy Wray, Ms. Joan Ruddock, Mrs. Maria Fyfe, Ms. Harriet Harman, Ms. Clare Short, Mrs. Alice Mahon, Mr. Alfred Morris, Mr. Eddie Loyden, Mr. Jimmy Hood, Mr. Don Dixon, Dr. Lewis Moonie and Mr. Alan Meale.