Prostate and Testicular Cancer

HL Deb 12 December 1995 vol 567 cc1166-8

2.55 p.m.

Baroness Masham of Ilton asked Her Majesty's Government:

What research the Department of Health has commissioned into the possible benefits of wide-scale screening for prostate and testicular cancer in men over 40, and what are their conclusions.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, the Government have identified prostate cancer as a priority area for research. There is no case for introducing further research into testicular cancer as the vast majority of cases are detected and cured.

Baroness Masham of Ilton

My Lords, I thank the Minister for her reply. Is she aware that both these forms of cancer are on the increase? Is it not good news that the death rate from testicular cancer is going down but had and worrying news that about 10,000 men a year in the United Kingdom die from prostate cancer?

Baroness Cumberlege

Yes, my Lords, they are serious cancers. But lung and colorectal cancers kill more people than prostate cancer. Even when all the cancers are put together, coronary heart disease is still the greatest killer in men.

Lord Ashley of Stoke

My Lords, I appreciate that the noble Baroness is willing to help. However, if it is a fact that a screening programme saves lives; if it is a fact that a screening programme is cost effective; and if it is a fact that Germany has had a screening programme since 1979, the year this Government took office, why are the Government making such heavy weather of creating a screening programme?

Baroness Cumberlege

My Lords, before we introduce any screening programme we have to be certain that it will increase the length and quality of life. There is no evidence that this would be achieved in relation to prostate cancer. We also have to ensure that the screening tests are specific and sensitive. That is not the case with this cancer. Furthermore, there is not yet a professional consensus about how to treat men who have positive screening tests. Our view of experience in both the United States and Germany is that their screening programmes are not effective and do not achieve what we would set out to achieve if we were to introduce a programme.

Lord Walton of Detchant

My Lords, does the Minister agree that whereas there is a close correlation between high levels of prostate specific antigen in the circulating blood on the one hand and prostate cancer on the other, in individuals who have a slight or very moderate increase in this antigen in the circulating blood this may be associated with benign enlargement of the prostate? Is it not the case that much more research is needed before a widespread screening programme is introduced because of the risk of raising needless anxiety in those who have slight or moderate increases in this antigen in the blood?

Baroness Cumberlege

My Lords, the noble Lord has said it perfectly.

Lord Rea

My Lords, does the noble Baroness agree that an indicator of the seriousness of prostate cancer is that your Lordships' House has lost three of its Members from this disease in recent years, including two medical Peers? Is it not the case that the disease often spreads, usually to the bones, before a diagnosis can be made, whether it is made by a blood test, as my noble friend Lord Walton said, or by a clinical examination? Does she not agree that, while present screening methods may well result in more cases being detected, they will not necessarily reduce mortality? Does the Minister agree that the most productive action the Government can take is to back more good research into the fundamental causes and the treatment of this condition rather than indulging in further screening campaigns at the moment?

Baroness Cumberlege

My Lords, if we had a good test and if we knew what to do about the cancer once it was detected, and if it met the criteria for screening that I have outlined, we would introduce a national screening test. I believe that it has been well explained that that is not the case with this particular cancer. The noble Lord is right: we do need more research in this field. In fact, two projects have been commissioned to review the available evidence both on the cost effectiveness and also on the clinical benefit of different methods of detecting and managing this cancer.

The Countess of Mar

My Lords, is it not the case that testicular cancer is more a disease of young men and that it is often associated with undescended testes? Can the Minister say whether it is possible, through self-examination and by dealing with backache when it is found very early on, to save lives? I understand that if this disease is caught very early there is something like a 95 per cent. cure rate.

Baroness Cumberlege

My Lords, deaths from testicular cancer are indeed very rare. The noble Countess is right in saying that it is a disease of young men. We believe that we are tackling it well at the moment and, as the noble Countess said, 95 per cent. of the patients are cured.

Baroness Masham of Ilton

My Lords, is the Minister aware that there are enough cancer specialists throughout the country to enable GPs, when they detect prostate cancer, to send the patient to a specialist? Will she press for more research into this very worrying condition?

Baroness Cumberlege

Yes, my Lords. As regards research, I believe I explained that there are two projects under way at the moment. As to the number of cancer specialists, there are very different types of cancer consultants. We are aware that the National Health Service could do with more cancer specialists; indeed, we have allowed for that in our budgetary proposals.