§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pope.]
§ 10.2 pm
§ Dr. Ian Gibson (Norwich, North)I raise this subject in some anger because of the disdain manifested by tobacco chiefs and their friends, among whom is a former Chancellor of the Exchequer. They have displayed total irresponsibility in respect of women and lung cancer. The Government have shown a degree of nonchalance about an issue that affects the health of many women in this country and throughout the developed world.
Since 1987, more women in the United States of America have died of lung cancer than of breast cancer. It is four times more common than cancer of the cervix. Lung cancer is the most common cancer in the world and the third most common cause of death in the UK, with about 30,000 people a year dying of it. Among men, deaths from lung cancer increased by 20 per cent. between 1976 and 1994, but among women the increase was 150 per cent. in the same period. Nearly one half of all new lung cancer cases are women. The problem must be addressed.
I believe that the problem has arisen because of the increasing propensity of young women to smoke cigarettes. Women in the United States are twice as likely as men to develop lung cancer, despite the fact that women smoke less than men and women smokers inhale less deeply than men smokers.
That shows that there may be genetic differences between men and women which result in cigarette smoke and the chemicals it contains having different effects on their biochemistry. As the human genome project unfolds, the problem will be that people will think that they do not have the gene in question, and can smoke as much as they like because they are not predisposed to these cancers and the development of illnesses associated with cancers and chemicals in the smoke.
At the recent world summit on cancer in Paris, the potential epidemic of lung cancer was underlined and equated with the increasing prevalence of smoking among women in the developing world. Ninety per cent. of lung cancers are smoking related. It is disturbing to realise that cigarette smoke is the greatest serial killer in the western world, and smoking is most common among young people in the 20 to 24 age group. Each day, 450 teenagers and children start smoking, and it is estimated that a quarter of all 15-year-olds in the United Kingdom smoke.
Lung cancer sufferers may be treated by surgery, chemotherapy, radiotherapy or a combination of those treatments. Five-year survival rates remain poor, and according to the Cancer Research Campaign and BACUP, the British Association of Cancer United Patients, five-year survival rates are half as good in the UK as in France. In this country, 7 per cent. of lung cancer patients are still alive five years after diagnosis, whereas in France 14 per cent. survive that long. There is plenty of evidence to show that outcomes are better if treatment is managed by specialist, multi-disciplinary teams, and more patients should have access to that type of care. There is also an urgent need for extended radiotherapy and for more lung cancer specialists.
275 As regards screening for lung cancer, long-term recovery depends more on early detection than on any other factor. A recent conference at the Royal Society of Medicine focused on improved methods of detecting lung cancer, which could lead to the development of a screening system similar to that used for cervical cancer. The United Kingdom Co-ordinating Committee on Cancer Research into lung cancer, chaired by Professor Ian Smith of the Royal Marsden, is currently designing a proposal for a lung cancer screening trial—so-called spiral CT scanning. Data from the United States of America and Japan suggest that such screening has a higher pick-up rate than even screening for breast cancer, and that most of the tumours it identifies are small and surgically curable. I hope that funding will be provided for the NHS research and development budget for that trial.
The Government have some significant initiatives to tackle lung cancer, especially as it affects women. In the past year, the Department of Health has issued guidance on treating lung cancer as part of its series of guidelines on different types of cancer and their treatments. Last spring, the previous Health Minister, the noble Baroness Hayman, announced £10 million for new initiatives to improve lung cancer services, primarily by speeding up access to diagnosis and treatment.
Department of Health figures show that treating smoking-related diseases costs the national health service £1.7 billion per year. The previous Minister for Public Health, my right hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), said that reducing smoking was the Government's top public health priority. Ministers have made available £100 million over three years for anti-smoking initiatives. In the pre-Budget statement in November 1999, the Chancellor announced that future real term increases in tobacco duties would be spent on health care. That is an amazing step forward. Tobacco duty will rise by 5 per cent. in real terms next month, yielding an additional £300 million a year for the health service. There is a case for using that money to target lung cancer, given its links to tobacco.
Ranged against the Government is a powerful tobacco industry. Documents recently released under the US freedom of information legislation show that the industry plans to use a variety of techniques to target women, particularly young women, women in the third and developing world, women who are unemployed and those on low incomes. In this country 90 per cent. of lone parents, mostly women, smoke. We would do well to remember that 41,000 people in the country die each year because of smoking-related illnesses—not just lung cancers, but heart disease, strokes and other illnesses associated with tobacco.
It would, however, be less than honest to forget that there is a shadowy third party in the equation. Successive Governments have found tobacco to be an apparently endless source of revenue, and it would seem that they are now as addicted to the tobacco revenues as the tobacco consumers are to tobacco. There is therefore a dilemma, or rather a series of dilemmas. Smokers are numerous, and although their addiction is recognised, they are encouraged by groups such as FOREST—the Freedom Organisation for the Right to Enjoy Smoking Tobacco—and the tobacco industry to regard smoking as a human right.
276 Legislation to prohibit tobacco does not seem to be an option. Health education programmes make the Government feel rather good, and the tobacco industry loves that, because it knows that they are completely ineffective among the population whom it is most anxious to target: young women. Leaving it to individuals is not enough, in my opinion and that of others. We need collective activity against the whole tobacco industry.
The Exchequer, of course, finds it difficult to forgo such an important source of revenue. So what are the options? Is it really an option for us, knowing the facts as we do, to stand by and let succeeding generations become addicted to tobacco and suffer the consequences? Much could be done through the engineering of a social change that could phase out tobacco use over a generation. Gradual change would be easier to implement, and would make it easier to compensate for effects such as loss of revenue. Gradual change, however, should not be interpreted as a willingness to let tobacco companies off the hook; quite the contrary. Surely it is time we decided that the injury they cause our society is unacceptable.
A system of progressively punitive taxation on the commercial activity of tobacco manufacture—not just a tax on the product, but a special tax on the profitability of the industry—would allow a screw to be tightened progressively, which would eventually cause companies to diversify into non-harmful products, or to wither and eventually become much less attractive to investors. In the end, they would simply disappear. There are recent precedents for that, in the form of windfall taxes.
There cannot be an inalienable right to trade in products that cause misery, premature morbidity and death. We need to increase awareness of tobacco consumption as the single most important women's health issue—which I believe it is—rather than as a personal freedom. Women must be made aware of their special susceptibility to lung cancer and other problems, and must be given more practical help and support to overcome the problems of addiction and social pressures to smoke. The industry must also have its wings clipped in terms of the marketing of its existing products, and must be given notice of the determination that its products will not be tolerated in the future and that effective steps will be taken to phase out production altogether.
It is vital that research into the treatment of tobacco-related disease should continue. Excellent work is going on at, for instance, the Roy Castle centre in Liverpool, but I believe that a national cancer institute should co-ordinate a major clinical research effort focused on women's lung cancer, while applying continued pressure on succeeding Governments to ensure that an effective solution is found to the social problem of tobacco production and marketing.
I plead with the Minister to "make my Parliament" and to make her career. I plead with her to take up the cudgels and save all the thousands of lives that might otherwise be ended because of smoking, particularly among young women. That is the action that would make the best headlines and engender confidence in our cancer programme.
§ The Parliamentary Under-Secretary of State for Health (Yvette Cooper)I am grateful to my hon. Friend the Member for Norwich, North (Dr. Gibson) for raising 277 what is an important matter. As he pointed out, the scale of the problem is considerable. Lung cancer is the most common cancer in England and Wales. There are about 35,000 new cases every year and 30,000 deaths, of which some 11,000 are women.
Although the number of men diagnosed with lung cancer has been steadily falling for almost two decades, we are seeing a rise in the number of women diagnosed with the disease. That is of great concern. The latest figures suggest that, between 1993 and 1996, there was a rise of about 5 per cent. in the number of women diagnosed with lung cancer, at a time when the number of men diagnosed fell by an equal amount.
We have to do better. The United Kingdom has one of the worst records in Europe on deaths from lung cancer among women, with death rates more than double those of many European Union countries. The Government have set clear and demanding targets for improvement. In the White Paper entitled "Saving Lives: Our Healthier Nation", which was published in July last year, we committed ourselves to achieving a reduction in the death rate from cancer among people aged under 75 by one fifth by 2010. That translates into saving 100,000 lives. The Secretary of State for Health has made clear his personal commitment to tackling the big killers: cancer and coronary heart disease.
If we are to meet those targets on cancer, that will mean not only tackling lung cancer, including among women, but taking the right approach to cancer across the board. It will mean not simply improving treatment services, vital though that is, and reducing waiting times, essential though that is, but having a full multi-pronged strategy to bring together prevention, early detection, screening, access to services, treatment and research—action across the board.
We have already taken several important steps towards an integrated approach towards cancers in general and lung cancer in particular. Professor Mike Richards, our national cancer director, is responsible for improving cancer care across the board. In particular, with lung cancer prevention is extremely important. Given the technology and treatments that are available, we can make the greatest difference through prevention of lung cancer. That is the way to save the lives of both women and men.
My hon. Friend is right to say that lung cancer is highly preventable. Smoking is the primary cause of 90 per cent. of lung cancers. We know, too, that 70 per cent. of smokers say that they want to give up. Put simply, if we can support more smokers and help them to quit, we will make a big impact on lung cancer.
Today's epidemic of lung cancer among women largely reflects the fact that women took up smoking from the second world war onwards. The current alarmingly high rates of smoking among young girls will, if we do nothing, lead in due course to many more lung cancer deaths among women in the first few decades of the new millennium.
Recent research suggests that women smokers may be more genetically susceptible to tobacco carcinogens than men and therefore more likely to contract the main types of lung cancer at every level of exposure to cigarette smoke. That is all the more reason to take seriously the smoking epidemic among women.
278 The Government's programme to tackle smoking was outlined in "Smoking Kills", which was published in December 1998. In "Smoking Kills", we committed ourselves to achieving three clear and strong targets: a reduction in smoking throughout all social groups, so that the overall prevalence of smoking in the adult population falls from 28 per cent. to 24 per cent. by 2010; a reduction in the number of 11 to 15-year-olds smoking regularly from 13 per cent. to 9 per cent. over the same period; and a reduction in the number of pregnant smokers from 23 per cent. to 15 per cent..
Clearly, to achieve the pregnant smokers target, we must ensure that our campaign reaches women. To achieve the reduction in the number of 11 to 15-year-olds who smoke regularly, we need specifically to ensure that we target young women smokers.
As my hon. Friend said, we backed up that commitment with more than £100 million, over three years, for smoking cessation and tobacco education. There will therefore be additional support for smoking cessation in the 26 health action zones. Those services are now all up and running. Free nicotine replacement therapy for smokers on low incomes will be available, first, in health action zones, and, from April, across the country. Moreover, from April, additional money will be invested to help all health authorities across England to provide specialist smoking cessation services. From next financial year, all smokers who require specialist help should be able to get support. That is a huge step forward. Never before have a Government introduced an overarching campaign to stop smoking.
The United Kingdom is a world leader in providing smoking cessation services to its population. More smokers, particularly more heavily dependent smokers who have been unable to quit without specialist help, should be helped to quit. Providing them with such help will cut the toll of death and disease from smoking, particularly lung cancer deaths. So far, the results show that 55 per cent. of those who are accessing the new smoking cessation services are women. We therefore expect to have a particular impact on women smokers.
Smoking cessation support is only part of the programme. The tobacco education campaign was launched successfully—in December 1999, under the slogan, "Don't give up giving up"—to encourage smokers to persevere until they succeed in quitting. The helpline has received almost 80,000 calls since the campaign started. We are developing ideas for more targeted campaigns, building on the general campaign that we have already launched. As I said, as smoking rates for young girls are alarming, the campaign aimed at young people must aim to have a real impact on that group.
We shall also fulfil our manifesto commitment to ban tobacco advertising. The high court has supported our case to introduce the ban. If the tobacco companies were to drop their opposition to the ban, we would be able to implement it straight away. We estimate that the ban could, in the short term, save 1,500 to 1,600 lives a year.
I take issue with my hon. Friend that the Government might be reluctant to act on smoking because of the impact on tobacco revenue. That is plain wrong. The Government's case on tackling smoking is completely independent of the impact that that might have on tobacco revenue. We have made that case extremely strongly.
279 It is a public health measure. The Chancellor has made it very clear in his actions on tackling smoking that he supports the public health aspects of the policy.
There is a case for a stronger regulatory framework on tobacco products, and for actions such as tackling tobacco additives. That is one of the issues that we are pursuing in the European framework. I agree with my hon. Friend that there is further action that we have to take—we are taking it—on those issues.
Prevention is the best way of tackling lung cancer. However, as my hon. Friend has rightly pointed out, we also need to work on early detection and screening. Survival rates for cancer are poor, partly because of the difficulty of detecting the condition at an early stage.
Recommendations on national screening programmes are considered by the United Kingdom national screening committee, which advises Ministers on all aspects of screening policy. The NSC assesses proposed new screening programmes against a set of internationally recognised criteria, and draws upon the latest research evidence and the skills of specially convened multidisciplinary expert groups.
Currently, screening for lung cancer would not meet the NSC's criteria for a screening programme, because there is no evidence of the effectiveness of screening. More research is needed on that matter. We are aware of recent reports from the United States suggesting that it is possible to detect lung cancer at a stage when it is still susceptible to treatment. We are also aware of the work being done in this country—to which my hon. Friend referred—to examine some of the issues raised in the United States. The NSC will review its position on screening for lung cancer in the light of any robust new evidence.
High quality diagnosis and treatment are at the centre of our commitment to cancer care. Patients and clinicians alike want faster and better care. Patients need to have confidence in the health service and to know that if they have symptoms that could be cancer, they will be able to discuss them with their GP and be referred quickly and appropriately if necessary.
Although more than 220,000 cases of cancer are diagnosed each year, an individual GP is unlikely to see more than a few cases. That is why we are working with primary and secondary care providers, the voluntary sector and patient groups to develop cancer guidelines for primary health care teams, to help them identify those patients most likely to have cancer and to require urgent specialist investigation.
280 Patients who have suspected cancer want to be seen by a specialist quickly to take away the uncertainty and anxiety. That is why it is so important that we move ahead in implementing the two-week standard for all cases of suspected cancer. That standard of care will apply to all lung cancer patients needing an urgent referral from April this year. That is supported by additional resources to speed access to diagnosis and care.
We must also ensure that all cancer patients, wherever they live, have access to the same high-quality services. My hon. Friend mentioned the importance of having access to multi-disciplinary teams. I agree that that is vital. The work being done by the cancer collaboratives, putting patients at the centre of care, following the process through from primary care in multidisciplinary teams and encouraging working together to cut waiting times and improve the quality of care has a huge potential to make a big difference for patients with lung cancer and other cancers as we roll the programme out. We have invested an extra £70 million in cancer services since 1997 and will be investing a further £80 million over the next two years specifically in cancer treatment and diagnosis.
Whatever improvements we manage to make in the prevention and treatment of cancer, we still need to know more and to continue to support research. The Government fund research into cancer in many ways—through the national health service research and development levy and through specific projects, including the development and evaluation of clinical nurse specialist follow-up in the management of patients with lung cancer and a large-scale trial of chemotherapy for all stages of non-small cell lung cancer.
I am grateful to my hon. Friend for raising this important issue. He is right that lung cancer is an increasingly serious issue for women. I hope that I have made clear to him the seriousness with which the Government treat cancer in general and lung cancer in particular among women. We are determined to make a difference on the big killers—cancer and coronary heart disease. The best way to do that is by tackling cancer across the board, through action on prevention, screening, fast access to treatment and high-quality treatment, as well as palliative care. We need to improve the lot of cancer sufferers and prevent far more people—women as well as men—from contracting cancer in the first place.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Ten o'clock.