§ Dr. Howard Stoate (Dartford) (Lab)Thank you, Mr. Deputy Speaker, for giving me the opportunity to raise this issue in this Chamber.
We are now in the middle of national men's health week, so there could not be a better time to debate the issue of men and cancer. Few health issues could be more serious for men than cancer. It is now the single most common cause of death for them. Every year, 80,000 men in the United Kingdom die from the disease, and 134,000 are diagnosed with it. One in three will be diagnosed with cancer at some time in their lives, and one in four will die from the disease. I am sure that, in one way or another, these statistics will have touched the lives of all Members of the House in a very personal way.
As hon. Members may know, the theme for this year's national men's health week is men and cancer, which means that the debate is doubly well timed. The Men's Health Forum, which organises national men's health week, has done an excellent job in raising this sensitive issue with the male public, not least by producing, in conjunction with the Haynes Publishing Group and several national cancer charities, an excellent book, written by a friend and colleague, Dr. Ian Banks, in a car manual format. The book gives essential information about the disease in a male-friendly style, and offers a practical, step-by-step guide for men to preventing, detecting and beating cancer. I commend it to hon. Members, and thank the Minister for the financial support that her Department gave to the Men's Health Forum to help to produce the book.
I was particularly pleased to learn that the manual and national men's health week have secured the support of the Football Association. Hon. Members may have seen in press reports this week that SvenGoran Eriksson and his coaching team took time out from their busy schedule in the run-up to Euro 2004 to help to promote it. I understand that one reason why the FA was keen to become involved is that Brian Kidd, Sven-Goran Eriksson's assistant coach, is recovering from prostate cancer surgery and has been forced to miss events in Portugal. I am sure that hon. Members will join me in wishing Mr. Kidd a speedy recovery.
There is no doubt that much progress has been made in recent years towards the "our healthier nation" target of reducing the death rate from cancer in people under 75 by 20 per cent. by 2010. The NHS cancer plan, in particular, is improving, and will continue to improve, cancer prevention, diagnosis, treatment and care. These initiatives and others like them are benefiting the whole population, and the Government deserve the congratulations of health professionals and patients alike on their successes in this area.
The establishment of the prostate cancer advisory group, which is working in close partnership with the prostate cancer charter for action, will be instrumental in improving services, stimulating research and raising public awareness about cancer in men. That important development is very welcome, but we must be wary of the pitfall of assuming that tackling cancer in men means simply addressing male-specific diseases such as prostate cancer and testicular cancer. That is emphatically not the case. Action is required against a broad range of cancers.
228WH I should also make it clear from the outset that I am not seeking to diminish the issue of cancer in women, or to argue that resources should be diverted from work on women and cancer to fund more work on men. Such a step would be disastrous. Nor am I seeking to criticise or to undermine the fine work that is being done to tackle cancer on a population-wide basis. This debate is about how we can improve still further the outcomes for men and in doing so improve the health of the population as a whole.
Men are more likely to develop cancer than women and to die from it. Age-standardised data for England shows that the incidence of all cancers for men is just over 400 per 100,000 of population. The figure for women is only 340 per 100,000—a difference of almost 20 per cent. The comparable figures for mortality show an even starker difference between men and women. Men are 40 per cent. more likely to die from cancer than women. Several of the most common cancers in women are, however, sex-specific and include cancers of the uterus and ovary. The most common cancer in women, breast cancer, is not strictly sex-specific, but it is exceedingly rare in men and is generally regarded as sex-specific for statistical purposes.
The most common cancer in men, prostate cancer, is obviously also sex-specific. We need to examine particularly closely the cancers that can affect both sexes if we are to make a more meaningful comparison between the incidence of cancer and death between men and women. It cannot be doubted that this is an issue of proper concern.
Of the 10 most common cancers that affect both men and women, nine are more common in men—in many cases, markedly so. Extraordinary as it may seem, men are almost twice as likely to suffer from those nine cancers. When it comes to death rates, the picture is even starker, because men are twice as likely as women to die from one of those cancers. The statistics show that for the one cancer for which the incidence rate is lower in men —malignant melanoma, the most serious form of skin cancer—the death rate is higher for men than for women. If we could reduce the incidence of those most common shared cancers in men to the level experienced by women, we would make a significant impact on cancer rates in the population as a whole and, therefore, make progress towards important targets.
It is worth noting that cancer, in common with all other serious illness and disease, is subject to a social class gradient. The poorer a man is, the more likely he is to develop cancer and to die from it. The very poorest men are no less than twice as likely to develop cancer as men in the highest income brackets. If properly targeted, therefore, any strategy to reduce the incidence of cancer in men would also help to reduce health inequalities. Although tackling such inequalities is, quite properly, already a central objective of health policy, the action that is taken often lacks the necessary awareness of, and focus on, the increased effect of gender on health in such circumstances.
Why are men so much more likely than women to develop cancer? There are no established biological reasons why that should be so. We must therefore look to two other sets of factors: men, their attitudes and behaviour, and, more importantly perhaps, the way in which the NHS and other service providers treat men.
229WH The critical factor is almost certainly to be found in the field of cancer prevention. It is now widely accepted that the majority of cancers are preventable, although risk determinants have been established in only about 50 per cent. of cancers. We know that men in general are more likely than women to drink alcohol at levels that are harmful to health, to eat a poor diet and—this was especially true in the past—to smoke and to do so more heavily. On the face of it, that seems to place the emphasis squarely on the individual man and on the need to change his behaviour. As we all know, however, the real world is rather more complicated.
Putting aside for a moment the relationship between an individual's lifestyle and the intractable structural factors in his environment, as well as the cultural pressures on men to conform to traditional behaviours, we must ask why cancer prevention strategies have been so much more successful with women. The answer is almost certainly that we have not yet got to grips with the need to construct services and deliver advice in a way that is directed specifically at men.
For that reason, I drew attention a few minutes ago to the Haynes cancer manual. The Men's Health Forum has developed considerable expertise in understanding how to communicate with men, and it has supported and encouraged innovative approaches to service delivery. Examples from within the NHS include initiatives to introduce health improvement programmes and basic health cheeks on men's own turf—in working men's clubs on Tyneside, village halls in Devon, pubs in Wolverhampton and barbers' shops in Bradford. Indeed, Bradford's "Health of Men" project, of which the barbers' shop initiative is part, is an exemplar of good practice in the field. It has just won the northern region health and social care award, and I congratulate it on that achievement
Most significantly of all perhaps the workplace has been shown several times in recent years to be a highly effective setting for work directed at improving the health of men. The Royal Mail, for example, which is the largest employer of men in the country, is using national men's health week to deliver health advice to large numbers of its employees and as a springboard for other, longer-term health-improvement strategies.
The success of this year's national men's health week in England and Wales in engaging the support of the England football team's backroom staff leads me to ask whether the Minister will encourage the football authorities, in conjunction with the Men's Health Forum, to consider developing health improvement initiatives at league grounds. Small-scale work along those lines is already going on in the rugby super league, and men's health messages, which I have been developed by the Men's Health Forum, will appear on line-side signs at 10 televised matches. That is something that we can learn from, and I would very much like the Minister to tell us whether more could be done at football grounds. As I say, it has already been done at rugby grounds.
I am sure that the Minister is aware that the Scottish Executive are committed to investing substantially in a network of outreach health check services for men in a variety of community-based settings. Fittingly, the Scottish Executive are announcing the winning bids for those new services this week. I hope that she will ensure 230WH that the health services for which she has responsibility consider the Scottish initiative so that men south of the border do not get left behind.
I have been able only to touch on cancer prevention: there is much more that could be said. However, it is important to leave enough time to explore another reason for the great disparity in the incidence of cancer in men and in women. It is commonly believed by many experienced clinicians that men are less good at early detection of potential symptoms and are much less likely to seek help when symptoms are present. That has certainly been my experience in my work as a GP.
Although there is limited research to back up that hypothesis, what evidence there is seems to bear out the perception. One study in Oxford in 2002 found that, of 45 men diagnosed with testicular cancer, some had put off seeking help for weeks or even months after first becoming aware of the symptoms. At a recent meeting in this House of the all-party men's health group, which I chair, a patient who had suffered from cancer very bravely told us that he left it 10 months after he developed rectal bleeding before he saw his GP. He kept putting it off by saying, "It's only a bit of bleeding. It's probably piles. I've been working too hard: it's just stress." He kept on rationalising why he did not need to see a doctor, and it took him 10 months before he received the treatment that he needed. I am quite sure that a woman in that situation would have taken action much more quickly.
At the beginning of the debate, I drew hon. Members' attention to the fact that men have higher incidence rates for nine of the 10 most common cancers that can affect both sexes and higher death rates for all 10. It seems extraordinary that in the case of malignant melanoma, of which there are fewer male than female cases, men are still more likely to die. The reason may well relate to the failure to act soon enough to early signs of disease. Malignant melanoma is an aggressive disease and even a short delay can prove fatal. The cancer tsar, Professor Mike Richards, interviewed in the current Men's Health Forum magazine suggests that the explanation of the paradox is
almost certainly due to women coming forward more quickly.Forgive me for returning one last time to the Haynes cancer manual, but the function of helping men to recognise the importance of acting in good time is one that it fulfils admirably. One of the predecessors of the book was the generalist Haynes "Man" manual, which was published in 2002 and has sold more than 80,000 copies in mainstream retail outlets, including car spares shops. That proves that men will take an interest in their own health provided that the issues are addressed in the right way—in a way that is appropriate to them.For last year's national men's health week, the advice on sexual health in the "Man" manual was reproduced in a pamphlet—a mini-manual—for free distribution to men in a wide range of settings. Some 40,000 copies were given away to punters in Ladbrokes betting shops around the country. That is another good example of how to get health information into the right hands. The mini-manual was extremely well received.
I would like the cancer manual to be made available in a similar format for distribution by national cancer charities and in the NHS. A significant number of cancer charities have been partners in writing the manual, 231WH including CancerBACUP, the Prostate Cancer Charity, Beating Bowel Cancer and the Orchid Cancer Appeal. The content is therefore reliable and up to date, as well as being delivered in a suitably blokeish style. I urge the Minister to continue to support the production of such a version of the manual and I would like to see whether that can be progressed.
The policy document prepared by the Men's Health Forum to inform the public debate about men and cancer during national men's health week proposes a five-point action plan to improve what is a most unsatisfactory situation by any standards. I do not have time to deal with all the points here and now, but I encourage all hon. Members who are interested in the issue to read the copies sent to their offices.
I endorse all the recommendations, but the one that stands out as deserving the most serious consideration by the Government is the proposal that we set targets for the reduction of cancer in men that are separate from the targets for the population as a whole. That proposal seems well worth trying, at least at a local level, and I would like to see some primary care trusts encouraged to pick up the baton and run with it.
We require medium-term targets for the reduction of risk behaviour in men and longer-term targets aimed at reducing the incidence of cancer. I concur with the view of the Men's Health Forum that it is only by setting male-specific targets that minds will be concentrated on the delivery of male-friendly services and prevention strategies predicated on the recognition of men's health concerns and sensibilities. Such an approach would be challenging and would require innovation, but it would also be hard-hearted and practical.
The recommendations have already been endorsed by 10 cancer and other charities and by the Royal College of Nursing, and I urge the Minister to act on them. I hope that she agrees that closing the gap between men and women in terms of the incidence of cancer and rates of mortality would be a realistic, achievable and measurable objective that could be pursued without any detriment to women.
A successful outcome would be an important contribution to the achievement of gender equality in health, and a leap forward in the pursuit of population-wide targets. I hope, too, that the Minister will take forward an awareness of the importance of men's health in her discussions on the forthcoming White Paper on public health. It is my firm view that we cannot improve the health of all unless we take action to improve the health of men.
§ The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)I congratulate my hon. Friend the Member for Dartford (Dr. Stoate) on securing the debate. It is particularly timely, as he said, because we are in the middle of national men's health week. The theme of this week is male cancers, and I would like to take this opportunity—the second I have had this week—to congratulate the Men's Health Forum for its efforts in raising important issues about men and cancer. I am delighted to say that it does an extremely good job.
232WH I turn first, as did my hon. Friend, to the excellent Haynes cancer manual. Despite its blokeish style, I enjoyed reading much of it. As my hon. Friend says, the Department of Health has contributed £30,000 to the publication of the excellent manual "Cancer: any age, any time". It is written in a way that is accessible and appealing to men. Our funding has enabled the publication of the manual, and 20,000 copies are to be distributed free of charge by voluntary organisations. Of course, I will be delighted if it meets the target of 80,000 copies set by its predecessor volume. I join him in welcoming the Football Association's support for the manual and its involvement in raising important issues about men and cancer. I hope that the FA will seek further involvement in such public health issues.
I also welcome my hon. Friend's support and congratulation for the work being done under the cancer plan. We have taken great strides, and they can be recognised not I least through the fact that there has been a 10 per cent. cut in deaths from cancer in the period from 1996 to 2002–03. There is much more to do—we need to make continued progress—but we can be pleased by the p ogress that we have made so far.
I agree strongly with my hon. Friend that action is required on all cancers and on improving health and preventing disease. It is therefore important that we raise awareness of cancer and its early symptoms in men of all ages; that is important. I also agree strongly that men need to seek medical advice sooner; earlier diagnosis leads to better outcomes. It is indeed worrying that there are such differences between the outcomes for the two sexes when it comes to cancers, and both the incidence and mortality rates are bound to give people pause for thought.
Of course, most Department of Health campaigns are designed to address a mass-market audience, with special emphasis on socially disadvantaged groups that risk exclusion. The inclusiveness in which we believe is reflected in the creative development progress. We actively seek the views of men in a bid to move beyond having women as the only family health gatekeepers.
Where certain audiences need to be addressed separately or specifically, we have developed bespoke strands. The current tobacco campaign includes a testimonial from male lung cancer sufferer. The advertisement is aimed at both sexes, and has performed well for both male and female audiences. We also address men via public relations activity—for example, via our recent tobacco campaign pull-out in the "Goals" supplement of The Sun. Most of our campaigns are developed according to an understanding of how men consume media differently from women. Radio, tabloid newspapers and online are key environments to reach the male audience. We know that men prefer to access health information directly, rather than to go to doctor's surgeries or a health centre, and that has resulted in the introduction of dedicated websites and telephone helplines, both from the NHS and a number of the key charities. That has increased men's access to health information and the general knowledge of health issues.
As my hon. Friend said, we must do more to reach men in their own settings. I have seen innovative work, and he mentioned some examples, including the work being done by Royal Mail, which we are pleased to learn about. I have also seen more local work done in a 233WH number of community settings. People have developed materials to distribute in local communities to alert men to the importance of getting checked out for prostate cancer and so on.
We will continue to scope our health campaigning around key target groups, adapting messages and creative work where need be. We wi11 also continue to make our centrally driven campaigns relevant to health promotion at primary care trust level,and complete the circle by obtaining feedback on the efficacy of our approach and its relevance to the target groups.
For example, in my hon. Friend's constituency, partnership work with the local councils is under way through health action teams. During national men's health week this year, the teams are engaging with workmen at Springfield industrial estate to raise the issue of men's cancers and preventive health issues, such as those relating to physical activity, alcohol consumption, drugs, smoking, nutrition and sun safety. Those are all very important.
The issue of giving health information in the workplace is important. I would like to ensure that hon. Members are aware of the home page of the Department of Health's internal website for staff which has a direct link to the Men's Health Forum's men's national health week website.
My hon. Friend mentioned prevention, which is very important. It is particularly close to my heart because of my wider role in respect of public health. The five-a-day programme is an important strand of that. The aim is to raise awareness of the importance of eating at least five portions of fruit and vegetables a day. The programme recognises that attitudes and awareness differ greatly by age and gender. Over the next year, the Department will develop detailed plans to convey the five-a-day message to teenage boys and young men, who consume less fruit and vegetables than older men or women.
I agree with my hon. Friend that all such work will help to tackle health inequalities, which is a big priority for the Government. We share his concern about closing that gap. He also mentioned the gap between men and women. It is important to recognise that some programmes will simultaneously address the latter as well as the former. If we implement the programmes effectively, we will inevitably be targeting and working with those who are most in need of the messages and of the change.
My hon. Friend spoke about football match and line-side information. I visited Middlesbrough. Just before no smoking day, people were planning to put no smoking messages for supporters on the screens at its stadium at the start of a match and in the break. It is important to recognise that there are many avenues for getting the messages across. Some of those people who are highly respected and in leader ship roles in their communities have a key role, particularly with younger people. They are important vehicles for us to use for these purposes. The initiative that I have described was entirely a Middlesbrough-based initiative, but a number of clubs have been working on helpful initiatives. Any further suggestions or ideas that we can encourage them to take up will be welcome.
234WH I also agree with my hon. Friend's comments about the delays in men seeking treatment and in men getting to treatment fast enough. That is another area in which the cancer manual will prove helpful in alerting people to the need to come forward quickly.
It may be useful if I mention some of the work that is being done in some of the major areas. Some of them are the sex-specific cancers, such as prostate cancer. We spent £4.2 million on research into that cancer in 2003–04, and that investment is beginning to pay off. Only last week, Professor Colin Cooper—director of the southern prostate cancer research collaborative and a member of the prostate cancer advisory group—announced that his team had found a significant gene in the battle against prostate cancer. The gene, E2F3, will help clinicians to decide whether a prostate cancer is aggressive or very slow-growing. It is hoped that a test could be developed within the next two years.
Much of the work has been funded through the prostate cancer collaborative. Of the £7.7 million funding over five years, the Department of Health is contributing £4.2 million, and the Government-funded Medical Research Council a further £1.3 million. The remaining £2.3 million is provided by the key partner, Cancer Research UK. As part of the cancer risk management programme, evidence-based primary care resource packs were sent to all general practitioners in England in September 2002 to aid them in counselling men who are worried about prostate cancer. From earlier debates that my hon. Friend has secured on this subject, I know that he takes it very seriously.
Some 98.8 per cent. of patients with suspected urological cancers, including prostate, are seen for their first out-patient appointment within two weeks of their GP deciding that they should be urgently referred. Since 1997, there has been a 40 per cent. Increase—from 343 to 473—in the number of consultant urologists. All that, as well as efforts on public awareness and the national prostate cancer website, indicates the Government's commitment to a very important issue, and one in which there is still considerable uncertainty for men receiving the diagnosis.
Earlier detection is particularly important for testicular cancer, which is why we have collaborated with Cancer Research UK in the production of a testicular self-awareness leaflet, "Testicular cancer: spot the symptoms early". That echoes the points that my hon. Friend has been making throughout the debate.
I shall move on to something that is not gender specific: bowel cancer. That accounts for the lives of around 7,500 men a year. My hon. Friend has already given us the sad, but graphic description of the difficulty that people have in coming forward with that cancer. We are developing a programme in partnership with all the key stakeholders, and Professor Mike Richards, the national cancer director, has set up an advisory group, supported by four working groups, on the key strands of the programme: screening, patient pathway, treatment and endoscopy.
That programme is developing a national screening programme for bowel cancer for both men and women. The methodology is not clear cut, and there are some difficult issues to be addressed, but we are striving to improve services for people with bowel cancer symptoms, and work is under way on making the 235WH patient pathway more streamlined. We have also made a major investment in training, which is vital to the diagnosis of bowel cancer, and have established three national and seven regional centres to train more staff in endoscopy.
Finally on bowel cancer, we are developing a communications strategy, and consulting key stakeholders on what the key messages are about bowel cancer for the general public. I would welcome in particular the views of the Men's Health Forum; it might think that certain angles should be pursued in order to reach men early.
I do not have time to say much about lung cancer—another cancer that affects both men and women. It is killing around 17,000 men a year in England and Wales. We have a comprehensive service for smokers who want to quit, and have announced a deal on products: manufacturers are giving away free NHS stop smoking products, such as nicotine patches and gum. We have obviously done a lot: 99 per cent. of suspected lung cancer patients are now seen by a specialist within two weeks of being urgently referred, and we established an advisory group in November last year to support the development and delivery of high-quality services for lung cancer patients. The National Institute for Clinical Excellence will produce clinical guidelines later this year.
I hope that my hon. Friend agrees that we are not complacent when it comes to men and cancer. The consultation on the public health White Paper ends on 28 June, and I urge him and others with whom he is working to feed in their comments on men's health. We are determined that professionals and managers should have the freedom to innovate, including on service delivery—another point that he made. We will make sure that we continue to make significant progress on cancer for both men and women, while recognising that there is a lot more to do in engaging key stakeholders in making that progress.
§ Sitting suspended until Two o'clock.