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Helen Jones (Warrington North) (Lab)
I beg to move,
That this House has considered e-petition 225767 relating to lowering the age for smear tests for cervical cancer from 25 to 18.
It is a great pleasure to serve under your chairmanship, Sir Roger. Before I move to the substance of the debate, I want to say a little about the woman who started the petition, Natasha Sale. She died on 28 December last year. She was 31 and left four children. I have spoken to her friends this afternoon, and I think Natasha must have been a remarkable person, because it takes a remarkable person to decide, when they have a terminal diagnosis, that they will use their time to help others rather than to bemoan their fate. That is what Natasha did. In her petition, she said that
“it’s too late for me but it’s not too late for the next generation”.
I thank her family and friends, who encouraged people to sign the petition to get the debate today. I particularly thank Natasha’s family, who have kindly said they are happy with the debate going ahead. That, too, takes courage, and I am grateful to them.
Cervical cancer is something that all women fear. Like breast cancer, it strikes at the heart of how we see ourselves and how we define ourselves as women. Because of that, screening programmes have been introduced in this country. In fact, screening is changing so that women will be tested for the human papillomavirus before they get cervical screening, because most but not all cervical cancers are caused by HPV. Screening is currently on offer only to women between the ages of 25 and 64. Those between 25 and 49 are called every three years and those from 50 upwards are called every five years, yet the reasoning behind that offer is perhaps not often understood. Before the age of 25, not only is such cancer very rare, but changes in the cervix are very common. A test can produce false positives and lead to unnecessary treatment and anxiety for women.
Nevertheless, there have been repeated calls to lower the age of screening, not only in this petition, but in others, including one we received previously. In response, the Government would rightly say that the UK National Screening Committee has looked at the evidence and decided that there is no real evidence to support reducing the age of screening. Their reasoning, which is valid, is that one in three tests below that age will produce a false positive; and that, when people are given unnecessary treatment, there is a risk to future pregnancies. I hope the Government will publish the evidence on the risks of getting cervical cancer at that age and the risks from screening so that women can make an informed decision. They should publish that in a way that can be understood by people who, like me, are not doctors or scientists. The evidence is often couched in scientific jargon, which conveys very little to most of us. That is the first important thing that we want to do.
Even with that evidence published, there will always be some cases, and cases in young women can be very tragic. They can lead to the loss of a young life, and often leave children without their mother. Because the disease can be so devastating, in 2008 the then Labour Government introduced a programme of vaccination against the most virulent forms of HPV for all girls from the age of 12. In fact, for that first cohort, we vaccinated up to the age of 18 to catch up. Those who were 18 at the time will now be undergoing their first screening. If as expected the rate of cervical cancer in that age group drops, it will have been well worth while.
When the programme was introduced, I well remember MPs getting a lot of letters from parents saying they did not want their daughters vaccinated—it still happens—because they somehow saw it as encouraging promiscuity. That is not what vaccination is about. It is about vaccinating girls before they become sexually active. I hope parents will think about the risk they are putting their daughters through if they do not have the vaccinations.
Jim Shannon (Strangford) (DUP)
I thank the hon. Lady for presenting the case in the petition. While the vaccine has been shown to lower incidence of cervical cancer, does she agree that cervical screening should take place as a matter of urgency, initially for those who are sexually active? The average age when sexual activity begins is 15.6 years across the United Kingdom of Great Britain and Northern Ireland. Does she agree that people cannot be allowed to wait 10 years for a first cervical smear? It must be addressed immediately.
Helen Jones
I will answer that point in a moment, because it is important that we look at the evidence. There will always be some cases, even among women under 25. We can never eliminate the risk completely. When that happens, it is important they get the right treatment. That is why in 2010 guidelines were published for GPs to ensure that young women who presented with abnormal symptoms were offered screening and referred on to a consultant if necessary. That does not always happen—I will come on to that in a moment.
Louise Haigh (Sheffield, Heeley) (Lab)
I apologise that I cannot stay for the whole debate. What monitoring is done of GPs providing that screening, including for women over the age of 25? I had a smear that presented as abnormal. I had HPV. I went to my local GP and asked for my smear test that I was required to have and was told that they did not do smear tests. What monitoring is being done to ensure that all GPs are adhering to the guidance and their duties under the legislation?
Helen Jones
My hon. Friend makes a very good point and I will be asking the Minister to look at that. Our first problem is getting people through the door. If there is something wrong with us, it is natural to think either that it will somehow go away or that it might be cancer—we kid ourselves that, if we do not get a diagnosis, it is somehow not happening. We need to have much more publicity to encourage young women to report to their GP if they have abnormal symptoms. After all, it might not be cancer and they might be reassured. Equally, if it is cancer, the sooner someone gets treated, the better their chances of survival. I do not think that that message is always getting through, particularly to younger women.
The other problem is that the rates of people attending screening, even among those who are eligible, are falling. In the last year for which I have figures, only 69.1% of eligible women attended their screening appointments. That is down from 73.7% in 2011. In practice, that means that 3.5 million women in this country have not been screened in the past three and a half years. That is very worrying. Even more worrying is the fact that 1.7 million have never had a test. Some 345,000 have not had a test in the past 10 years. What is more, there are significant regional variations in the rates of screening. For instance, for those aged between 25 and 49, the rate of screening in London is 61.6%. In the north-east, it is 72.9%. Among over-50s, the rate in London is 74% and in the east midlands 78%. We need to look closely at those figures and find out why women do not attend. It is no use getting into the blame culture. We need to ask the right questions. Are they frightened, for example? Are appointments not at convenient times? Are there particular groups of women who do not turn up for screening? It is probably a mixture of all three.
I was sent some very interesting information from Jo’s Trust, who asked a group of young women in a survey why they did not attend for their screening. Seventy-one per cent. said they were frightened of the test and 75% said they felt vulnerable. A whopping 81% said they were embarrassed, which is a particular factor for young women who are constantly bombarded with air-brushed photos of what they should look like and what their bodies should be like, so they suffer from a lot of body consciousness. Despite the fact that doctors and nurses keep repeating, “We don’t care what you look like, we are not interested in what you are wearing, we do hundreds of these tests”, the message is not getting through. It is therefore important that tests are conducted in a supportive environment.
Interestingly, in the same survey, 67% of the women said they had felt they were not in control of the test and 68% said they would not discuss their fears with a doctor or a nurse. That particular problem applies to survivors of sexual assault: 72% are put off going for their screening or do not go at all. It is vital that women are screened in a supportive environment where they get the chance to discuss any fears they have with a practitioner beforehand.
Anna McMorrin (Cardiff North) (Lab)
My hon. Friend is making an excellent speech. I apologise for not being able to be here for the whole of this absolutely critical debate. Cervical screening uptake in Wales is at an all-time low. More than a quarter of women did not attend their cervical screening in the past year. Importantly, last September, Wales became the first nation in the UK to provide high-risk HPV testing as the primary cervical screening test across Wales. It leads to more sensitive and specific tests, more certainty for patients and more appropriate referrals to colposcopy services, faster treatment and then faster discharge times. Does my hon. Friend agree?
Helen Jones
Yes, and I hope those tests will be rolled out across the rest of Britain.
On the problem of women getting access to screening services, time and again they report that they ring their GP for an appointment that is then weeks ahead. Someone I met recently told me that, in her case, it is months ahead. It can be as much as 10 weeks. All are offered appointments at times they cannot attend, perhaps because they work shifts—that applies particularly to younger women who are more likely to be in insecure employment and therefore not eager to ask for time off.
I do not know why we persist in this, but very often the comments on screening give the impression that someone is saying, “These stupid women are not going for their screening.” Actually, there is a problem of access. I remember when we had mobile breast cancer screening units that came to a place of work. I got my blood pressure tested in the middle of Warrington shopping centre because the hospital had a programme to encourage people to go for testing in case they were at risk of vascular disease. Why can we not do more to take cervical screening to places where women are? Why can they not be screened in the workplace, for example, where groups of women are much more likely to say, “Come on! We will all go together”? It is not beyond the wit of man to arrange that.
Helen Jones
I will give way one more time and then I must make some progress.
Jim Shannon
Constituents have expressed concerns to me on two issues: first, that it is very painful; and secondly that it is embarrassing. When it comes to giving peace of mind to ladies going for cervical cancer screening at whatever age, it is very important that the doctors and GPs are involved at an early stage to put their minds at rest. The importance of cervical cancer screening cannot be underlined enough, but the ladies need to be assured of not having the pain and embarrassment, which is a big task for the NHS.
Helen Jones
The hon. Gentleman is right. Women need to be assured that they will be treated sympathetically, whatever their age. All of us who have been to screening know that sometimes it is fine, but sometimes someone is a bit ham-fisted and it is not fine. It is better than getting cancer.
Another issue needs tackling: when women under 25 present with abnormal symptoms such as abnormal vaginal bleeding, they are not always treated according to the guidelines. In fact, they are frequently not treated according to guidelines. There are plenty of examples of younger women going to their GP with symptoms and being told they are too young for cervical screening, and plenty of examples of women going time and again and, as one lady told me earlier, being fobbed off. The problem is that GPs do not see a lot of cases and cervical cancer is therefore not the first thing they think of. The Government must do more to alert GPs to the possibility of cancer to get early diagnosis and ensure that people are referred to consultants where necessary.
Emma Little Pengelly (Belfast South) (DUP)
I absolutely agree with the hon. Lady that GPs and others must take the concerns of young people under 25 seriously. I recently attended a pensioners’ parliament in Northern Ireland and many women over 64 spoke of the difficulty of being taken seriously when they go to the doctor. The vast majority of deaths from cervical cancer happen to those over 50 and many of those over 64. Is that not also an issue that needs to be addressed? Those women feel that they are being left behind.
Helen Jones
The hon. Lady makes a good point. We need people to realise that women know their own bodies and know if something is wrong, so people must listen to what they say. There are too many examples of women having to pay for a private test before finding out they have cervical cancer. If it is not diagnosed early, there is a chance it will become terminal. If it is diagnosed early, the chances of survival are much greater, so we need to ensure that people are diagnosed early.
On the question of whether the age for screening should be reduced, I am not convinced at the moment. The scientific evidence does not support it, but I hope that the Government will keep it under review. If the evidence changes, we need to change what we do. Sir Mike Richards is undertaking a review of cancer screening and is due to report by Easter. I hope he looks at the issue. Ministers must ensure that they get the best advice and they have to proceed on that advice. We have to remember that, rare as it is, in 2016, 15% of women diagnosed with cervical cancer were under 30, and last year, 12 of those who died were under 30. We can and should do much more to prevent such deaths by ensuring that women are screened where necessary, even if they are under 25. If they have indications that require them to be screened, they should be. We must ensure that we promote the HPV vaccination programme, which is one of the best things that has been done in recent years. I say to parents who worry about it, “Don’t put your daughters at risk. Get them vaccinated.” We have to do much more to convince them that vaccination is the right thing. We have to do much more to make screening accessible and easily available to women, and it must be done in a supportive environment. Let us be honest: it is a bit like a sausage machine when we go to the GP, precisely because health workers are screening all the time. To them it is not at all unusual, but it is to the people who attend; that is the difference.
John Howell (Henley) (Con)
I hope that, like me, the hon. Lady will support the Public Health England awareness campaign that is about to start, which will try to tackle all the misunderstandings about screenings, and to overcome the feelings of fear and embarrassment that she described so well.
Helen Jones
The hon. Gentleman is right, and it is not before time to have such an awareness campaign. However, it is no good having one unless we ensure that screening is easily available and that people are treated well when they go. That is vital, because one bad experience can put a woman off ever going again, which is not what any of us want.
Natasha started the petition because she wanted to raise awareness of the symptoms of cervical cancer, and to ensure that other women did not suffer as she had suffered. That was a remarkable thing to do, and I hope that today’s debate, which I know her MP, the hon. Member for Newton Abbot (Anne Marie Morris), would have liked to have attended—unfortunately, she has to be in Committee elsewhere—will go some way towards doing that. I hope the debate will open up the dialogue on how best to get women screened, and when they should be screened, and I hope that the Minister will commit to keeping the age of screening under review, so that, if the scientific evidence supports screening earlier, that is acted on.
John Howell (Henley) (Con)
It is a pleasure to serve under your chairmanship, Sir Roger, and to follow the hon. Member for Warrington North (Helen Jones) in this important debate. I thank the petitioners, as it is good to have the opportunity to discuss such an issue in open debate. I think that all Members will get the strong impression that there is agreement across the House for what is being proposed.
I will start with the Public Health England campaign, which I mentioned when intervening on the hon. Lady. I agree with her that it is about time we had such a campaign, and that it will have a hard job. On the one hand, it has to tackle issues concerning the women themselves—the enormous misunderstandings about the screening process, and the fear and embarrassment that surrounds it. There is not just fear about the illness; anything to do with cancer creates fear, so there is an enormous amount to overcome.
However, I suggest that the Public Health England campaign should also look at the other side. The Minister has heard us talk strongly today about the impact on GPs, and the way in which they have to handle the issue and make facilities available. It would be very good to have something in the campaign that targets GPs, making those points to ensure that testing happens in the right place, at the right time and in the most effective manner.
The hon. Lady also mentioned inoculation against HPV, which I support. I am pleased that we are now inoculating young boys against it as well, as that makes a very big difference. Those who have talked to medical professionals in this area will have heard stories about the number of people who develop cancer as a result of HPV. It is very good to have such inoculations, and to be able to support the campaign.
Like the hon. Lady, I am not yet convinced that the age for screening should be reduced. Around the world there has seemingly been a general trend to increase the starting age of such programmes. I think the American Cancer Society recommended that the age for cervical screening go up from 18 to 21, which is interesting. The reason she and I believe that the screening age should not be reduced is the false positives that are created. No one wants to be put in the situation of having a false positive test. It is not about the waste of money, but about the concern that a false positive creates for an individual. I am not yet convinced that the age should be brought down but, like the hon. Lady, I call on the Minister to look very carefully at it, to keep it always in his mind, and to keep reviewing it.
I think that Scotland has increased the age at which women go for their first smear test from 20 to 25. That, too, is an interesting reflection of the way things are going, and builds upon the difficulties in dealing with this matter. However, I thank the hon. Lady for presenting the case, and the petitioners for bringing it, and allowing us to discuss it in the way we are doing.
Sarah Champion (Rotherham) (Lab)
It is a pleasure to serve under your chairmanship once again, Sir Roger. I am hugely grateful to the friends and family of Natasha, and all those who signed the petition, for enabling us to have the debate, which is much needed.
HPV accounts for 99.7% of cervical cancers. It also accounts for cancers in boys. I would like the Minister to seriously consider rolling out the vaccine programme to boys as well. I cannot think of any other inoculation programme where we inoculate only half the population. It seems a bizarre approach to trying to eliminate a reasonably common form of cancer.
I will build on what my hon. Friend the Member for Warrington North (Helen Jones) said about the fears. As soon as I started tweeting about this matter, people replied saying how dangerous the vaccine was. I am sorry, but the evidence does not support that. It is an insurance policy for people’s children, and I urge parents to look at the evidence, rather than the scaremongering on Facebook and Twitter.
HPV is a sexually transmitted virus. As my friend the hon. Member for Strangford (Jim Shannon) said, unfortunately children start having sex, on average, at 15.6 years of age. Legally they can have sex from the age of 16. I am sorry, but to me it does not make sense to have a gap of nine years, knowingly, between when children are likely to become sexually active and be exposed to a sexually transmitted disease and when they have any screening.
When I started talking about this issue a couple of weeks ago, two of my friends came to me and said that their cervical cancer was picked up when they were 21. They were incredibly fortunate in one way: because they had a history of cancer in their family, they were on the programme for high-risk people, so it was picked up. I am very concerned about the people who are not on that programme and for whom it does not get picked up. If two of my friends had this cancer at 21, I am sure that many others are at risk, and will have cancer that is not picked up until it is too late.
The smear tests are not fun and can be embarrassing, but at my GP they have changed. They now use a small brush that is nowhere near as uncomfortable. I say to the Minister that there are ways of minimising the discomfort of such tests. Turning to my personal experience, I have always gone for my smear tests. After one test, I received the letter we all dread, saying that there were some abnormalities and asking me to go back for a biopsy. When I did so, lo and behold, it was confirmed that I had cancerous cells.
I did not have any symptoms. If I had had the symptoms, I would probably have put them down to something else, because they are irregular bleeding, discomfort during sex and back pain—I am 49, so I suffer those quite a lot anyway. [Laughter.] Those are not abnormal symptoms at any age, even at a younger age—I look to the women in the room. If I had had those symptoms, the last thought on my mind would have been, “Oh, my goodness; I might be at risk of cervical cancer. I must go and do something about it.”
I was lucky that it was picked up really early, so I had simple day surgery and did not require any further treatment. Two weeks ago I got the letter saying that I was six months clear, which is just wonderful. I want everyone to know that feeling, and that is why I am so grateful that the petition was put forward and there are campaigns, and why I am so concerned that the number of women going for smear tests is dropping.
The figure cited by my hon. Friend the Member for Warrington North that 1.7 million women have never had a smear test chills me, but there are often very good reasons why women are not going. A lot of it, for the women I speak to, is due to past sexual violence or childhood trauma. I ask the Minister to look at the guidance that goes out to GPs. If a women has never been for a test, or has missed a number of appointments, instead of assuming that she is being difficult or that she cannot be bothered, is it possible to put something in the chase-up letter that says, “We understand that this can be very difficult, so here is the nurse you can talk to, so we can minimise some of the trauma and the worry that going for a smear test might create”?
These are simple things that we can do and that can change lives. I am very supportive of lowering the age for smear tests, for the reasons I have outlined, but I also think that we owe it to young women to give them the best protection they can possibly have.
Hannah Bardell (Livingston) (SNP)
It is a pleasure to serve under your chairmanship, Sir Roger, and to speak in this debate. I was supposed to be with you and others at the Council of Europe last week, but I was not there; I was having a biopsy done, because I had had an irregular smear. It was an uncomfortable and painful experience, but it was largely made better by the fantastic doctors at St John’s Hospital in Livingston. I will get the results in three to four weeks—hopefully they will be all-clear.
It is very important that those of us who have a voice use it to speak out and encourage young women and people in the trans community to have their smear tests. I had a really fantastic conversation last summer with people from Jo’s Trust, who spoke passionately about the work they are doing with members of the trans community.
I want to pay tribute to some of the organisations that work in the area, including a charity in my constituency called the Michelle Henderson Cervical Cancer Trust. Michelle Henderson was in the year below me in high school; I did not know her well, but we occasionally attended the same house parties and I knew her to be an incredibly bright and vivacious young woman. In October 2010, at age 26, she was diagnosed with cervical cancer. She died on her 28th birthday in October 2012. Her father is the famous football player Willie Henderson. Michelle set up the charity not long after she was diagnosed, and Willie has continued her incredible work in her memory. A couple of years ago I did the 120 km last leg of the Camino de Santiago to raise money for that incredible charity.
Too many women are dying young. Many of us feel that we must listen to the health professionals; we absolutely must, but we must also consider the individual cases of those who, like me, had irregularities picked up early on, well below the age at which cervical smears are now being carried out in Scotland, England and the rest of the UK.
The hon. Members for Rotherham (Sarah Champion) and for Warrington North (Helen Jones) mentioned victims of sexual violence. I want to pay tribute to the work of My Body Back, a project set up in August 2014 by Pavan Amara that supports women who have experienced rape or sexual assault to take their bodies back again. It runs specialist services and recently opened a clinic in Glasgow that includes a cervical screening and maternity clinic. That work is so vital, because for women who have been victims of sexual violence it can be a harrowing experience to have to go and have a smear done. The fact that the design of speculums has not developed or changed in decades, if not longer, says something about the care that is given to women’s health.
I was diagnosed with HPV—for the rest of the world, let us remember that that presents itself as genital warts—in my late teens. I had intercourse with a man—I was not out at that point—and the condom broke. He was good enough to get in touch to tell me that he had contracted HPV, not from me but from a previous partner. That was an experience that I have lived with ever since. It has been a source of deep shame, because it means that no medical professional has ever been able to tell me whether my irregular smears—I have had many over the years, and much treatment for pre-cancerous cells—were directly related to that experience.
The positive part of the story is that a few years after my experience, and after I was given the all-clear, I was contacted by a big health conglomerate that was developing a vaccine to stop HPV and asked me to give my cells. I was happy to do that, so I spent a couple of years travelling back and forth to clinics, giving my cells and blood. My unfortunate experience—the experience of many women the length and breadth of the country, and not something we should be ashamed of—led to my cells being used to develop the vaccine that is now given to many women and young girls across the country. That is something I am very proud of.
I had not planned to speak about my personal experiences today, but I figure that those of us who have a voice should use it. Cervical smears are at an all-time low. There may be an element of complacency because we are wiping cervical cancer out, but—as my doctor reminded me the other day as she was peering over me while doing my colposcopy—the vaccine protects against only three strains of HPV, which, like all viruses, has a habit of mutating. We must say to every person who should be getting their cervical smear how vital it is, and we must listen to them about their real and genuine concerns.
As the hon. Member for Warrington North said, the terrible shaming of women’s bodies in the media plays a key part in why women and girls feel that they cannot come forward. We must remind them that our bodies come in all shapes and sizes, and they are all beautiful. The only way to prevent this terrible disease from killing more women is to make sure that we get out there, talk about it and encourage them to go for their cervical smears.
Jenny Chapman (Darlington) (Lab)
It is a pleasure to speak in this debate, particularly under your chairmanship, Sir Roger. It is great to be in a Parliament in which women are prepared to stand up and share some of the most private, intimate things about their lives—probably things they have not told their mothers—in a forum such as this.
Hannah Bardell
I just want to say that, when I went to the sexual health clinic in Edinburgh, my mother came with me. She was the only person I trusted—and, yes, until today there were only a handful of people in my life who knew that story.
Jenny Chapman
She sounds fantastic—how lucky you are.
We are now in an age in which women can stand up in Parliament, as I do not think they could even as recently as 2010, when I was first elected, and talk about the cost of Tampax, smear tests, their sexual history—
Jenny Chapman
And mesh, as my hon. Friend never stops reminding me. That is a good thing—a wonderful thing—and I am really proud to be part of it.
When I saw that this debate was taking place, I asked for the data for Darlington, because I wanted to see where we stood. I was anticipating the same thing I normally get when I compare health data for the north-east with the rest of the country, but I was pleasantly surprised: take-up is better in the north-east than in most places in the UK, which is a very interesting fact. Part of it, I think, is about the stability of communities and the ability to access services that are themselves stable. They do not tend to move around too much and GPs tend to serve for longer. Although there can be many problems with access to services, it appears that, in this regard at least, women in my constituency are availing themselves of the opportunity to get tested at a higher rate than women in other parts of the country. That is very welcome.
Looking at the data on Darlington, I notice that the participation rate among 25 to 49-year-olds is fairly steady at about 74% or 75%. The take-up among older women—those aged between 50 and 64—has gone down by 2% in the last year, which seems to be the case in other parts of the country as well. I welcome the discussion about testing young women under the age of 25, but we should be mindful that we might be sending the message to older women that they do not need to worry. Take-up is perhaps dropping off more quickly among older women than among those in other age groups due to embarrassment, indignity and all of that. At the risk of oversharing, the only smear test I have ever had—where I really did not care happened not long after I gave birth to my second child. That was not an issue at that point. However, I am mindful of the fact that older women are not taking part in the way we would wish. Some of that is obviously about the indignity, but also there is a lot of misinformation and misconception about cervical cancer.
I have heard it said that once a person is no longer as sexually active as they might have been earlier in their life, or does not change partners quite so often, they are somehow at less of a risk or no longer need to be so concerned about cervical cancer, and their need for a test is therefore reduced. I have heard people say that, if they are in a same-sex relationship, they do not need to have a cervical screening test. There seems to be an association between sexual activity and a risk of cervical cancer. I do not know where that has come from or why it persists—my hon. Friend the Member for Warrington North (Helen Jones) referred to it when she talked about vaccination. That kind of misconception seems to apply to older women as well. If the campaign mentioned by the hon. Member for Henley (John Howell) takes place, it is very important that they take the opportunity to get those messages right, too.
My hon. Friend the Member for Rotherham (Sarah Champion) made a very helpful point about women who have been victims of sexual abuse. They have a very special and entirely understandable concern that is not taken into account by the blunt approach that service providers can take. More thought needs to be given to that. Disabled people might have additional needs when accessing this test, and I am absolutely certain that not every setting will be able to cater for those needs in a way that enables a disabled woman to have the test with the dignity and sensitivity that we would all expect.
The declining participation in smear tests is a trend that should ring an alarm bell for Ministers, and I am sure it does. This is a red-flag dataset. It is great that we have the data—it is fantastic to debate something with clear information, and when we can see good-quality data over time and get a good idea of what is happening in different parts of the country. We must use that to nip this problem in the bud before it gets even worse. From people I have spoken to, access to this service is one of the principal reasons, along with all the other things that we have talked about, why women are not participating in increasing numbers and why we are seeing those numbers decline.
The GP patients’ survey last year found that 28% of patients found it “not easy” to make an appointment over the phone to see a nurse—up from just 19% in 2012. We have had many debates in this place on the difficulty in accessing GP services, which I know the Government will want to grapple with. It is affecting these women. A smear test is a very easy thing to want to put off. Someone might get round to making that phone call, but if it does not quite work the first time, it is tempting not to get round to it again for some weeks or probably months.
The work that Jo’s Cervical Cancer Trust has done is absolutely phenomenal—what a tremendous organisation. It is really impressive. Its data, stories and the way it puts those across in a manner that everybody can access and understand are fantastic. The trust found that one in eight women find it difficult or impossible to book an appointment for their smear test, which just cannot be right. It might be the case that women should be encouraged to access services not through a GP, but through a specialist clinic where they could access contraceptive services at the same time. That is now available in Darlington—it is also open in the evenings and is a very good service, which might be one of the reasons participation rates in my constituency are holding up relative to other areas of the country.
Obviously I take the point that the age of screening must relate to science, but I wonder whether this is a situation in which we might be able to prevent some of the misconceptions and anxieties about pain, which does not need to happen, or a lack of dignity, which there does not need to be if screening is done sensitively. Young women can have a good experience if they are encouraged to have a test at an early age. Perhaps we need to give some thought to positive early experiences of smear tests to increase participation rates among women over 25.
We need to consider an awful lot about access to the test and cervical cancer generally. This is an important part of it and I congratulate everybody who signed the petition and put it in front of us. We have an opportunity to do something that would make the lives of my constituents and everybody else’s so much better and safer. The Minister is listening and thinking hard, and I know he wants to do right by the people who signed the petition.
Christian Matheson (City of Chester) (Lab)
It is a great pleasure to serve under your chairmanship, Sir Roger, and to take part in a debate in which there have been so many thoughtful and personal contributions. I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on her detailed opening. I tried for some time to secure a debate on this subject, in order to raise the concerns of my constituents and others who were denied smear tests because they were under 25 and so did not receive a diagnosis of cervical cancer. My hon. Friend raised the case of a young lady who died of cervical cancer around Christmas. She believed that had she been allowed a smear test earlier, the cancer might have been caught at an early age.
My understanding of the campaign under way at the moment is that it does not necessarily aim to extend access to smear tests to all women under the age of 18; it argues, more simply, that a smear test should be carried out when a doctor believes it is necessary. I know of the case of a young woman, Lucy, who lives in a constituency neighbouring mine. She had a history of cervical cancer and so was given a smear test, but the lab did not even test the sample and destroyed it because she was under 25. She went on to develop cervical cancer—it was detected when she went for a private smear test. I am happy to report that it was eventually cured, but not without the difficulties of treatment.
My constituent Sophie wrote:
“I’m 23. I have two children (aged 5 and 16 months). When I was 17, I fell pregnant with my first son and my midwife asked for a smear test a few months after I gave birth, as I was suffering from abnormal pains in my pelvis area. My sister had been diagnosed with cervical cancer that year and my nan sadly died from it a few years before”—
So there is a family history. Sophie went on to say:
“I wasn’t given one, due to my age. Three years ago, I was suffering from pain again and they refused a smear, again due to my age, but used a cotton wool bud for a swab. This came back with abnormal cells and I was given antibiotics to clear these up and take the pain away. The doctor advised me if it carried on I would develop cervical cancer and may not be able to have further children. However, he did not refer me for a smear.
I had my daughter in June 2017 and still suffer from strange pains and, again, my midwife asked my doctor to refer me, but my age has always been a massive problem. I’m 23. I have two kids. I’m a law student, and it’s always in the back of my mind that, due to my previous abnormal cells, which they didn’t look further into, and my family’s history, I could potentially have cancerous cells I don’t know about, which would completely ruin and change my babies’ lives.”
Sophie concluded:
“I totally back you, Chris, with this, and hope that this legislation is changed. It’s totally against women’s human rights and discriminatory in age.”
The proposal is that women under the age of 25 should have access to cervical smears if they are needed. Objections to the proposal suggest that smear tests that are done too early might be inconsistent and inaccurate, and throw up false positives, as other hon. Members have mentioned. The campaign is not about testing all young women by extending the testing programme to 18 to 24-year-olds; it is about allowing a test only when the circumstances require it.
My hon. Friend the Member for Warrington North talked about the current regulations, which she believes are not being implemented. The regulations behind the 25-year age limit are now 13 years old, and they have not been reviewed in that time—my hon. Friend therefore asked the Minister that they be reviewed. The Smear on Demand campaign has prepared an extensive research paper that shows that the initial figures used 13 years ago to justify the 25-year age limit may have been incorrect, as they related only to when patients were diagnosed with stage 1B onward, as opposed to stage 1A. Many of the high-profile cases that we have heard about today were initially diagnosed with stage 1A. The campaign looked at figures for women under 28. The number of women diagnosed with stage 1A is highest in those aged 25—the figures start only at 25 and are not collected before then.
The smear test is supposed to be a preventative measure, but women can access it only at 25. It makes no sense to remove the possibility of prevention for the lower age limit. I do not think that it is in dispute that 25 is a good age at which to start routine smears, but when a doctor believes that a woman under that age needs a smear test, it should surely be allowed on the NHS. The campaign is not asking for all women under 25 to be tested; only those for whom that is recommended by a doctor. Some 99.7% of cervical cancers are treatable, because cervical cancer goes through three stages of pre-cancer, which means that it can be very slow growing. Currently, a smear test is the only cancer-detection test available that can detect pre-cancers.
I welcome the Secretary of State’s commitment to prevention in the NHS strategy that he recently presented to the House. I also welcome his commitment, which he gave to me in the main Chamber, to asking Mike Richards to look into the issue. I have not yet heard from Sir Mike, but I am sure that he will soon be in touch following the Secretary of State’s commitment. The House is currently dealing with some very difficult, intractable and divisive issues. This is not one of them. It is an easy issue for which a Minister can perhaps change the regulations and direct that if a doctor believes that a young women under the age of 25 has symptoms that require investigation, they are investigated. That is a minor change that could have major consequences. In these difficult times, I urge the Minister to apply some common sense and grab that chance with both hands.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
It is a pleasure to serve under your chairmanship, Sir Roger. I thank everybody who signed the petition and all the women who have come to listen to the debate. I know that getting down to London can be quite tricky—I say that because I come from Hull—so I thank them all for coming.
I agree that having a smear test is not pleasant, but I think that we would all agree that it is crucial. While we are in a sharing mood, I will share a little bit with you all as well. I too had abnormal smear tests and was found to have pre-cancerous cells when I was in my early 20s. I had just finished university and decided to move to Leeds to spend time with my sister. It was fine, because I had the biopsy and—they had to remove the cells—went through the various bits and pieces of the operation. Since then I have been on a yearly recall, so I have had so many smear tests. Every time I ask whether I still need to be on a yearly recall, they say, “We’ll let you know,” and then the following year I have to go back. I am due to go back again, so this debate has prompted me to pick up the phone and arrange that.
I did not take my mum with me to that procedure, because unfortunately she was unable to come, so I took my sister, who is five years younger than me —I was only about 21 or 22. The experience of coming in to watch terrified her; she was there to offer me moral support, but I found myself reassuring her throughout my operation, saying. “Don’t worry; it’s fine. I’m perfectly okay.” I think that we should be a bit more open and honest about these things.
We should also do the brilliant thing that we all do when we get a little embarrassed: laugh about it, because it can actually be quite comical. As I said, I have had so many smear tests, and when my friends are worried about them, I joke about the ridiculous, small piece of blue towel that is meant to preserve our modesty. The midriff is hidden by the piece of blue towel while all the rest is exposed to the world—that is funny. It was also quite funny when, not long after being elected, I was lying there and someone asked, “Are you our local MP?” I said, “Oh, yes. I am.” We then proceeded to have a conversation about how I was finding life at Westminster. I said, “Well, slightly more comfortable than this, thank you very much!” We should find those things funny and we should laugh.
While I am in the sharing mood, I have a little tip for all the women out there. If, like me, they suffer from a hidden cervix—apparently mine is quite shy—a towel or cushion under the bottom lifts it up so it comes into view. That is a little bit of health advice while I am here.
In all seriousness, there is a growing problem. In Hull, the figure for women having smear tests has dropped to only 73.1%—that is a huge fall. The figure is slightly higher in East Riding, at around 78%, but that is nowhere near the 80% for which the NHS is aiming. I echo the words of all hon. Friends and hon. Members who have spoken when I say that the Government need to conduct some kind of survey to find out why. Is the problem, as my hon. Friend the Member for Warrington North (Helen Jones) said, that women associate smear tests with sexual activity? Do they think that they have no need for one? Do their working hours mean that they are not able to attend tests? Let us find out and make life that bit easier for all of them.
We know, when looking at the NHS cure rates, that 92% of those whose cancer was detected are cured. That is wonderful. I cannot possibly say what would have happened to me had mine not been removed—I do not know. I am here today, all is well, and I will book my next smear test. Some 66% of all those diagnosed after developing symptoms are also cured. We need to do more to push that message out to people and get rid of the myths. I absolutely support what my hon. Friend the Member for City of Chester (Christian Matheson) said in his beautiful speech about the importance of reducing the age to 18 under a doctor’s advice.
I have been involved in a campaign for teaching menstrual wellbeing in schools, on the education side of the issue, because I am not sure that everybody understands what the abnormal signs or symptoms are. I became involved in the campaign through my support for the charity Endometriosis UK, but I think that removing the taboo around periods, smear tests and so on would also help a lot of people. We must start talking in schools about menstrual wellbeing, what normal and abnormal periods are, and what normal and abnormal symptoms are. If we start to have that conversation, we will give people the language and ability to talk about the matter without feeling really shy and saying, “I’ve got a problem with my—I can’t say the word.”
We should be able to talk about it, which reminds me of a brilliant story. When I was doing a radio show for my campaign on vaginal mesh, I spoke to the show’s producer before I was due to speak live. He said, “We’re very supportive of the campaign, but it’s a breakfast show, Emma, so could you not say the word ‘vagina’?” I therefore spent the entire interview talking about problems with “mesh” that was “in” women’s bodies. We need to dispel all of that nonsense and shyness and start being a little more open, and I implore the Minister to work with the Schools Minister in support of my call for menstrual wellbeing to be taught in schools.
Hannah Bardell
I absolutely agree with the hon. Lady about how, for some reason, we cannot talk about parts of our bodies at that time in the morning. In the same way, I still find it incredible that adverts for sanitary products depict women’s period blood as being blue rather than red. I do not know about anyone else, but I have never bled blue in my life.
Emma Hardy
Perhaps that is the royal family only. The hon. Lady is absolutely right. For years I was convinced that if we used Tampax, it would suddenly make us fitter, more active and able to roller-skate—[Laughter.] Sorry, we are descending into farce.
On a serious note, I ask the Minister, please, to look at what my hon. Friend the Member for Warrington North said about lowering the age to 18 when doctors give a recommendation. I also ask him to support my call for menstrual wellbeing to be taught in schools, and to have a wider survey into understanding why people are not attending tests, so that we can do something to change that for the future.
Angela Crawley (Lanark and Hamilton East) (SNP)
It is a pleasure to serve under your chairmanship, Sir Roger. I am grateful to be able to speak in the debate. I thank the hon. Member for Warrington North (Helen Jones) for introducing it, and I welcome everyone in the Public Gallery. Natasha’s friends and family who are here have definitely brightened up the gallery and this debate, and we are grateful.
I pay tribute to Natasha Sale, a brave young woman who organised the petition that we are debating. As we heard, she was diagnosed with metastatic cervical cancer before passing away on new year’s eve last year—a 31-year-old woman who left behind four children. It is incredibly sad to hear that she never got to see this moment through, but I hope that, by having the debate, we pay tribute to her tenacity and her commitment to ensure that it was heard. On the petition webpage, she wrote:
“If I can do anything with my life I want to make this change happen, it’s too late for me but it’s not too late for the next generation of young ladies.”
That is a truly brave statement. I am only sorry that she could not make it to see the campaign debated on the Floor of the House. We are, however, very grateful to have all those present in the Public Gallery.
Natasha’s bravery and selflessness to the last in the face of that horrendous disease is truly humbling and should be commended by all. In doing so, we must also recognise the commitment of her family and friends who continued her endeavour to reach more than 100,000 signatures on the petition, which is a feat in itself. In raising awareness of cervical cancer through their campaign and by encouraging women to take smear tests, they have undoubtedly already saved lives.
Breaking the taboo is so important in the fight against cervical cancer. This debate should serve not only as a motivation for every young women who is scared to get regular check-ups and to see their GP, but as a reminder—I am sure it has reminded many of us present—never to be too busy to do the same.
Contributions from hon. Members in all parts of the House are most welcome, and it is always a pleasure to have men speak in these debates because, as the hon. Member for Darlington (Jenny Chapman) rightly pointed out, for too many years in this House such issues as this one have been seen as women’s issues. They are not women’s issues, because every man has a mother, a wife, a daughter or a sister, so the discussion should be had by everyone. It is therefore most welcome to have had those contributions.
I will summarise some of the contributions. The hon. Member for City of Chester (Christian Matheson) raised cases from his constituency and others, especially that of the young woman who, sadly, died around Christmas last year because she was denied access because she was under 25. That she is not here at this point is a great sadness. The hon. Member for Darlington highlighted how the debate should be part of everyone’s agenda, not only on behalf of their constituents but to raise awareness that it is not just a women’s issue. I also join the calls of the hon. Members for Warrington North and for Henley (John Howell) for the Government to keep the matter under review.
The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) brought a bit of light-heartedness to the debate. As harrowing and awful as this is, it is important to find a way to laugh. I found myself in a similar position and, up in stirrups, someone telling me, “Oh, that’s where I know you from”—easily the strangest time to be recognised, and a little bit weird. None the less, I had gone to have my smear test.
The hon. Members for Kingston upon Hull West and Hessle and for Rotherham (Sarah Champion), and my hon. Friend the Member for Livingston (Hannah Bardell) gave very personal contributions. The House is always richer when people share such experiences and give voice to the many more people who do not have a platform. I am grateful to each and every Member who shared in their contributions—they were deeply personal, but we appreciate their honesty and candour.
I also pay tribute to Jo’s Trust, especially because it has actively sought to ensure access to GP services. That is particularly important not only in England but in Scotland, so that people know they can access such services.
Cervical cancer is the most common cancer in women aged between 25 and 35 years old. I find myself in that bracket, so I use this opportunity to encourage every young woman in Scotland: please, have your smear test done if it has been a while or you have never done it. Now is absolutely the time, with about six women in Scotland diagnosed every week—please, do not be scared. Go and have that done. It is so important.
We know that smear tests are the best protection against that form of cancer. A test is not the most comfortable or nicest experience, but it has to be done, because when tests are done, they are estimated to save about 5,000 lives each and every year across the UK, and to prevent eight out of 10 cervical cancers from developing. Despite that remarkable fact, however, the most up-to-date figures show that, as we heard, only 73% of eligible women accept the offer of a test—but, ultimately, that means that 27% of eligible women do not, and they miss out on a potentially lifesaving trip to the doctor.
I have heard some of the reasons why people avoid participating in the tests, as the hon. Member for Warrington North also told us. The test might be said to be intrusive, offensive, scary or gross but, although it is not a pleasant experience, that is not a reason not to have it. While it is true there are more fun things than getting a smear test, the same can be said about a number of other routine check-ups. I do not particularly like going to the doctor or the dentist, but doing so is important.
Clearly, more work has to be done to encourage the take-up of screenings among certain groups of the population. As we heard, evidence shows lower participation in cervical screening among young women living in areas of deprivation, women with a learning or physical disability, black or minority ethnic women, and lesbian and bisexual women—the myth among those women, myself included, was that they should not have to have a smear test because they are sleeping with someone of the same gender. As my hon. Friend the Member for Livingston rightly highlighted, the test is also for those who are trans. It is easy to assume that this is a women’s issue, but it is an everyone issue.
In Scotland, we are working hard to ensure that all those at risk see the importance of attending cervical screenings through public awareness campaigns to tackle the fears that people might have about having a smear test. The contrast remains apparent between the least and most deprived areas, however: 78% of women who live in the least deprived areas attend their smear test, whereas only 67% took up the offer in the most deprived areas. Ultimately, those in the most deprived areas are least likely to attend. I hope the Minister recognises those figures and looks at what the Government can do to raise awareness in those areas. That proves that we have so much work left to do.
In Scotland, we are introducing tests for HPV within the routine smear test to allow for earlier detection and more effective treatment. Health Scotland has produced a toolkit to help GPs, practice nurses and practice staff to optimise uptake, reduce barriers and ensure that women make an informed choice about cervical screening. Despite those efforts, according to a recent study, 72% of young women said that they had delayed a test or never went for screening because they felt embarrassed. I do not know about anyone else, but I dread to think that the notion of “dying of embarrassment” could truly be the case. I hope we can do more so that young women know they should not feel embarrassed and ashamed. We must do more to encourage women to get further screening. If we break the taboo, we will save lives.
We should use the opportunity of World Cancer Day on 4 February to raise awareness and to encourage women to come forward. We should use the House as a platform not just to speak about Brexit—I am sorry to mention that word—but to tackle the issues that affect women so much.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is a pleasure to serve under your chairmanship, Sir Roger. I begin by thanking my hon. Friend the Member for Warrington North (Helen Jones) for introducing this debate on behalf of the Petitions Committee. I, too, pay tribute to Natasha Sale, who started this important petition. As others have said, it is so sad that she did not live to see this debate take place. Her family, I am sure, are very proud of her.
I thank all hon. Members who have spoken in the debate: the hon. Member for Henley (John Howell), and my hon. Friends the Members for Rotherham (Sarah Champion), for Darlington (Jenny Chapman), for City of Chester (Christian Matheson), and for Kingston upon Hull West and Hessle (Emma Hardy), whose speech was excellent and we will not forget any time soon. I thank the hon. Members for Livingston (Hannah Bardell), and for Lanark and Hamilton East (Angela Crawley), who spoke on behalf of the SNP. It has been an excellent debate with very good contributions and lots of sharing. I am a classic oversharer, but I will try to resist the urge. Finally, I thank the 167,000 people who have signed the petition so far.
This is a very timely debate, because Cervical Cancer Prevention Week concluded only yesterday. The age to start screening is a very emotive issue. Every year in the UK, more than 3,000 women are diagnosed with cervical cancer. As we have heard, 15% of those women are under 30. Last year, 12 of those under 30 died from cervical cancer. The number of cervical cancer deaths has fallen in recent years, but it remains the most common cancer in women aged 35 and under. That is why I welcomed preventive measures such as the introduction of the HPV vaccination, which was offered to adolescent girls in secondary school.
My daughter was one of the first to receive the vaccination when she was 13. I was very pleased to give that permission; I would not have hesitated for a second to give it, although as my hon. Friend the Member for Warrington North said, a number of people do not give permission. That is very concerning; genuine concerns will have led them to that decision, but we must do what we can to allay their fears. We heard about the catch-up programme at the time, to ensure that all girls up to the age of 18 were vaccinated.
At that time, I looked extensively into this policy area, following a campaign by Washington constituent, Claire Walker Everett, and her family. Claire led the campaign before her untimely death at the age of 23 in 2008, and her family continued it for some time afterwards. I called for a further catch-up programme to address what I called the “seven-year gap”, so that women between 18 and 25 could be vaccinated until they were eligible for smear tests. I said that the gap would close each year until almost all under-25s had been vaccinated, as is now the case. That was 10 years ago, so that gap has closed. Many of those first vaccinated are approaching 25 and are eligible for a smear test, so we should have a whole generation of young women and girls who mostly have been vaccinated against the HPV virus, to help protect them from cervical cancer.
The vaccination programme has been very successful on the whole, with a high national uptake of around 85%. However, I have previously raised with the Minister the significant regional differences in the uptake of the HPV vaccination, which need to be addressed. The lowest uptake for the two doses is in Stockton-on-Tees, at 48.3%; the highest uptake is in East Renfrewshire, at 95.6%. That is curious, and flies in the face of the screening statistics cited by hon. Members, which show that the north-east reached higher rates than others. Perhaps the differences are in pockets rather than whole regions.
I therefore ask the Minister what steps he is taking to investigate and address the regional inequalities in HPV vaccinations and screening. How do the Government ensure that the HPV vaccinations are taken up by the vast majority of girls? Otherwise, the reassurance of my earlier statement that a whole generation of women and girls approaching 25 have been vaccinated falls short in certain areas, which is extremely concerning. Cervical smear tests are available to women aged 25 to 64, yet cervical screening is at a 21-year low. Last year, it was discovered that more than 40,000 women had missed out on crucial information about cervical screening appointments and test results. Has the Minister made any assessment of the impact that has had on uptake? Can the Minister give assurances that this issue has been solved?
According to Jo’s Cervical Cancer Trust, which I commend for its tireless work and campaigning, one in four women across the UK do not attend cervical screenings. That proportion increases to one in three among those aged 25 to 29, when they are first eligible for screening, and to one in two in some of the most deprived regions in the UK. That decline can be for a host of reasons, such as fear or embarrassment.
I pay tribute to TV shows that show the medical equipment involved in a smear test; the “Victoria Derbyshire” show even showed a smear test live on the show on Friday, in an attempt to address those reasons. There was no wincing or obvious cries of pain, so it will have been reassuring to someone who has not had one, although I am sure some viewers complained that it was not suitable daytime viewing. Aside from doing more of that, will the Minister tell me what steps he is taking to increase take-up? Additionally, what steps is he taking to educate women on the need for cervical smears and what the tests are for? I understand that some women believe that a cervical smear will also detect ovarian cancer—as he knows, that is not the case.
As I mentioned, most women under the age of 25 have received the HPV vaccination, giving them excellent protection from the HPV virus. That means that the reason that once may have existed to lower the screening age no longer does. However, I say again, that reason falls down in low take-up areas. Additionally, I worry that lowering the eligibility age for a cervical smear test to 18 would cause additional problems and worries for young patients, as my hon. Friend the Member for Warrington North detailed so well in her excellent speech. False positives are more likely in younger women, as they often undergo natural and harmless changes in the cervix that a smear test would identify as cervical abnormalities. In most cases, those abnormalities resolve themselves without any need for treatment.
Treating false positives as cancer can damage the neck of the womb, which can cause a woman to give birth prematurely in any future pregnancies. In women under 25, therefore, the risk is deemed to outweigh the benefit. However, as my hon. Friend said, women should be provided with that information, to make judgments for themselves. Wider education should start in school; my hon. Friend the Member for Kingston upon Hull West and Hessle called for that to start as early as possible, to tackle the fear and embarrassment as soon as possible. I also believe that much more research should be done on the age so a decision can be made that is best for all women.
Cervical cancer is very rare in women under 25, with under three cases per 100,000 women. However, every such case is an awful ordeal for the woman and her family, and sometimes it becomes a tragedy, as it did in the case of Natasha Sale. That was also true for Claire Walker Everett from Washington in my constituency, who died at 23 and whose case first brought this issue to my attention, and more recently for Amber Rose Cliff from the neighbouring Sunderland Central constituency, who died in 2017 at the age of 25. If a young woman has abnormal bleeding or symptoms that she is concerned about, she should be taken seriously by her GP and offered a smear test as soon as possible as part of the health investigations into what is causing her symptoms.
I believe that is part of current guidance and best practice, but we have heard clearly that that guidance is not always followed. That was the case in the short life of Amber Rose Cliff. Between the ages of 18 and 21, she went to the doctor around 30 times, complaining of worrying symptoms and asking for a smear test, only to be told 30 times that she was too young and sent away. When she was 21, her mum paid for her to have a smear test privately. The results were devastating. It was cancer, and the cancer had spread. She died just four years later, aged 25. Young women should not be excluded from a valuable screening service just because of their age if they have symptoms, as Amber obviously did. GPs should be aware of cervical cancer symptoms and know that they should refer young patients who present with such symptoms for smear tests as part of wider investigations.
With all I have said in mind, I conclude that the age for cervical smear tests should remain at 25, on the condition that further research and debate is conducted and tests are offered to those under 25 who present with symptoms. The Government must also ensure that preventive measures such as the HPV vaccination are taken up as fully as possible, and that women who are eligible for a cervical smear test attend their appointments when they are invited or as soon as possible thereafter. I know the Minister cannot drag them all there personally, but I look forward to his response.
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
It is a pleasure to serve under your chairmanship, Sir Roger—I shall refer to you again in a moment. I feel somewhat outnumbered, along with the hon. Member for City of Chester (Christian Matheson) and my hon. Friend the Member for Henley (John Howell), but I am rather used to that, having chaired the all-party parliamentary group on breast cancer for five years with the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson). We were often referred to as “Steve and the girls”.
I completely endorse the point by the hon. Member for Lanark and Hamilton East (Angela Crawley) that this is not a women’s issue. Natasha, whom I will come to in a moment, had four children—two of each. It is very much a boys’ issue for them, as it is across the board. [Interruption.] We may have heard the B-word only once during the debate, but I could have sworn I just heard something from outside. I must be imagining things.
It has been a privilege to be part of this debate. It is only right that I start by expressing my sincerest condolences to the family and friends of Natasha Sale, who tragically passed away in December. I know I speak on behalf of all Members present when I say that our thoughts are with her family and friends. Anybody who has lost a loved one to cancer knows the pain and anguish that the family are experiencing due to Natasha’s loss. As somebody who has fought and lost more than I have won, I am one of those people. In some of the coverage of Natasha’s death, I saw a quote from Amanda Scott, her best friend, who said:
“God only takes the best”.
I thought that was a lovely quote. We have heard that many times before, but I was interested in how that was reported.
As the Minister responsible for public health and cancer, cancer prevention and early diagnosis are vital priorities for me. I am delighted to see Natasha’s army here today. I saw the pictures on the bus on social media this morning, with some interesting hand signals—I must ask them about that. It is very good to see them all here. I hope they know, as Members know, that I will continue wholeheartedly to support the efforts of the NHS and Public Health England, which I hold to account, and of all our excellent cancer charities, which work as part of team cancer to prevent cancer and reduce the number of families who have to go through what Natasha’s family is going through.
There have been so many interesting speeches. Luckily, for once I have time to touch on a number of them, if not all of them. I was very interested in the point made by the hon. Member for Darlington (Jenny Chapman) about the data showing that take-up is better in the north-east than almost anywhere else. I was interested in what she had to say about the reasons behind that. The NHS as a system too infrequently talks to Members of Parliament, who know their areas better than most. I will ask Sir Mike Richards to contact her, perhaps along with the hon. Member for City of Chester, who is obviously still waiting for an introduction. I am very happy to facilitate that. Her other point was about access, which many Members mentioned. I will ensure that her very good point about disabled women is fed into Sir Mike Richards’s review, and I encourage her to raise that with him when she sees him.
[Ian Austin in the Chair]
I will come to the hon. Member for Warrington North (Helen Jones), who introduced the debate on behalf of the Petitions Committee, because many of the points she raised will come up in my speech. I was pleased that my hon. Friend the Member for Henley talked about the “Be Clear on Cancer” campaign and the new Public Health England campaign that will be rolled out next month. He mentioned the role of GPs in those campaigns. “Be Clear on Cancer” is a public-facing campaign, but elements of it relate to GP education, which I will come to. He often makes very good points in our debates, and I thank him for raising that topic. The hon. Member for Rotherham (Sarah Champion) also mentioned GP understanding, which I will touch on.
The hon. Member for Livingston (Hannah Bardell) made a very personal speech. She said she is awaiting results, and I think I speak for everyone when I say we wish her well. We will be thinking of her, and our fingers are crossed for her. She made a point about the trans community, which I had not heard mentioned in this context. NHS England has published clear guidance for trans men—people who have changed from female to male. Trans men who still have a cervix and have not had a hysterectomy remain entitled to screening. If a trans man is still registered with their GP as a female, they will continue to receive invitations for screening. If they are registered as a male, they remain eligible for screening but will not automatically be invited. The guidance makes clear that trans men need to request screening from their GP. I thank her for raising that point, which is another that I want to feed into Sir Mike’s screening review.
The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) made a brilliant speech, as always. She should be on the stage. The rather unconventional advice surgery she talked about may not catch on, but I enjoyed hearing about it. We constituency MPs all dread somebody saying, “I’m sure I know you from somewhere.” She talked about education, particularly in schools. Public Health England has a range of materials aimed at providing teenagers and their parents with information about things such as the HPV vaccination programme. She will know that the Department for Education is also working on new relationships and sex education guidance. Its consultation closed in November. That guidance, which will include input from Health Education England, will be published in the first half of this year.
I took the Teenage Cancer Trust and CoppaFeel!—a breast cancer charity with possibly the best name of any cancer charity—to see my right hon. Friend the Minister for School Standards at the end of last year. We were very keen to make the point to them that we must improve awareness in schools of health, bodies and particularly cancers, but in a balanced way that educates children about warning signs without frightening the life out of them. I think we have struck that balance, and I think Members will be pleased when they see that guidance rolled out in the first half of 2019.
Helen Jones
Will the Minister tell us whether that guidance includes educating young girls about the need to go for smear tests? Some of Natasha’s friends have forcefully made the point to me that if we do that, it may encourage girls to go for smear tests when they reach the age for screening.
Steve Brine
I cannot tell the hon. Lady that, but I will find out and write to her and other Members who in the debate. It is not my policy area—obviously I am not the Minister of State for School Standards—but it is a good point and it would seem logical that that is done in consultation with the Department of Health and Social Care and with Health Education England.
To go to the heart of where I want to start, the hon. Member for City of Chester talked about a constituent being refused a smear test. He said that it would be simple for a Minister to change the regulations and said that this was an example of the system not doing what we direct it to do. As the shadow Minster said, the system should already do that. It would not be appropriate to go into individual instances, but it is important to understand that cervical screening is a screening test and not a diagnostic test. It aims to detect abnormalities of the cervix that if left undetected may develop into cancer, so it is preventative. Cervical screening is not appropriate for women with symptoms, but if women of any age, including under-25s, have unusual symptoms or abnormal bleeding, they should consult their GP immediately and they should be treated under the NHS and initially offered a speculum examination in accordance with the National Institute for Health and Care Excellence guidance for primary care. If that is not happening and if that were one of my constituents, I would be taking that up through the procedures that the hon. Gentleman will know about as an experienced constituency MP. I think that is clear.
The hon. Gentleman also touched on the petition. To be clear, the petition is entitled:
“Lower the age for smear tests from 25 to 18 to prevent cervical cancer.”
He is right to raise the point about women requesting that. We do not often hear about “Liberating the NHS: No decision about me, without me” in the House these days, but it is still very much alive. I would encourage him to take that case up, as I would encourage any other Member who runs into that issue to do.
Liz McInnes (Heywood and Middleton) (Lab)
Will the Minister address the issue of self-screening kits for HPV in his remarks? I am sure he will go on to talk about them. My interest is at the other end of the spectrum, with women aged over 64, but it is pertinent to young women, aged 18 to 25, as well.
Steve Brine
Indeed. If the hon. Lady is not satisfied with what I say now, then please come back and we will make sure that she gets more information after the debate. Self-testing for HPV is an emerging area of medicine. It is not in the same place as the fecal immunochemical test for bowel cancer, but it is an emerging and exciting area of policy. I echo all the positive words that have been said about Jo’s Trust, Jo herself and Rob Music, who runs that charity.
Members will be aware that the NHS offers cervical screening to all eligible women aged 25 to 49 every three years and to those aged 50 to 64 every five years. The screening is designed to detect abnormalities of the cervix at an early stage so that women can be referred for effective treatment. It is important to remember that the purpose of population screening is to reduce mortality and morbidity from cancer and other conditions—that is why we do it—in people who appear healthy and have no symptoms, by detecting conditions at an earlier, more treatable stage. Hence prevention is better than cure.
The purpose of any screening service is to maximise the chances of healthier outcomes and, by association, minimise risk of harm to the whole population. With this in mind, the UK National Screening Committee considers the evidence on whether population level screening should be offered and makes recommendations to Ministers. It is not Ministers who make this stuff up, and nor should we. Using research evidence such as pilot programmes and economic evaluation, the NSC assesses the evidence for programmes against a set of internationally recognised criteria. It is important that these recommendations are made by experts based on the best available evidence, and not by politicians.
On this basis, in 2012 the UK NSC recommended that women should be invited for their first cervical screening at the age of 25. This recommendation was based on evidence that showed that the majority of women below this age would receive little benefit from being screened and treated, which can lead to unnecessary treatment, as we have heard from hon. Members. It is very rare that cervical cancer occurs in women under 25 —as the shadow Minister said, there are fewer than three cases per 100,000 women. That is no consolation to someone who, like Natasha, is one of those three who pays the ultimate cost. I am only setting out the facts as they are.
Younger women often undergo natural and harmless changes in the cervix—it is part of their physiology—and screening could identify those as cervical abnormalities. In most cases the abnormalities resolve themselves without any need for intervention. The recommendation picked up by the NSC in 2012 concurred with a major review by the Advisory Committee on Cervical Screening undertaken in 2009, so the advice goes quite a long way back. The hon. Member for Warrington North asked me whether the NSC would publish its evidence on the decision to screen from the age of 25. The NSC publishes minutes of all its meetings and the full rationale behind any recommendations. However, I will ask Public Health England and the UK NSC to publish any relevant evidence used by the NSC in reaching its conclusions and on which they based their recommendations that is not already in the public domain, which I hope she will be pleased to hear.
I will talk about HPV primary screening. Every life is precious and we cannot be complacent in continuing to do all we can to prevent cancer—those who know me know that I am not complacent. Therefore, we are modernising the cervical cancer screening programme by introducing the detection of human papillomavirus as the primary test in the NHS cervical screening programme. I can confirm that this will be implemented across England by 2020. Cancer Research UK estimates that, when fully implemented, HPV primary screening could prevent an additional 600 cases of cancer every year. As we have heard, almost all cervical cancers are caused by HPV, which is a very common sexually transmitted infection which is linked to the development of the disease.
In addition to changing the primary test in the cervical screening programme itself, I want to highlight that vaccination against HPV, introduced in 2008 under the previous Government, is now routinely recommended for all girls aged 12 to 13. In England and Wales the first dose is offered in school year 8. The programme aims to prevent cervical cancer related to HPV infection and the best way to do that is to vaccinate girls and young women. We are fortunate to have achieved good uptake of the HPV vaccination in adolescent girls since 2008.
The first cohort of teenage girls to receive the HPV vaccination in year 8—those born in September 1996—will turn 23 this year and become eligible for routine screening in two years’ time. It will be of intense interest to all of us to see what impact the vaccination will have on the number of abnormalities detected through routine cervical screening and we will be monitoring this very carefully. I will be watching it like a hawk, as Members would expect. We have already seen that the vaccine has led to a reduction in HPV infection in young women and we anticipate a fall in the numbers diagnosed with cervical cancer at the age of 23 to 24 this year.
Boys have received a level of protection from the girls’ vaccination programme over the last 10 years and we have had debates in the House about that. I referred to the previous Chair, my right hon. Friend the Member for North Thanet (Sir Roger Gale), because he led a debate in the House about HPV vaccination for boys and there was a lot of debate about it. A lot of people said that the boys get herd immunity and therefore they do not need the vaccination programme. Again, I am led by the evidence and the advice that I am given, but my personal view was that I did not agree with the herd immunity argument. I was pleased that I agreed with the advice and from September 2019, all boys aged 12 and 13 will also be offered the HPV vaccination against HPV-related diseases, such as oral, throat, penile and anal cancer. I know the hon. Member for Rotherham wanted to hear about that. That will help reduce the incidence of HPV infection circulating in the population.
It is worth saying that, although HPV infection is the primary cause of cervical cancer, many other cancers, such as head and neck cancer, will be seen a long way down the line. Without wishing to be indelicate, I am told that the popularity of oral sex means that HPV vaccination will have a big impact on the incidence of oral cancers. As the dental Minister, I often hear from dentists that that is a growing problem, so I am pleased that we are able to make a positive policy response, which has been well received.
As the hon. Members for Warrington North and for Rotherham said, there are plenty of people who disagree with HPV vaccination. Whenever I speak on the subject— I can feel the tweets landing in my inbox as we speak—I open myself up to the responses of those who vehemently disagree. All I can say is that I think they are wrong and that that is what the evidence suggests. This is a free society and they are of course entitled to that opinion, but we base policy decisions on the evidence. That is where we are. What I have said about the HPV vaccination for girls, and now boys, is important, but I reiterate the message that it is still important for women who have been vaccinated to attend their cervical screening appointments when invited. It does not turn people into Wonder Woman.
The hon. Member for Washington and Sunderland West asked me what we are doing about education for young adults on HPV vaccination, and regional variations in uptake, a point that she has raised with me before. NHS England works in close liaison with Public Health England to deliver the HPV vaccination programme for girls, and in future for boys, and closely monitors uptake rates. It sends me regular reports. Local NHS England commissioners have access to those uptake rates in their area and, in due course, so will MPs. They work with providers, schools and healthcare professionals to improve coverage, sharing best practice where relevant. It became clear to me when looking at the information that there are variations, which is a concern. I made my concerns about regional variation in vaccination uptake clear to the NHS and have had meetings with NHS England and Public Health England on a number of occasions—twice in recent months—asking for additional action to increase uptake across England. I want them back in my office on a regular basis to report to me. That somehow seems to stimulate them.
I am pleased that the NHS long-term plan featured involving local co-ordinators to encourage uptake. That came out of those meetings along with various other commitments to improve vaccination rates, not just for HPV but across the vaccination piece. That includes requiring CCGs to ensure that all vaccination programmes are designed to support a narrowing of health inequalities. They know that I remain on their case. If the hon. Member for Washington and Sunderland West would like to continue the conversation on that with me, I should be pleased to hear it.
The review that the Secretary of State has asked Sir Mike Richards to carry out has been mentioned. Cervical cancer affects many women and their families, and screening can help to prevent many people from developing cancer each year. It is obviously important that women take up their screening appointments to help spot abnormalities. However, with uptake only at about 75%, we know that we need to make it easier to book appointments and more convenient for women to attend them—that point about access came up a number of times in the debate.
I met Mike recently and said that I have an app on my phone that tells me when my car is due for a service and lets me book a local appointment at a time that suits me. We do not embrace that kind of no-brainer technology enough in healthcare. We have to embrace modern technology to ensure that screening programmes are fit for the 21st century. The Secretary of State and I feel passionate about that, and it should offer greater ease of access. Doing that will, I am sure, improve uptake rates. That is one key reason why we are considering comprehensively how our current national screening programmes can be improved, particularly in the light of recent issues that could affect public confidence in screening and lower uptake.
Professor Sir Mike Richards will be leading a review of all three cancer screening programmes, which of course includes cervical screening. His review will report in the summer and will specifically assess the strengths and weaknesses of the individual programmes. It will also address, as I have just outlined, how the latest innovations can be utilised and integrated with research to encourage more people to be screened, and to make it easier for them to do so. That point was raised by many hon. Members, including the hon. Member for Warrington North. I met Sir Mike a couple of weeks ago to discuss the fact that his review clearly needs to set out how we can bring our screening programmes right up to date to make them fit for the people who use them. I await his recommendations with optimism. Mike ran screening programmes in the Department of Health and Social Care before the passing of the Health and Social Care Act 2012. He has great experience and credibility within the system, which is important. We have great optimism about his work.
We must do more to raise awareness not just of the importance of taking up screening, but of how to recognise the potential symptoms of cervical cancer. Breast cancer awareness campaigns have been phenomenally successful in that kind of work. In her petition, Natasha said that she wanted to make a difference to the next generation of young women by raising awareness of the symptoms. I have seen the videos online of her little girls—they are heartbreaking. Natasha certainly raised awareness of the symptoms of what is a terrible disease. I believe she has already made a difference, highlighting how vital it is for women with symptoms to contact their GP as soon as possible. Indeed, it is 10 years since Jade Goody, who also took on the fight to raise awareness, sadly died of the illness. We shall, with the permission of Jade’s family, use the anniversary to help raise awareness of the importance of screening, and of taking up appointments. In the aftermath of Jade’s sad death attendance rates rocketed. Obviously that has waned. We will, in Jade’s and Natasha’s honour, make the most of the 10-year anniversary to save other women.
Jenny Chapman
It is encouraging to hear what the Minister says, and his comments about the legacy of Jade Goody and others. It is a tremendous thing that they have left to us, with the campaigns we have benefited from. However, is there not, up to a point, cause for concern in that the examples being used are younger women, which could reinforce the misinformation about the need for younger women to be more concerned about cervical cancer—and therefore for older women to be less concerned? Sometimes I wonder whether the prominence given to the examples in question may create an issue for another group of women.
Steve Brine
The hon. Lady makes a good point, and there is always a danger with public awareness campaigns, even down to the models, actors and actresses used in the advertising campaigns, with presentation and positioning. I take the point, and Public Health England, which works on such campaigns for me, will also take the point the hon. Lady raises. I assure her it will be sent a copy of the debate.
A number of hon. Members, including my hon. Friend the Member for Henley, who is no longer in his place, have raised the matter of GPs. Guidance for GPs has been developed and published, specifically aimed at improving the primary care of young women who present with gynaecological symptoms. That guidance, produced by a multidisciplinary group, including professionals, patients and the voluntary sector, and endorsed by the relevant royal colleges, offers clinical practice guidelines for the assessment of young women aged 20-24 who present with abnormal vaginal bleeding. GPs are continually made aware of the symptoms of cervical cancer and the need to refer women under the age of 25 for further investigation. From today’s debate, it sounds as if we have further to go, but we knew that, of course. As part of the delivery of essential medical services under the National Health Service (General Medical Services Contract) Regulations 2004, GP practices must offer consultations and, where appropriate, they must also offer physical examinations for the purposes of identifying the need, if any, for treatment or further investigation and, if needed, referring the patient onwards as soon as possible. The hon. Member for Rotherham made an excellent point about understanding the history of trauma that some women on their lists had had. Obviously it is a subject that she has a lot of experience of in her constituency; I thank her for making that excellent point, and I will ensure it is fed into the Mike Richards review.
I have mentioned the “Be Clear on Cancer” campaign a couple of times, and said that Public Health England will work to raise awareness of this disease through that campaign, which we have run in partnership with Cancer Research UK since 2011. It has covered many different areas and is scheduled to promote the uptake of cervical screening from next month.
While we are still on the awareness point, in the 2016 Budget the Government announced that Jo’s Cervical Cancer Trust, which does so much good work in this area, as has been said, would be a beneficiary of the tampon tax. It received £650,000 in funding to kick-start a campaign to get closer to eradicating cervical cancer. I take part in many of these debates and talk about cancer, as does the shadow Minister. One third of cancers are preventable and two thirds of cancers are just bad luck. With some cancers, we are nowhere near, but this is a cancer we can get rid of. This is a “bad” that we can eradicate. That is why we are so determined to get it over the line.
Jo’s Cervical Cancer Trust ran a campaign on eradication in 2017 and 2018; it was a wide-reaching awareness programme, with a specific focus on groups where there is a higher prevalence of non-attendance of cervical screening: interestingly, that is women from black, Asian and minority ethnic communities, women from disadvantaged backgrounds—a point already made—and women in the 25-to-29 and over-50 brackets. The funding enabled the trust to provide targeted education and information to those groups and to produce a body of evidence on the barriers to screening and how to overcome them.
The trust found that some young people do not attend appointments because they are embarrassed; that finding received a lot of press coverage and came out in Prime Minister’s questions last year. Others do not think the test is important, and yet more do not think they are at risk because they lead healthy lifestyles. One in four do not attend their screening appointment, and that needs to change, so this is important work.
From talking to Rob from Jo’s Cervical Cancer Trust, I know that one thing they found on the roadshows when they were testing this work in 2017 and 2018 was the importance of talking to women’s partners and the role partners can play in reminding, or nagging—whatever word we choose to use—women about taking up their screening appointments. Last week, the trust led their annual cervical cancer awareness week, with an event here in Parliament. The aim is to help as many people as possible to know how they can reduce the risk of the disease, and to promote that among their constituents.
The #SmearForSmear campaign reinforces the message that smear tests prevent 75% of cervical cancers, so while they may not be pleasant, as we have heard, they are important. I was pleased to support them myself, as most of the Health team did, at the event in Parliament last week, and I thank all hon. Members who took part; I know Jo’s Trust found it helpful. As Natasha’s Army says—this is such an important message—we need to support all young women to “lose the fear, take the smear”.
If I may try to draw my remarks to a close, this Government—as did the previous Government, and as will the next Government—recognise that cervical cancer is a devastating disease, and we are committed to providing well-managed screening programmes based on the most up-to-date, peer-reviewed evidence. Cancer is right at the heart of the NHS long-term plan, which was published on 7 January, and I am very proud of that fact. The plan sets out a comprehensive package of measures that will transform cancer diagnosis and treatment across the country over the next 10 years, a decade in which patients can expect to see vast improvements in the prevention, diagnosis and treatment of cancer. The aim is to see 55,000 more people surviving cancer for five years in England each year from 2028. That is quite an ambition, but we will get there.
Cervical screening saves an estimated 5,000 lives a year, and the Government are committed to continuing to do all we can to prevent cancer and ensure early diagnosis, which is often rightly called cancer’s “magic key”, so that more families do not have to go through these personal tragedies, as the Sales have done. We are up for the fight. I thank everyone for taking part.
Helen Jones
I thank the hon. Members who have participated in this debate. I have learned more about some of my colleagues than I ever thought I would. I cannot compete with their stories of recognition; the only thing that happened to me was after I had had a smear test, which did not show abnormal cells but was a bit dodgy for various reasons. I was waiting in hospital for an exploratory op, and everyone was being very, very careful about not saying who I was, until the porter came in to take me to theatre and proclaimed loudly across the ward: “You the MP then, love?” God bless Warringtonians.
We have heard a lot of useful comments in this debate about the need to look at variations in the take–up of screening, including variations between regions; about the need to find out what is going right and what is not; and about the need to be careful how we communicate with women. I had a letter following a mammogram that began, “Do not be alarmed.” As I told the person in charge of screening, who happened to be someone I had gone to primary school with, that is immediately very alarming. People often do not think about what they are sending out in letters.
We have also heard about the need to ensure that the guidance on young women presenting with abnormal symptoms and how they should be screened and treated is put into effect. I hope the Minister recognises the concern around the Chamber that that guidance is not always being followed; when it is not, it can have disastrous results. We have heard about the need to review the evidence on what should be the best age for screening and to keep that evidence continually under review.
We have heard about the need to counter any resistance to the HPV vaccination programme. There is now a lot of false information about vaccination programmes going around on social media and the internet, and it needs to be countered, not by us as politicians, but by doctors and clinicians who really understand the value of vaccination. Like the Minister, I will probably get a lot of angry tweets and emails after this debate, but we must ensure that the evidence, not false information, is what leads us. I am glad to hear that the Minister takes this matter seriously—I am confident that he does—and I hope we will make further progress in the coming years.
Question put and agreed to.
Resolved,
That this House has considered e-petition 225767 relating to lowering the age for smear tests for cervical cancer from 25 to 18.