Breast Cancer Screening (Hansard, 6 November 1995)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, last month we announced two pilot schemes to extend breast cancer screening to women up to the age of 69.

§ Lord Gainford
My Lords, I am most grateful to my noble friend for that short and concise Answer. Bearing in mind the fear that women have of breast cancer, would it be possible for scanning to be extended both to elderly and to younger women? Has any action been taken by the Government on the double X-ray which has been recommended in the media recently?

§ Baroness Cumberlege
Yes, my Lords. As I said, we are extending, through pilot schemes, screening for older women. Indeed, we have a research project for younger women—those from 40 to 50 years old. We have also taken on board the recent research on two-view mammography which detects more cancers. It reduces recall rates and we know that it is very cost effective. That is the Government's policy now and every mammography unit of the NHS will have introduced the new scheme by 1st August this year.

§ Baroness Jay of Paddington
My Lords, I am sure that we are all pleased by the Minister's response to the new research, which is very encouraging. As it is so encouraging, does she agree that it would be advantageous if the double-mammography approach was extended to include women of all age groups and 1576 was available at every appointment? It would therefore be offered not only at first appointments but would be available at follow-up visits.

§ Baroness Cumberlege
My Lords, implementation for all age-groups will depend on research studies that we are conducting. At the moment the facility is offered only on the first appointment. The researchers are looking at the efficacy of offering it for every appointment. However, at the moment our advice is that it would not be effective.

§ Baroness Gardner of Parkes
My Lords, can my noble friend say whether there is a problem in terms of the additional radiographic exposure required for the double view, and whether the radiation dosage now required is being reduced by improved techniques or films to offset the need for the double imaging?

§ Baroness Cumberlege
Yes, my Lords, my noble friend is right. There is a marginal increase in the amount of radiation that women get through this process. However, it is very minimal and it is well below the limits that have been set.

§ Lord Ashley of Stoke
My Lords, can the noble Baroness tell the House why pilot schemes are necessary for a measure which is so obviously desirable and necessary?

§ Baroness Cumberlege
My Lords, it is a very expensive process to introduce nationwide. We do not know at the moment how many women would take up this opportunity. We do not know what the costs would be in terms of the detection of cancers. It is traditional in the health service, before introducing very costly schemes, to run pilot studies so that we can learn from them.

§ Baroness Rawlings
My Lords, what are the Government doing to improve the treatment of cancer for women?

§ Baroness Cumberlege
My Lords, an enormous amount is going on in terms of improving the treatment of cancer. In April we published a new policy called A Policy Framework for Commissioning Cancer Services. Its key recommendation is that all patients should have access to the best possible cancer service regardless of where they live. We are also introducing guidelines through our clinical outcomes group. We are increasing the number of consultants and the number of breast care nurses. Over the past three years we have provided £15 million to health authorities and trusts for equipment for diagnostic and treatment services.

§ Lord Shepherd
My Lords, it is clearly early days but the noble Baroness referred to high costs or added costs. Can she give an indication of what would be the added cost for carrying out the scheme that is now being proposed?

§ Baroness Cumberlege
My Lords, we do not have the details of that. To set up the two pilot schemes will cost in the region of £80,000. What we do not know is how many cancers will be detected and what implications that will have for the whole of the service. One of our greatest constraints is not so much the 1577 funding of the services but ensuring that we have trained staff to carry out the procedures once the cancers have been detected.

§ Lord Shepherd
My Lords, the cost is therefore not necessarily a prohibition on introducing the scheme.

§ Baroness Cumberlege
My Lords, your Lordships will he aware that year on year we spend more money on the National Health Service. Spending has never been higher. On the question of cancer services—I am aware that this is a very sensitive time to be talking about the funding of any service—the greatest constraint is manpower rather than cost.

§ Baroness Robson of Kiddington
My Lords, I thank the noble Baroness for introducing the pilot studies. In the sums of money that are going into improved breast cancer care, has adequate thought been given to increasing the number of specialist breast cancer nurses? I understand that in this country we need 250 specialist breast cancer units whereas we have only 170 specialist care nurses. There is a great gap and I hope that some of the money will go towards increasing that number.

§ Baroness Cumberlege
My Lords, the introduction of breast care nurses is a new development. The increase in their number over the past three years has been considerable. We share the noble Baroness's view that they are most effective, especially in terms of communicating bad news and, indeed, sometimes good news. But again the question is one of training, and it is up to local health authorities to decide whether to purchase services that include breast care nurses. We believe that many of them are doing that.

§ Lord Ironside
My Lords, I apologise to the House for not being present when the Minister gave her Answer. Does she not think that the time has come for a 10-year overview of the screening programme, as happens in Sweden? Does she not agree that one should he looking at all the problems, such as two-dimensional imaging, the ageing bracket and the interval for screening; and, above all, at what the EU now calls in its third action plan "the women of suspect image"? Those are the EU's words. I think that those issues are important and I hope that my noble friend will pay particular attention to them.

§ Baroness Cumberlege
My Lords, I think that I covered all the points that my noble friend has made. He will be able to read them in Hansard. If there is anything outstanding, I shall write to him.

§ Lord Strabolgi
My Lords, will the noble Baroness confirm that the Royal Marsden Hospital is now absolutely safe in terms of its future, as the hospital was under threat at one time by the Government?

§ Baroness Cumberlege
My Lords, we have discussed the Royal Marsden on many occasions in your Lordships' House. The noble Lord will be aware that the Royal Marsden is now part of the general scheme of things. It is a trust; and like every trust, its services are purchased through the health authority.