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The Minister for Public Health and Patient Safety (Dame Diana Johnson)
It is a pleasure to serve under your chairship, Dr Murrison. I am grateful to the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont) for opening this important debate and setting out so clearly the questions he wants answered.
I want to begin by acknowledging the strength of feeling behind the petition. More than 100,000 people have signed it and a large number of right hon. and hon. Members in the Chamber have made very powerful speeches. I will reflect on the issues raised; I will try to address as many of the points in my contribution this afternoon, but if I do not answer every question, I will reflect on them and I will certainly write to the shadow Minister.
There is a very real desire for us to do more to diagnose prostate cancer effectively, treat it earlier and ultimately save more lives. I am grateful to Members from across the House who have spoken so openly about their own experiences and those of their constituents, friends and families. I too am thinking of all those individuals facing a prostate cancer diagnosis and undergoing treatment at this time, and I was very pleased to hear that our former colleague, Gary Streeter, is doing well. I am sure that the whole House sends him our best wishes.
As we have heard, prostate cancer is the most common cancer in men in the United Kingdom. Around 68,000 men are diagnosed in the UK each year, and although survival rates are high, tragically, around 12,000 men still die from prostate cancer every year. Every one of those deaths is a loss to their family, friends and community. The Government are determined to improve outcomes for men with prostate cancer.
The UK National Screening Committee advises all four nations. Scottish officials are present at committee meetings and officials in the Department of Health and Social Care work with their counterparts across the devolved Governments to share information and good practice. In June, we announced England’s first targeted prostate cancer screening programme. From 2027, eligible men aged 45 to 61 with a BRCA2 gene variant and a family history of prostate, breast, pancreatic or ovarian cancer will be offered a PSA test every two years. We are working with the UK Cancer Genetics Group to identify further men who will be eligible for screening. That is an important step forward, but I recognise that for many it does not go far enough.
The petition asks the Government to go further than the UK National Screening Committee’s recommendation and introduce screening for all men at higher risk. I understand that ambition and I share the determination behind it, but we have a responsibility to ensure that the evidence tells us that, when we introduce screening, it will do more good than harm. That balance is particularly difficult with prostate cancer, as we have heard from some of the medically qualified Members. Unlike many other cancers, prostate cancer is often slow growing, and many men who develop it will never experience symptoms or come to any harm from it.
At the same time, treatment can have profound consequences. More than half of those treated experience significant side effects, including bladder leakage, bowel incontinence and erectile dysfunction. When we talk about the harms of screening and overtreatment, we are not talking about something abstract; we are talking about potentially lasting consequences affecting a man’s health, dignity and quality of life.
Dame Diana Johnson
I am going to make some progress, because I am keen to address the points that the hon. Member for Berwickshire, Roxburgh and Selkirk raised. If I have time at the end, I will take an intervention.
I want to turn to the issue of ethnic minority men. I have listened very carefully to the concerns about men at higher risk who are not included in the initial screening programme, particularly black men and men with a family history of cancer. We know that black men are twice as likely as white men to be diagnosed with prostate cancer, and that disparity rightly worries us all. What we do not yet know is whether screening black men would identify more aggressive cancers that need treatment, rather than slower growing cancers that may never cause harm. If screening leads to men being diagnosed and treated for cancers that would never have harmed them, we risk causing significant and lasting harm, and that cannot be right.
We should not accept the gaps in the evidence that prevent us from giving men the answers that they deserve. That is why the Government are investing and building on the Transform trial introduced by the previous Government by investing £34 million to identify better ways to screen for prostate cancer and enable all eligible black men to be invited to participate at stage 2. Prostate Cancer UK is working with charities and organisations experienced in working with black communities to encourage participation. That matters because we need stronger evidence built with the men most affected to inform future decisions about screening.
Family history is another important part of this picture. We know that it can increase a man’s risk, but the evidence does not yet tell us precisely which patterns of family history confer the greatest risk. Work is under way to refine the definition of family history and ensure that it is properly reflected in the UK National Screening Committee’s model. I totally accept that men need support now, which is why Cancer Research UK, the UK Cancer Genetics Group and the Royal College of General Practitioners are bringing together expertise to develop guidance to support GPs when advising men about familial risk.
Dame Diana Johnson
I will carry on because I want to make these points.
The important point is that the evidence and clinical practice are evolving, and our approach must be able to evolve with them. That is why the Government are funding the prostate cancer screening model used by the UK National Screening Committee for a further three years. Work is already under way on family history, risk algorithms and biomarkers, including Stockholm3, and significant evidence from Transform can be considered as it emerges. The initial programme is therefore not the end of the process. Where robust new evidence supports screening additional high-risk groups, that evidence can be considered and screening recommendations revisited.
Dame Diana Johnson
I will carry on because I am conscious of time and I want to make these points.
I want to address directly the concern about the evidence underpinning the current screening recommendation. The committee considered the current NHS standard of care, which includes the use of MRI before biopsy. It did not include newer and innovative approaches for which the evidence is not yet sufficiently established. There are enormously encouraging advances taking place, including more targeted approaches, such as focal therapy. Better diagnosis and less harmful treatments could change the balance between the benefits and harms of screening, and as robust evidence develops, it will be considered.
I also want to deal with the point about GPs. I have heard the strength of feeling about PSA testing for men who are not eligible for the new screening programme. I want to reassure men that the policy has not changed. Any man who is concerned about prostate cancer, including a man without symptoms, can discuss PSA testing with his GP. Separate from the decision on national screening programmes, it is my view and the Secretary of State’s view that men who ask their GP or urologist about a PSA test should be able to make an informed choice, based on good-quality information, about the likelihood of being helped or being harmed. The Secretary of State worked on this issue as a Health Minister at the Department almost 25 years ago, and personally ensured that the guidance includes references to the importance of informed choice.
Dr Luke Evans
Is the Minister therefore saying that a 52-year-old patient who understands the risks on both sides and wants their PSA has the right to get it, or is it the GP’s decision? The GP could deny it on a clinical basis even if the patient wants it. That is the change that people are worried about. Could she explain that point?
Dame Diana Johnson
I recognise the hon. Gentleman’s experience as a GP. My understanding is that a man who requests a PSA test from a GP will have that test if he is given the information and the choice is there, but I will write to the hon. Gentleman if that is not correct. It has to be an informed choice, with the man knowing the risks and the harms but also the potential benefits.
Ultimately, everyone in this Chamber wants the same thing: we want fewer men to die from prostate cancer, cancers that need treatment to be found earlier, and every man to receive the care that is right for him; but we must achieve that while protecting men from unnecessary diagnosis and from receiving treatments that can have lifelong consequences for a cancer that might never have caused harm. The question is not whether we want to prevent more deaths from prostate cancer—of course we do. The question is how we can do so safely, effectively and fairly, using the best available evidence while continuing to build the evidence where it is not yet strong enough. As I have said, as that evidence develops, we must be prepared to act. I thank the hon. Member for Berwickshire, Roxburgh and Selkirk for raising this important issue, and all Members who have contributed to this thoughtful and powerful debate.