§ Motion made, and Question proposed, That the sitting be now adjourned.—[Vernon Coaker.]9.30 am
§ Mrs. Marion Roe (Broxbourne)
I am sure that I am correct in saying that everyone in the Chamber will know someone, woman or man, who has been diagnosed with breast cancer, and will therefore know the challenges that they, their family and their friends face in dealing with the disease. That is why I appreciate the opportunity to have this debate during breast cancer awareness month 2003, on the 10th anniversary of one of the key health awareness campaigns in the United Kingdom. I am delighted to see that the Minister and many other hon. Members are wearing pink ribbons as a symbol of support for the campaign.
I pay tribute to the breast cancer and other cancer charities that have been working in partnership this month to raise awareness of the disease, which also work hard all year round. I shall mention some of them by name. Breakthrough Breast Cancer is a research and awareness charity, which established the Breakthrough Toby Robins Breast Cancer Research Centre. It is the first centre in the UK dedicated solely to breast cancer research. Breakthrough Breast Cancer also provides much-needed administrative support for the all-party group on breast cancer, of which I am one of the joint chairmen. We are extremely grateful to Breakthrough Breast Cancer for all its help.
The UK Breast Cancer Coalition successfully involves hundreds of patients with direct experience of breast cancer in its advocacy work. I congratulate it on the success of its Westminster Fly-in, which took place earlier this week. Breast Cancer Care is the leading provider of vital information and support for everyone affected by breast cancer. Breast Cancer Campaign is a charity specialising in funding independent breast cancer research, and also supports individual research projects.
I am delighted to announce to hon. Members the news of the impending merger between Breakthrough Breast Cancer and the UK Breast Cancer Coalition, which will create the country's largest charity dedicated to breast cancer research, campaigning and advocacy. It will be known as Breakthrough Breast Cancer.
We should not forget the other cancer charities that work tirelessly, carrying out research and providing support to people affected by breast cancer: charities such as Macmillan Cancer Relief, Cancer Research UK, Marie Curie Cancer Care, CancerBACUP and the Institute of Cancer Research. I also take this opportunity to pay tribute to the countless companies that go out of their way to support breast cancer awareness month, in particular Avon Cosmetics, which announced earlier this month that it had raised more than £10 million for cancer charities through the Avon breast cancer crusade.
76WH I know that a number of hon. Members wish to contribute to the debate, so I shall try to be brief. Perhaps it would be helpful if I began with a few facts about breast cancer. It is the most common form of cancer in the United Kingdom, with more than 40,000 women and about 300 men diagnosed with the disease every year. Over the course of her lifetime, a woman's risk of developing breast cancer is one in nine. Tragically, about 1,000 women lose their lives every month as a result of the disease, a sure sign that there is still much to do to improve treatment in the United Kingdom.
This debate gives us the opportunity to raise awareness of the improvements in breast cancer services that have taken place over the last few years, but also to highlight key concerns about breast cancer research, service delivery and patients' access to treatment. Let us focus first on one of the key targets, the two-week wait from the urgent referral of a suspected breast cancer patient to an appointment with a specialist. According to the statistics for the first quarter of 2003–04, the target has been effectively reached, with a 98 per cent. success rate for England. However, the all-party parliamentary group on breast cancer estimates that approximately 10,000 women in England are diagnosed with breast cancer through the routine referral route.
In a recent report entitled "Left in the Dark", Breakthrough Breast Cancer highlighted the horrific reality that some of those women could have waited up to 17 weeks—a third of a year for—an appointment wit a specialist. The report states:Many women referred routinely are living in fear and literally putting their lives on hold while they endure long routine waits. They are left in the dark, anxious to know if they have breast cancer. This is unacceptable—women deserve better and they deserve a more mature higher quality debate on the subject.
Researchers found that 90 per cent. of women who were interviewed for the report said that they would want an appointment within two weeks of visiting their GP, regardless of whether their case was deemed urgent or non-urgent. Furthermore, we know that the wait between referral and diagnosis is an extremely distressing time. The views of those women, and of patients in general, must be taken on board if a patient-centred NHS is to become a reality.
I want to share with the Minister and other hon. Members further statistics on the process of breast cancer referrals, all of which paint a worrying reality for patients and health professionals alike. For instance, 42 per cent. of GPs felt that it was difficult to distinguish between urgent and routine referrals, 35 per cent. of them admit to not using any form of guideline on whether to refer, and 42 per cent. never receive feedback from consultants on the accuracy of their referral decisions.
I am sure that the Minister shares my concern about the findings of that report. Perhaps she will comment on the unacceptable wait faced by many of those women. I should also like to know how the Government plan to reduce those waiting times and improve the accuracy of the referral system by improving communication between GPs and consultants, and how health professionals can be encouraged to work towards continuous improvement.
I draw the Minister's attention to one of the key concerns of those involved in the health sector—that is, the implementation and monitoring of the National 77WH Institute of Clinical Excellence guidance. About a year ago, NICE issued guidance on Herceptin, a drug known to extend and improve the quality of life of women with terminal breast cancer. If the drug were to be made available to all who could benefit from it, it would be an extremely important step in bringing an end to the so-called postcode lottery for treatment.
However, recent research by Roche, the makers of the drug, unveiled the fact that there are still serious inequities in access to Herceptin. In some parts of the country only one in 30 of the patients eligible for Herceptin receives it; I am sure that the Minister will agree that that statistic is shocking. Sadly, it is not just Herceptin—or, indeed, cancer drugs in general—that seems to be affected; there is a problem with NICE implementation across the board in health care, as has been demonstrated in recent reports by the Arthritis and Musculoskeletal Alliance, Breakthrough Breast Cancer, Breast Cancer Care, CancerBACUP and the UK Breast Cancer Coalition. The problem is to ensure that not only is NICE guidance implemented, but the implementation is effectively monitored.
The Minister acknowledged the problems with NICE implementation as recently as last week, at the all-party group on cancer's Britain Against Cancer conference. I ask her to outline today how the Government plan to ensure that primary care trusts have adequate support to implement guidance, and what methods they will use to monitor national implementation systematically.
Although we have come a long way in improving services and treatments for breast cancer patients, we must acknowledge that we have much further to go. I urge the Government to ensure that breast cancer, and cancer in general, remains a top priority. For the sake of the women and men directly affected by the disease every day, we cannot afford to be complacent.
§ Mr. Deputy Speaker (Frank Cook)
Order. Two hon. Members have written seeking to make contributions, and since my arrival a further two have indicated that they would like to catch my eye. I remind the Chamber that it is customary to begin the first of the three winding-up speeches at least 30 minutes before the conclusion of the debate. There is ample time today, provided that hon. Members take account of that time limit in making their contributions, in accepting interventions and in responding to them.
§ Mrs. Anne Campbell (Cambridge)
I am pleased to be able to speak in the debate, and I congratulate the hon. Member for Broxbourne (Mrs. Roe) on having secured it at this important time for breast cancer treatment.
Three years ago, the new Labour Government identified cancer as a top priority. I was especially pleased about that, because my local cancer specialists at Addenbrooke's hospital had recently summoned me, and neighbouring Members of Parliament, to a cancer summit. They were concerned about the fact that treatment in the UK was not as effective as that in the United States, that more people were dying after 78WH diagnosis, and that equipment was extremely outdated. I am pleased that since that time we have made progress: the figures for the periods 1995 to 1997 and 2000 to 2002 show a 10.3 per cent. reduction in the death rate from cancer among people under 75. None the less, I would be the first to say that there is much more to be done.
National statistics indicate that more than 96 per cent. of women with breast cancer now receive their first treatment within one month of diagnosis. During the 1997 general election campaign, I spoke to two women who had recently discovered symptoms of breast cancer and were highly anxious. They had to wait 15 weeks for their first hospital appointment. That is totally unacceptable, as the hon. Lady said. The situation is now much improved.
I realise that I am extremely fortunate that Addenbrooke's is my local hospital. I am even more fortunate that it has the Cambridge breast unit, which Cherie Blair, the Prime Minister's wife, opened in 2001. That allowed the hospital to bring together in one centre all the breast cancer treatments that were provided in different parts of the hospital. The centre is staffed by a group of professionals from different disciplines, whose primary goal is to ensure that high-quality care is given to all women with benign and malignant breast cancer and breast disease. Work at the centre is led Dr. Purushotham and his team, and I pay tribute to their pioneering work.
Each year, some 3,000 new patients are referred to the unit. The Cambridgeshire and Huntingdonshire breast-screening service also refers patients to the unit, which is constantly flagged up as a model for the development of other tumour treatment sites in Addenbrooke's. Other cancer specialists are learning from the work done by the breast unit and in the West Anglia cancer network—a highly effective network developed in the past few years through which local hospitals may share good practice. It has made quite a lot of progress: it has consistently delivered against all Department of Health targets, despite the pressures of an enormous work load. It has succeeded because of the high level of commitment shown by all its members.
The target wait for a patient whose GP has referred her to the unit is now two weeks, and 100 per cent. of patients see a specialist at the unit within that period. That represents a huge improvement since 1997, when the patients with whom I spoke had had to wait much longer. A woman experiences great anxiety when she finds a lump in her breast. That results in pressure on GPs to refer patients even though they may not believe that it is breast cancer, and leads to a heavy demand on the service. Providing a better service therefore creates greater demand, so it is not always sustainable and may break down.
In response, the unit has issued GPs with detailed guidelines on the referral process, which is available on its website and in hard copy on each GP's desk. The guidelines contain detailed patient information sheets, which GPs may hand out to patients to reassure the worried well and to provide information for patients referred to the unit. There are regular GP education meetings, and frequent discussions with members of the GP liaison committee.
There have, however, been problems, one of which is the reduction in junior doctors' hours, which has led to a reduction in the time available to the specialist 79WH registrar and the senior house officer to contribute to the unit's service delivery. Addenbrooke's has considered the unit's service delivery as the model for its own service delivery, which has led to two significant developments that could be copied elsewhere.
First, Dr. Liz Cox, a GP specialist, underwent rigorous and updated training in the breast clinic with a view to functioning as an independent practitioner in the new patient clinic. She now runs a new patient clinic and follow-up clinic with the clinical nurse practitioner. The clinical nurse practitioner is also a new role, which has been developed following two years of intensive training supervised entirely by the consultant at Addenbrooke's. For the past two years Sister Dawn Chapman has been an independent nurse practitioner in both the follow-up and the new patient clinics. That is a unique role in the United Kingdom and is attracting considerable interest from other units.
It is rewarding that the Cambridge breast unit is regarded nationally as an excellent place to train. The unit has been rewarded with an appointment from the Department of Health of an oncoplastic surgeon, following a competitive bid for 10 such new posts that have been created in England over the last 18 months.
It is good too that the hospital recognises the importance of breast cancer. High priority is given to patients with breast cancer and a concerted effort by all hospital staff has ensured no cancellations of operations on the day. I cannot imagine what it must feel like to go into hospital thinking that one is going to have an operation for breast cancer only to find that the operation has been cancelled, so I am sure that the elimination of that problem at Addenbrooke's has been a huge relief to many.
Addenbrooke's is also reducing the length of in-patient stay for patients treated for breast cancer, from seven days to a mean of three days. The hospital has done that by training district nurses in the area to manage the drains that drain the fluid after the operation. Patients are therefore discharged within 48 hours post-surgery with their wound drains in situ. That is the result of efforts made by Sister Dawn Chapman, which resulted in her receiving the nursing standards award for surgical nurse of the year 2001.
The Cambridge breast unit is evaluating a new surgical technique in the context of a randomised control trial called sentinel node biopsy. Patients undergoing the procedure are discharged within 24 hours after surgery, and the process leads to far less trauma and surgery than normal breast cancer surgery does. It is predicted that the technique will revolutionise the management of early breast cancer, and it is also envisaged that within three years it will be possible for more than 50 per cent. of all women with breast cancer—approximately 150 patients a year—to be treated in the day surgery unit. I hope that that shows that every constituent of mine is fortunate to live in the catchment area of Addenbrooke's hospital.
I should like to talk about genetics and hereditary breast cancer. Since the publication of the White Paper on genetics this year, which promised £50 million over the next three years to help to realise the benefits of genetics in health care, there has been a great deal of publicity about genetics and hereditary breast cancer. 80WH The Breakthrough Breast Cancer genetics reference group is a national network of approximately 100 people who, as a consequence of their family histories, have a strong interest in breast cancer genetics and genetic services. Through the group's work, several areas of concern that need to be addressed if genetic services are to be designed round the needs of the patients have been highlighted to women.
To put the matter in context, it is important to remember that only 5 to 10 per cent. of the 40,000 women and 300 men who are diagnosed with breast cancer every year in the UK develop the disease as a result of a strong genetic risk. That roughly equates to between three and six people in each constituency developing breast cancer as a result of their genetic predisposition.
At present, there are very few ways of treating those who are known to carry genes linked to breast cancer. Therapies currently offered include prophylactic surgery to move the breasts and drug treatments that have unclear outcomes. Furthermore, approximately 20 per cent. of breast cancer cases occur in woman who are classed as having a moderately increased risk of developing the disease and are not eligible for genetic testing, as the genes involved in their breast cancers have not yet been identified. To aid early detection, access to screening and surveillance programmes is a priority for those women.
As most people here will be aware, the NHS breast-screening programme invites women between the ages of 50 and 64 for a mammogram every three years. By 2004 that programme will be extended to women aged up to 70. However, hereditary breast cancer is more likely to occur at a younger age. Will the Minister tell us what provision the Government are making to screen or to keep regular surveillance of women under 50 who have a moderately increased or high risk of developing hereditary breast cancer?
§ Dr. Ian Gibson (Norwich, North)
It has been enjoyable hearing about the work at Addenbrooke's, which is a paradigm for work that could go on across the country. It is wonderful that the debate has been secured.
My hon. Friend is really talking about prevention. I wonder if there are any other preventive measures that we might adopt. Although much research has been done, it is not quite enough. I wonder if anyone is as confused as I am about what the other causes of breast cancer might be. Do they include obesity or diet? How do we address such issues and give advice beyond genetics about how to prevent breast cancer from developing at any age?
§ Mrs. Campbell
My hon. Friend should consider joining the all-party group on breast cancer. He would then be able to attend some of our excellent presentations, such as the revealing one last week on the connection between hormone replacement therapy and breast cancer incidence in the UK. Knowing the risks about the increased incidence of breast cancer made many of us think quite hard about whether one should use HRT. That is an example of the excellent work that the all-party group does. I invite my hon. Friend to join.
81WH Many women wait up to 18 months for referral to a family history clinic for genetic services. Even after referral, the women who take a genetic test for gene mutations face long delays; many wait more than a year for the results. Some women who were tested in the late 1990s are still waiting for their results. They have received little, if any, explanation of the delay. Despite evidence that mutations occur throughout the gene, it is accepted practice to examine only two thirds of either gene, which is thought to detect approximately 60 to 80 per cent. of mutations. That results in the possibility of mutations being missed or occurring in another gene. Therefore, women wait more than a year for a partial test result, after which some are still left in the dark about their risk of developing breast cancer.
There are also indications that the diagnostic testing of the BRCA genes patented by Myriad Genetics, Inc. has seriously hindered the availability and adequacy of genetic tests for breast cancer in the NHS. Will the Minister comment on the position regarding the Myriad patent on the BRCA genes and commit to ensuring that the NHS provides the best-quality genetic testing available to those at risk from hereditary breast cancer, in order to provide accurate, meaningful and prompt results?
§ Mr. Iain Luke (Dundee, East)
I, too, begin by congratulating the hon. Member for Broxbourne (Mrs. Roe) on securing the debate. I admire the way in which she introduced the topic, which is highly charged and highly significant to many. I know that she speaks from a deep-seated concern and has a personal awareness of the anguish and distress that that form of cancer can cause.
As the hon. Lady said, this is a highly significant time to hold the debate, as it is national breast cancer awareness month. I must say that if the debate had been held this time last year, I probably would not have attended—but now I am very aware of the impact that breast cancer has. For me, until last year, cancer was a taboo subject to some extent: an acknowledged scourge, but something that happened to others, a wolf that was best kept at the door. I would certainly have sympathised with the sentiments of care and concern that would have been expressed in such a debate—but at a distance. However, the chance discovery of a small lump in my wife's breast on 13 November last year changed all that. Life for us all—my wife, myself and our family—was turned upside down, and my wife was set on a course of treatment which is, I am thankful to say, coming to an end this Friday after almost 12 months.
The year has passed quickly, if painfully; it began with two sessions of surgery, interspersed with frequent meetings with consultants and Macmillan nurses, moving through eight sessions of chemotherapy, lasting six months, and culminating in six weeks of radiotherapy, involving daily visits to hospital. My wife has made a significant contribution to the drafting and phrasing of my speech today, and much of the pain that we have felt has gone into it.
82WH The impact on family life of such intensive and debilitating treatment cannot be overstated, but the kindness and professionalism of the staff at our local hospital, Ninewells, with whom we have come into regular contact, have certainly made the past year's journey easier. The dedication of NHS cancer staff is something that we can be proud of, and my wife certainly appreciates it.
The first real impact of the breast cancer diagnosis on us as a couple was the strange feeling of being alone and in isolation—a feeling that within the hustle and bustle of a busy world we were set to one side. We found it difficult, initially, to talk to our immediate family and friends, as breast cancer was not a subject that people talked about. However, it is a subject that people should talk about, and that is why I am here today. Only by talking about cancer can we rid ourselves of the fear associated with it, and only by talking about breast cancer can we learn that it is no longer synonymous with an early death—far from it.
A year ago, my wife and I knew that breast cancer was not an uncommon phenomenon. We were well aware of the illness, given its media coverage, but it was from talking to friends, family, colleagues and acquaintances that we began to realise how many people we knew, both in Dundee and in London, were also coming to grips with that cancer, struggling, like us, through their treatments and the day-to-day reality of coping with whatever might hit them next. That revelation, coupled with our very frequent visits to Ninewells hospital, impressed upon us the enormity of the impact of breast cancer—the second most frequent cancer among women—on people's lives.
I appreciate the improvements that have been made in treatments, and the greatly improved survival rates that have resulted from those advances, so that nearly four out of five women survive for five years or more. There has been a 21 per cent. reduction in fatalities in the past 10 years. Encouraging as those survival rates are, I believe, and I am sure that everyone present would agree, that they need to be better. Breast cancer is still the second most common cause of cancer deaths for women in the UK, after lung cancer. There is no doubt that progress has been made and continues to be made, thanks to patient support for clinical trials—my wife was involved in a clinical trial at Ninewells hospital—research institutes, medical staff and drug companies, but the need to do more is constantly at the forefront of one's thinking.
It is encouraging that the current national screening programme will be extended to women of 70 by 2004. However, given that 8,000 pre-menopausal women are diagnosed each year, and that the earlier breast cancer is detected the better the chances of survival, should we not be looking into the possibility of extending the screening programme to younger women on a more regular basis?
Examination of the figures reveals the need for greater equality of access to fast-track treatment throughout the country. We have already heard about Addenbrooke's hospital. I live in Dundee, and my wife and others like her are lucky to live near Ninewells teaching hospital—part of an academic community linked to the Wellcome Trust institute, which is playing a major part in seeking the elusive comprehensive cure for cancer. Even in that centre of excellence, the lack 83WH of money threatens the Government's target of 80 per cent. of patients being seen at a symptomatic clinic within two weeks of their being referred to one by their GP.
Waiting times for urgent referrals at Ninewells are as long as six weeks, because of the lack of resources to fund additional sessions at the breast clinic to tackle the backlog of patients, which has built up because radiologists have been absent through ill health. Obviously, the situation is exaggerated by the national shortage of radiologists. Last year, my wife was seen in six days after a referral from her GP.
A six-week wait for an urgent mammogram has knock-on effects, which can delay surgery. Any delay increases the risk to the patient and can result in a more extensive and drastic form of surgery being required. The provisional resources to allow prompt diagnoses are surely the best way to take cost-effective action.
As a male contributor to a debate on an illness that predominantly affects women, I must admit that there have been moments over the past year in which I have been found wanting in the face of the demands placed on me. However, I am determined to do all that I can to assist in making the best possible package of care available to those who need it, whatever their postcodes may be.
In the fight against breast cancer, we must do all that we can not only to encourage direct medical care to alleviate by medicine and drugs the physical impact of cancer on patients, but to promote projects such as Maggie's centres, which offer support in the form of drop-in centres for cancer sufferers, carers and anyone whose life has been touched by cancer. In such centres, people can find support and information to help them come to terms with the initial diagnosis and to make treatment choices in peaceful and tranquil surroundings.
A Maggie's centre designed by the world-renowned architect Frank Gehry has recently been built in Dundee, and that is a place where people can make such choices. It is situated on the brow of a hill within the grounds of Ninewells hospital. There is a beautiful vista up the Tay valley estuary as it winds its way westwards up the Carse of Gowrie to Perth. Bob Geldof and Frank Gehry jointly opened the centre last month. It offers quiet and restorative contemplation, and the chances of a spiritual uplift and renewal to combat the invasive nature of one of the worst medical conditions known to women, and men. People who do not know the area will find it hard to picture the scene, but it is the most tranquil setting for a medical building that I have ever seen.
Many more such centres are urgently needed, and I hope that they will be built in the years to come, to benefit all those who suffer from cancer. Outside that form of supportive retreat, we must give the treatment of and cure for that scourge our fullest attention. We must renew, reinvigorate and resource our efforts to reduce the number of women and their families who are sentenced to experience the agony, distress and suffering currently associated with the disease.
Perhaps I should have said this at the beginning of my speech, but I welcome the initiative taken by the hon. Member for Broxbourne in securing today's 84WH debate, which allows us to focus on what can be done to reduce the suffering that future patients and their families endure from that type of cancer.
§ 10.8 am
§ Mrs. Ann Cryer (Keighley)
I start by putting on record my genuine appreciation of the work of the all-party parliamentary group on breast cancer. It was the first all-party group that I joined in 1997, when I was elected to Parliament. The all-party group has three joint chairs, and I particularly want to mention my hon. Friend the Member for Halifax (Mrs. Mahon), who has dedicated a great deal of time and energy to the group over many years. I am sorry to say that she will be standing down shortly—but I am sure that she will stay with us and attend meetings, as always.
I shall also mention the enormous help provided by Breakthrough Breast Cancer, whose clarion call is:"Our vision is a future free from the fear of breast cancer",which we can all endorse. The group's aims are set out in its current bulletin, which highlights breast cancer awareness month. They are that it:Raises issues of concern with Government and other policy makers.Provides a forum for MPs and Peers of all political parties to discuss breast cancer related issues.Takes action on behalf of people with breast cancer".
The unsung heroes of this place, who are not often mentioned, are the ever-helpful research assistants in the Library. They now complete an appropriate Library debate pack for all 90-minute Adjournment debates. I called into the Oriel Room last night to collect the pack on breast cancer. All copies had gone, so the assistants made me a reprint—but I shall not rely too heavily on those notes, in case we all seem to be singing too much from the same hymn sheet.
I shall quote just some of the information provided by Cancer Research UK, but shall not go into enormous detail because I want to allow time for others to speak. It says:Over 39,500 women are diagnosed with breast cancer every year in the UK. It is now the most common cancer in the UK and by far the most common cancer amongst women. For women, the lifetime risk of developing breast cancer is now 1 in 9",as the hon. Member for Broxbourne (Mrs. Roe), said. The document continues:Most of the women who get breast cancer are past their menopause, but over 8,000 are under 50 years old. About 300 men are also diagnosed with breast cancer every year.
Various factors are thought to increase the risk of breast cancer. These include:
A close relative with a history of breast cancer. About 10 per cent. of cases are thought to have a genetic basis.
Early start to menstruation (before the age of I1) and late menopause (after age 54).
Having a first child late.
Exposure to radiation (other than normal background radiation).
High fat intake in the diet.
Moderate to heavy drinking of alcohol.
Oral contraceptives and hormone replacement therapy (HRT) may very slightly increase the risk of breast cancer. 85WHThose with a strong family history of breast cancer carry one of a number of faulty genes which increase the risk of breast cancer. At the moment it is possible to test for two of them, BRCA1 and BRCA2. Up to 85 women out of every 100 that carry a faulty breast cancer gene will have developed breast cancer by the time they are 55.
I asked my local Airedale primary care trust to give me some information on what is happening in my constituency. I should mention that Airedale general hospital does not compare that well with Addenbrooke's, but it is a very good local general hospital, and the biggest employer in my constituency. Lyn Wilkinson, director of community and nursing services, has provided me with one or two points. She says:Airedale has a fully accredited Breast Cancer service with the Richardson Clinic providing women with access to Specialist Breast Cancer nurses and surgeon Mr Nejin who specialises in Breast surgery including reconstruction breast surgery (a recent development).Airedale has a prosthetic service and a lymphoedema service, led by a Macmillan funded lymphoedema nurse.She also says that the oncology and haematology day unit enables women to have chemotherapy locally in Airedale general hospital. However, women must still travel to Leeds for radiotherapy. The outcomes for women are good, as is referred to in a survey provided by Dr. Foster.
I went to the opening of the comparatively new haematology and oncology unit, and was delighted by it. It is a cheerful large room, well furnished and comfortable. At a time when they are pretty depressed and unsure of their future, it must help women a great deal to be able to go into such a room for chemotherapy.
Because of certain events that are to take place this afternoon, our debate may not grab the headlines. To paraphrase: it is a good day to bury reasonably good news. That is a pity.
§ Mrs. Alice Mahon (Halifax)
My hon. Friend the Member for Dundee, East (Mr. Luke) made a valuable contribution. I am always delighted when men stand up and move the case forward, and do so as movingly and as well as my hon. Friend did. He was also rather optimistic, which was good for us all. I echo the sentiments of my fellow officers of the all-party group on breast cancer in saying how delighted I am that we have this opportunity to highlight the importance of breast cancer awareness month.
I want to pay tribute to one or two people, including the joint chair, the hon. Member for Broxbourne (Mrs. Roe), who, way back in the mists of time, as Chair of the Select Committee on Health, oversaw the production of a useful report on breast cancer. We have seen a lot of progress since then. I also pay tribute to my other hard-working colleagues. I am going to stand down from the chair and hand over to my hon. Friend the Member for Keighley (Mrs. Cryer), because of pressure of work and because I am standing down at the next election. The group works really well. It is a cross-party group, but parties never come into it. We just consider the disease 86WH and the foot soldiers—the women—and we see how we can progress matters and help deal with this dreadful disease.
I want to focus on some issues relating to screening. I congratulate the NHS breast screening programme on its 15th anniversary. The programme has been remarkably successful in detecting breast cancers in British women. More than 15 million mammograms have been taken, and more than 90,000 cancers detected. Will the Minister confirm the number of cancers detected through the programme in 2001–02, including the number of cancers smaller than 15 mm, which are usually impossible to detect by self-examination?
As I am sure the Minister knows, the World Health Organisation's International Agency for Research on Cancer recently determined that there has been a 35 per cent. reduction in mortality from breast cancer among screened women aged 50 to 69, which may go some way towards explaining the dramatic 22 per cent. fall in breast cancer mortality rates in the UK over the past 10 years. That is good news for women, and I declare an interest here.
Bearing in mind the importance of the screening programme, we should be extremely concerned that not all women who are invited to take up the opportunity to be screened do so. That is a worry when one considers that 80 per cent. of breast cancers occur in post-menopausal women, and that early detection and diagnosis are vital in improving women's chances of surviving the disease.
The problem is of particular concern in London, where the minimum standard of 70 per cent. has not been met across the board. In the most extreme case—in central and east London—only 51 per cent. of women took up their invitation for screening. There is clearly a job to be done there. I am pleased to say that in my constituency, Halifax, we are way above the minimum standard, and we also have a beautiful facility with dedicated staff. I pay tribute to every one of them.
As joint chair of the all-party group on breast cancer over the years, I have put questions to various Ministers. Will the Minister comment on how the Government are encouraging women to take up their invitations? I know that there is an ongoing programme. Will she, in particular, investigate the low uptake in black spots such as east London? Perhaps the screening programme could be directed to conduct a survey into why that is happening. I accept that there are problems in certain inner-city areas, but the statistics are poor, and we should be finding out why those women are not attending. I have highlighted London today, but our main aim should always be to ensure that all women entitled to screening take up their invitations, because not doing so can have effects on their future health.
The programme also appears to be struggling with the numbers of women being screened, because of the increase. In 2001–02, the number of invitations sent out fell by more than 60,000 to 1.7 million, compared with 1.8 million during the previous year. We should consider and concentrate on that statistic. I know that it has been partly blamed on the pressure on the service due to staff shortages and recruitment problems, but getting the companies and charities that support us to publicise the issue through some sort of advertising campaign might help.
87WH I am not criticising the service. It has been brilliant, and it has saved lives, but I would like to see an improvement in that brilliant service. I am not making a criticism of anyone working in it, or the Government—or the last Conservative Government, who introduced it. However, there are numerous examples involving the interval between screenings. The agreed three-year period is now being stretched to four years in London in other areas. Some organisers are adding several months on to the three-year recall interval. That is a worrying trend, because a delay means that some women will miss the chance of having breast cancer spotted at the earliest opportunity.
Breakthrough Breast Cancer has evidence that many women have to chase up the results of their mammograms, or have to wait for more than two months for any result to be received. That is a worrying time, and we could improve that situation. The pressure on the existing system will no doubt be further compounded by the increased capacity when the programme is extended to women aged up to 65 and 70 next year. I declare an interest: I am very pleased about that, because I am in that age group.
Will the Minister comment on those situations and outline what initiatives are currently in place or being planned to ensure that all women who should be screened are given the opportunity to attend? It is important that they receive adequate information promptly and get accurate results from the programme. That goes without saying.
Finally, I want to draw attention to the information provided for women attending screening appointments. The information women receive when invited to routine screening as part of the NHS screening programme is different from what women and men receive if they are referred with symptoms. I am concerned that people who are referred with symptoms are not getting enough information about their situation. The standards of information differ throughout the country. I shall be interested to hear the Minister's response to that problem. This has been an excellent debate, and I congratulate the hon. Member for Broxbourne on securing it.
§ Mrs. Patsy Calton (Cheadle)
I add my congratulations to the hon. Member for Broxbourne (Mrs. Roe) on securing this important debate. It touches on all our lives, and none of us is in the happy position of knowing nobody with this particular disease. I would like to associate myself with the hon. Lady's remarks regarding the huge range of breast cancer charities that she mentioned. All of them have played an enormous part in the work that needs to be done on the issue.
I add my own personal thank you to the all-party group, which I joined on becoming a Member of Parliament in 2001. I was made aware of it by my hon. Friend the Member for Hazel Grove (Mr. Stunell), who passed me the documents produced by the all-party group after its 1997 resurrection. I was aware of the work being done by several hon. Members to raise the profile of the issue and point out the importance of getting more than adequate treatment. That group, alongside the secretariat provided by Breakthrough Breast Cancer, has made a real difference. Its calls for better treatment and care have not fallen on deaf ears.
88WH I also wish to mention the work of the hon. Member for Lewisham, Deptford (Joan Ruddock) who made such a valuable contribution to the group, but, sadly, as is the way with these things, had to move on to other responsibilities—and also that of my hon. Friend the Member for Richmond Park (Dr. Tonge), who as my predecessor was very involved with the group, and of the hon. Members for Halifax (Mrs. Mahon) and for Broxbourne.
The calls for better breast cancer treatment have shown that a multidisciplinary approach, which we have in various excellent centres—we have heard about the centre in Cambridge, and I can also point to the Christie hospital and the Nightingale centre in Greater Manchester—competes with the most advanced treatments in the world. It is a model for treatment of other cancers and for other illnesses. There has been progress, but there is a great deal more to do. Sadly, too often the multidisciplinary specialist approach is still not available, and women and men face a difficult journey on a system that is like the London underground, with parts out of action, parts delayed, and not enough signposting—I owe thanks to a speaker at last week's cancer conference for this analogy.
I pay tribute to the screening service, but there is a shortage of radiographers. The Nightingale centre in my area of Greater Manchester deals with that shortage by training others from related professions to do some of the work. I am sure that acknowledging the numbers problem and ensuring that people are retrained to perform parts of that valuable work are the right things to do.
As we have heard, breast cancer is the most common form of cancer, with around 40,000 cases diagnosed every year. In 2001 there were 13,000 deaths from breast cancer, and about 300 men every year are diagnosed with it as well.
We have heard from the hon. Member for Keighley (Mrs. Cryer) about the number of risk factors that are known because of the valuable work of Cancer Research UK and others. Early puberty and excessive weight gain are two not unconnected factors. Early pregnancy, more pregnancies and breast-feeding all lessen the risk. The point has been made that although we sometimes discourage women from early pregnancy, it seems that early pregnancy is what nature intended.
Between 5 and 10 per cent. of cases of breast cancer are connected with the BRCA1 and 2 genes, and it is appalling and offensive that Meridian has the patent for those genes and has therefore put an obstacle in the way of research across the world. I hope that the Minister will tell us of the progress that has been made in dealing with a company such as Meridian, which feels it has the right to make money out of people's genes.
Excessive alcohol, excessive post-menopausal weight gain, too little exercise and dietary factors all appear to be implicated in an increased risk of breast cancer. I am grateful to Cancer Research UK for its support of this debate. Its "million woman study" has found a clear link between HRT and increased rates of breast cancer, and it is investigating other factors such as diet, childbirth, breast-feeding, vitamin and mineral supplements, oral contraceptives and family history. I hope that it will soon be able to give a clear indication of the increased risks associated with each factor.
89WH Our main aim must be to reduce the number of breast cancer cases. More research is needed into how to reduce risk factors, and as important is the need to provide information about risk to ensure that parents, young and older women, and men, can make informed choices about reducing their risk.
The Government have promised to match pound for pound the money raised by charities for research by 2003. Will the Minister confirm that commitment? What will be the total sum devoted to cancer research? We heard at the Europa Donna lecture last year that treatments can be more tailored to particular types of breast cancer, thereby in some cases avoiding the need for the entire bundle of available treatments such as surgery, chemotherapy, hormonal treatment and radiotherapy. At the Europa Donna lecture this year, we heard that radical surgery is not always necessary and that outcomes can be as good with lumpectomy, which is becoming a more common practice. As the hon. Member for Cambridge (Mrs. Campbell) said earlier, all lymph nodes do not have to be removed.
Women with breast cancer, and their families, need patient-centred care with speedy and co-ordinated diagnostic investigations—I emphasise the co-ordinated element—followed by clear signposts to treatment and complementary therapy options. I never got a wig, because I was never at the hospital on the right day. I suspect that such things still happen in some places.
The Nightingale centre, which I attended, and the Christie hospital in Manchester have launched an appeal for a purpose-built centre like the Cambridge centre. It will have all the facilities on site so that women and men are not passed around or made to find their own way along a difficult path at an emotionally charged time, when finding their own way is very hard for them, and for their families.
We all want to know how to reduce our risk, and our daughters' risk, of breast cancer. Some factors are outside our control, but some are not, such as those associated with the other major health problems of heart disease, stroke, other cancers and diabetes: lack of exercise, excessive weight gain, excessive alcohol intake, smoking and dietary factors. The Government have acknowledged those factors in their public health programme, but it is important that their role in cancers, particularly breast cancer, is also played up. Women want to believe not only that first-class treatment will be available to their daughters, but that research to confirm the avoidable risk factors will be financed.
§ Mr. John Baron (Billericay)
I, too, congratulate my hon. Friend the Member for Broxbourne (Mrs. Roe) on securing this important debate, and I take this opportunity to congratulate all hon. Members on their contributions. This highly emotionally charged subject deserves to be handled sensitively.
This is an important debate. One in nine women in the UK will develop breast cancer during her lifetime. The disease accounts for almost one in three of all cancer cases in women and, as we have heard, it is the most common cancer for women in the UK. Last year, some 40,000 women were diagnosed with breast cancer, and 90WH unfortunately, some 12,990 died because of it. The UK survival rates for breast cancer are lower than those for the EU as a whole, and that must be corrected. There is no doubt that the Government are attempting to address the problem, but in the next 10 minutes I shall raise several questions about their well intentioned targets, and ask whether they are having the desired effect.
I begin with the two-week referral target, which my hon. Friend discussed. A two-week target was set—in April 1999, I believe—to ensure that all women with suspected breast cancer who were urgently referred by their GP should see a hospital consultant within a fortnight. The target has largely—98 per cent.—been achieved, which is creditable. However, research by the Thames Cancer Registry has found that although that target has been met and the proportion of women who are seen within that time has risen, waiting times for subsequent treatment have gone up, and overall waiting times have not changed at all.
The research found that the introduction of the target had meant that non-urgent referrals could easily wait for up to 12 weeks for an appointment; indeed, we have heard examples of 17-week waits. That is a major area of concern. Long delays can impact on treatment outcomes. As Dr. David Robinson, who was party to the research, put it:The problem with arbitrary targets is that they just seem to push patients from one queue to another.He went on,Our study suggests that the Government's two week target has changed little for women undergoing Breast Cancer treatment.
Indeed, the study found that women who went to their doctors with symptoms of breast cancer generally waited longer for appointments than those diagnosed through screening, even though their cases might have been more urgent. Some 86 per cent. of women whose cancers were detected by the screening programme saw a consultant within two weeks, compared with 68 per cent. who went to their doctors with symptoms of cancer. That brings us back to the points raised by a number of speakers. As Dr. Robinson put it:The effects we have observed reflect the risks inherent in a policy of targeting one element of the patient pathway in isolation.
Will the Government now make a detailed assessment of the effects that the two-week target is having on non-urgent referrals? There is concern that many women who need to be urgently referred are waiting too long to see specialists, and their treatment is subsequently delayed.
Another target that I would like to bring to the Minister's attention is the one-month wait from diagnosis to treatment. It is generally recognised that many trusts—almost 97 per cent., according to the latest figures—hit that target. That is laudable. However, the cancer plan's target refers only to the wait from diagnosis to the start of the first treatment. Concerns have been raised, particularly by Breakthrough Breast Cancer, about the time that patients have to wait between diagnosis and all the stages of treatment. Many patients receive the first stage of the treatment—often surgery via a lumpectomy or mastectomy—relatively quickly, but they then face significant delays before further treatment, particularly radiotherapy.
91WH Only last week the Royal College of Radiologists reported that the service is still short of the target set by the NHS cancer plan five years ago and, as the Minister will be well aware, the situation is getting worse. The president of the Royal College, Dr. Dan Ash, went as far as to say:There is no doubt that patients are dying unnecessarily.According to the report, many patients have to wait longer for treatment. When responding to the survey, the Government dismissed it on the basis that the figures were out of date. Will the Government now provide up-to-date figures? Furthermore, will the Minister outline other ways in which the Government are tackling the unacceptable wait for radiotherapy treatment?
In a debate such as this, it is important to pay tribute to all the staff within the NHS who deal with cancer in general and breast cancer in particular, for carrying out their work, often under difficult conditions. I add my tributes to those that have already been made to the many charities that have been active in raising awareness of the issue. I wish the merger of Breakthrough Breast Cancer and the UK Breast Cancer Coalition well.
The centre of our focus must always be the patient—today that means the breast cancer patient in particular. We often talk about patient priorities and the level of service and treatment that patients require, without finding out from patients what they really want. For example, many women affected by breast cancer feel that they still do not receive the written information about the condition, or about available support services, that they rightly feel they deserve. The Department of Health's own survey of cancer patients in 2000 revealed that only 51 per cent. of breast cancer patients were given information at the time of diagnosis. I hope that the Government will address that issue; I believe that they are trying to.
A recent survey of 50 cancer experts conducted by Breast Cancer Care, called "Breast Cancer in the UK: What's the prognosis?"—evidence that cannot be lightly dismissed—found that 80 per cent. of patients did not think that the NHS met the information and support needs of patients satisfactorily. Furthermore, 92 per cent. felt that patients needed more time and support from health professionals to help them make decisions about treatment.
There was also a concern about public misconceptions concerning the age-related risk of breast cancer. We know that 80 per cent. of breast cancer cases occur in women who are over 50—that statistic has been referred to on several occasions. That figure was confirmed in a survey commissioned in July 2000 by Breast Cancer Care in association with Boots. It found that many older women were unaware that the risk of breast cancer increases with age.
What initiatives will the Department of Health instigate to review its breast cancer education strategy in order to ensure that the right messages are getting to the right people at the right time? What efforts will be made to improve awareness generally and to inform decision making? We all know of the cancer risks created by smoking, obesity and diet, but it is felt that the message is not being put across aggressively enough.
I would also like to use this opportunity to bring attention to a group that has campaigned for 12 years to seek justice for its members, who have suffered from the 92WH effects of an overdose of radiation in the brachila plexus region. The group is called the Radiotherapy Action Group Exposure—RAGE for short. Its campaign started after the published case of Lady Audrey Ironside's failed court action against a consultant at the Royal Marsden hospital. During her case it was discovered that a large group of women had been injured accidentally at certain cancer centres between 1980 and 1985.
I ask the Minister to give the Government's position with regard to RAGE. In particular, will she urge the Secretary of State for Health to answer my letter dated 15 September 2003, which sets out the case for compensation for those affected by radiation exposure? It asks whether, as the Department of Health is set to make awards to those who have contracted the hepatitis C virus, it will now reconsider the case of the 250 or so women who are represented by RAGE.
I ask the Minister to address the following key issues that I have raised. The Government's two-week target is failing to bring down waiting times for breast cancer treatment, and may indeed in certain cases be leading to urgent cases being put on the non-urgent referral list. The one-month first treatment target may actually be causing significant delay in breast cancer patients receiving subsequent treatments, particularly radiotherapy. Most breast cancer patients believe that the NHS fails to meet their information and support needs. The Government have not responded to my request for a review of the RAGE campaign. I look forward to hearing from the Minister, in the hope that she will answer those specific questions.
§ The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)
It is with great pleasure that I rise to respond to this excellent debate. I congratulate, as others have done, the hon. Member for Broxbourne (Mrs. Roe) on giving us this opportunity. I think that we have all seen it as a fantastic chance to be able to talk about a subject very dear to our hearts and close to the concerns of many people across the country. It is always a pleasure to rise as a Minister, knowing that one is responding to a debate of quality and interest such as that demonstrated by hon. Members' contributions this morning.
I shall endeavour to respond to as many points as possible, but in the time left I may have difficulty in responding to all the many useful points that the numerous experts around me have raised. First, I shall mention the successes that we have had in working with breast cancer charities, whose contribution I welcome. The hon. Lady set out a long list of breast cancer charities, so I shall not risk rehearsing all of them, for fear of leaving one off the list. Their work with patients, their research work, their work on user involvement and the many campaigning and other activities in which they are involved form an excellent addition to the work of the national health service on breast cancer. They have a very important role in making women aware of breast cancer, and of symptoms, treatment and support. That is all to be warmly welcomed.
This debate gives us the chance to look at a wide range of issues. I shall say a few words on prevention, which a number of hon. Members touched on. We know that 93WH obesity contributes to the risk of breast cancer, and it is important that that message become more widely understood. There is a particular relationship between fat intake, including saturated fat, and the development of breast cancer. Only yesterday, Cancer Research UK published research detailing an association between high meat consumption and breast cancer. Improving diet, as we are advocating in general, by increasing fruit and vegetable consumption is considered the second most effective strategy in reducing the risk of cancer, after giving up smoking. We are therefore leading the development of a comprehensive food and health action plan, which will bring together current initiatives on diet and nutrition and focus more strongly on achieving a healthier diet for people in England.
We are also trying to do more to increase women's awareness of breast cancer. That is very important because 90 per cent. of breast cancers will be found by women themselves. There is a five-point code in that regard: women knowing what is normal for them, knowing the look and feel of their breasts, knowing what changes to look for, reporting any changes without delay, and attending for breast screening if aged 50 or over.
On screening, I join other hon. Members in congratulating my hon. Friend the Member for Halifax (Mrs. Mahon) on her contribution and her work with the all-party group on breast cancer in the past few years; hers was one of several contributions that mentioned screening. Of course, we cannot prevent all cancers, although it would be highly desirable to do so. Even if people took all the useful precautions that they could take, we would be a considerable way from achieving that. The fact that 8,500 cancers were detected through the breast cancer screening programme in 2001–02 speaks for itself. In many cases, screening finds cancers before they turn into detectable lumps. Many of those detected were small cancers that would not have been found by self-examination or by general practitioners. Early detection and treatment means that women have a far greater chance of survival than they would otherwise have.
As my hon. Friend the Member for Halifax mentioned, we are in the process of extending the breast screening programme to women aged 65 to 70 by 2004. That has been rolled out in a number of areas, and an additional 200,000 women have already been invited for breast screening since we began the extension in April 2001. By the time that the extension is completed next year, 400,000 more women each year will be invited, when the scheme is fully implemented. In addition, we are upgrading current services by offering two-view mammography at all screening rounds by 2003, which will lead to an estimated 43 per cent. improvement in the detection of small cancers.
We are aware that some women who are invited for screening do not take up the offer, and the point about the difficulties in London was well made. We cannot force women to attend, however, and problems can arise when they change address. What we can do is to make women aware of the importance of attending. The cancer charities have a major role to play in making women aware of the benefits, limitations and risks of 94WH screening, and in helping them to make informed choices. Hopefully, women will attend, but it is a matter for them.
I shall provide more information about our achievements through the screening programme, because it is important to realise how effective much of the work has been. In 2001–02, 1.3 million women in England were screened and more than 8,000 cancers were detected. Some 93.8 per cent. of women who had invasive breast cancer detected by screening are alive five years later, which is an impressive statistic. In cases of non-invasive cancer, 98.6 per cent. of women were alive five years later.
Early screening has reduced mastectomy rates, which have fallen by half since the introduction of screening. That is because women can often be treated with minor surgery, which conserves the breast, rather than with the radical surgery that results in mastectomy. The mortality rate fell by more than 21 per cent. between 1990 and 1998. One third of that fall is attributed to screening, which plays an important role in tackling breast cancer and its incidence.
On waiting times, as the hon. Member for Broxbourne said, the two-week wait has been a huge success. Some 98 per cent. of women wait two weeks from urgent referral to being seen at a clinic, which is welcome. In the last quarter of 1999, 28,000 women were seen within two weeks; in fact, the figure may be more recent, but my notes are not entirely clear. The two-week out-patient standard was introduced in 1999.
Patients must be confident that, if they have symptoms of what could be cancer, they can discuss them with their GP and be referred quickly and appropriately if necessary. A GP with a list of 2,000 patients, which is typical, can expect to see one new breast cancer patient per year, but they will also see a considerably larger number of women with benign breast problems.
The need for GPs to pick up and refer people appropriately has already been mentioned. Their task is to differentiate between patients whose symptoms may be cancer and the very much larger group of patients who have similar symptoms arising from other causes. We have developed cancer referral guidelines for primary health care teams to help them to identify those patients who are most likely to have cancer, and who require urgent specialist investigation. The National Institute for Clinical Excellence is currently reviewing those guidelines.
As was mentioned, the referral guidelines recommend a local audit of referrals and feedback to GPs, and we are looking systematically at the review across the local audits. Indeed, we have primary care clinical leads appointed in more than 300 primary care trusts, which is almost all of the trusts in England. As I said, the referral guidelines are being reviewed.
§ Mr. Baron
I hear what the Minister says, but will she accept that an increasing body of evidence suggests that the Government's two-week target is failing to bring down waiting times for breast cancer treatment and may, in certain cases, lead to urgent cases being put on the non-urgent referral list?
§ Miss Johnson
I think that the hon. Gentleman is exaggerating what may be a difficulty. We need to check, 95WH and I shall be happy to investigate whether there is a difficulty. Unfortunately, much of the available information on cancer tends to lag behind what is currently happening. The vast majority of women are served nothing other than extremely well by the target, and by its having been met by 98 per cent.
Another target, which also serves women well, requires that when breast cancer has been diagnosed, women should receive prompt treatment. They should receive treatment within a month of diagnosis, and during the most recent quarter for which we have information, the one-month diagnosis to treatment target was achieved in almost 97 per cent. of cases. I undertake to see whether we can do anything more, outside of reviewing the guidelines, about the time that it takes for some women who are not urgently referred to be seen.
As several hon. Members said, in general death rates are showing a marked improvement. The 21 per cent. reduction in breast cancer, and the 10 per cent. overall drop in cancer death rates over the five years, from the mid-1990s average to the 2000–01 average, indicate that we are making substantial progress on breast cancer and on other cancers. That is an illustration of earlier treatment and diagnosis, better treatment and better follow-up across the piece.
As I am short of time, I will turn to the question of a postcode lottery for prescriptions, and, as was mentioned, for Herceptin in particular. We were concerned by the recent evidence, produced by Roche and Breakthrough Breast Cancer, on Herceptin. As a result of that information, we asked Mike Richards, the so-called cancer tsar and the national director for cancer, to investigate the causes of the apparent differences in the prescription of Herceptin around the country. He has been asked to report to the Secretary of State within three months, and we will consider his findings. I assure hon. Members that we do not believe that funding should be the cause of any such postcode prescribing, and we are committed to ensuring that the drugs are available to patients in line with NICE guidelines.
Government matching of voluntary funding has also been mentioned. The latest analysis, covering the year 2000–01, shows that the Government matched voluntary funding—the figure was, I think, about £180 million per annum—and we continue to do so.
Macmillan Cancer Relief and the Department of Health are working with service users and leading experts in cancer and genetics to develop a model approach for people at risk. Plans are currently being drawn up, in partnership with Macmillan Cancer Relief, to pilot the model from 2004 in some six sites throughout England. In addition, NICE is producing guidelines for women who are worried about familial breast cancer, and they are due to be published early next year. As announced in the genetics White Paper, some of the £50 million investment will he used to upgrade genetics laboratories.
I have not had time to do justice to the many points that have been raised. However, I have had breast cancer and I understand exactly what this means for women. So I can assure hon. Members, whose enthusiasm and interest I welcome, that we are very committed to achieving huge improvements.