Cervical Cancer Smear Tests

Emma Hardy Excerpts

Monday 28th January 2019 Westminster Hall

[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—

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

And mesh.

[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.

--- Later in debate ---

[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.