Breast Cancer (Hansard, 12 October 2000)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the NHS Cancer Plan published on 27th September sets out the measures that the Government are taking to improve awareness and treatment of breast cancer. It is a major programme of action which links prevention, diagnosis, treatment, care and research. A copy is in the Library.

§ Baroness Billingham
My Lords, this is a very important and relevant Question. October has been designated Breast Cancer Awareness Month. Does my noble friend agree that, looking at the statistics, one great concern is the serious discrepancy in the take-up of breast screening opportunities as between women who are relatively well off, where the take-up is very high, and women who are less well off, particularly those from ethnic minorities? Clearly, that is wrong; it is also deadly. Perhaps I may ask the Minister what 500 steps the Government are taking to ensure that all women, irrespective of their backgrounds, and, incidentally, irrespective of their age, take the opportunity to actually visit the van and therefore have an opportunity to save their own lives?

§ Lord Hunt of Kings Heath
My Lords, my noble friend is right to point to inequalities in relation to the number of women taking up the opportunity of screening. My understanding is that of the age group who were sent invitations, 76 per cent accepted those invitations. There are issues particularly in relation to members of black and minority ethnic groups. Part of the Government's programme in trying to tackle the problem and encourage more women to have screening is to fund several projects to raise awareness among black minority ethnic groups in places of worship and women's organisations which undertake health work. We also expect all primary care groups to review their own screening coverage rates and, where there are specific problems, to target those members of the population who are not having the tests.

§ Baroness Fookes
My Lords, why is there an age limit for screening when it is known that there is—

§ Baroness Gardner of Parkes
There is no age limit.

§ Baroness Fookes
Is there no age limit? I thought there was an age limit for screening above 65 or 70. If that is not so, I should be delighted to hear it. Does the Minister accept that there is a greater risk of breast cancer in older women?

§ Lord Hunt of Kings Heath
My Lords, there are two points to make. First, we have announced our intention to extend screening to women aged 65 to 69. That is on the basis of some pilot programmes. Secondly, I should stress that women over 70, and women now between the ages of 65 and 69, have always been able to obtain a screening test if they wish. The point is that the younger age group have received positive information to come for those tests.
I listened with great interest this morning to the debate on the Age Concern survey, to which I think the noble Baroness alludes. Little hard research is available to show that population screening in the over 70s is effective in reducing mortality. We shall look at the survey and I will arrange for the Advisory Committee on Breast Cancer Screening to look at the results of that survey.

§ Baroness Northover
My Lords, does the Minister agree that it was a huge mistake to exclude older women from breast cancer screening? Does he also agree with the statement that Professor Ian Fentiman made today that 2,000 older women will die unnecessarily each year from breast cancer if routine screening is not extended beyond the age of 70? Given that 85 per cent of older women are unaware that they are at risk from breast cancer, is the Minister satisfied that adequate measures are being taken to turn this situation around?

§ Lord Hunt of Kings Heath
My Lords, I thought I answered the substance of that question. Perhaps I may just raise the issue of health promotion because clearly one of the helpful issues raised by the Age Concern survey is whether people aged 70 or over are in receipt of relevant information. We are working with Age Concern to produce appropriate leaflets. But we will look at that matter again.

§ Lord Dubs
My Lords, does my noble friend agree that one important aspect of treatment is the way in which women suffering from breast cancer are counselled and advised on the nature of their illness and the forms of treatment that are open to them? Does he further agree that some hospitals like the Royal Marsden are excellent in this respect? Can he say what can be done to ensure that standards in other hospitals are as good as those achieved by the Marsden?

§ Lord Hunt of Kings Heath
My Lords, I am very happy to endorse the points made by my noble friend and to acknowledge the fine work that has been undertaken at the Royal Marsden. The way that we will tackle the issues in relation to cancer, ranging from prevention to screening and treatment and to ensure that there is a continuum of care, is a very important challenge for us. We have already introduced protocol guidelines for GPs. The National Institute for Clinical Excellence will be providing further guidance. Information for women is vitally important and we shall be redoubling our efforts to ensure that the relevant information is available to them.

§ Earl Howe
My Lords, does the Minister agree that the recent adverse criticism of breast screening has been unfortunate? Does he also agree that a combination of screening and better treatment has brought about a significant reduction in mortality from breast cancer? Therefore, it is very important that the positive value of screening women is emphasised whenever possible.

§ Lord Hunt of Kings Heath
My Lords, I could not agree more with the noble Earl. The figure I have is that nearly 8,000 women in England had breast cancer detected and treated through screening in the year 1998 to 1999. That shows the effectiveness of the screening arrangements we have. That is why we want to extend them. In relation to other age groups, it is very important that we extend the automatic invitation recall system only on the basis of the best clinical evidence available.

§ Baroness Darcy de Knayth
My Lords, I went for breast screening at the age of 62 this summer. It was made very clear to me that I would be able to self-refer after that until the law that one will be called regularly comes into force. Does the noble Lord agree that it is a very good idea when one is screened for it to be made very clear that one can, and perhaps should, self-refer?

§ Lord Hunt of Kings Heath
My Lords, that is a very helpful suggestion. I shall certainly make sure that it is passed on to the appropriate officials.

§ Baroness Barker
My Lords, in view of the Minister's earlier replies and the fact that the extension of the age limit from 65 to 70 will not fully kick in until 2004, will his department ensure that health workers overcome their acknowledged ageist discrimination? Will his department also focus its energies on campaigning to get women over the age of 70 to make those self-referrals?

§ Lord Hunt of Kings Heath
My Lords, I want to take up the overall issue of the allegations of discrimination in the health service against older people. I have made it clear to the House on a number of occasions that such discrimination is totally unacceptable. Noble Lords will know that we have made that clear in relation to the "do not resuscitate" issue. We have given firm guidance to the NHS on that matter. That has arisen very much from the debates in your Lordships' House. We are developing a national service framework for older people which will be published at the end of this year. It will focus on ensuring that we give high-quality services to older people. But, as I have said, in relation to automatic recall and invitations to people over 70, that has to be based on evidence that that will be effective.