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Breast Cancer Screening Programme

Volume 588: debated on Monday 30 March 1998

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2.44 p.m.

Whether they will review without further delay their decision (Cm 3007) not to implement the recommendation in paragraph 96 of the House of Commons Health Committee's Third Report on Breast Cancer Services (Session 1994–95) that the upper age limit for inclusion in the call and recall system be extended to 69 to include those women most at risk.

My Lords, as the noble Lord will be aware, the report of the House of Commons Select Committee on Breast Cancer Services to which his question refers was received in 1995 by the previous administration.

This Government are firmly committed to providing a high-quality breast screening programme. Screening for women aged 65 and over is now available on request, and we are taking a range of steps to ensure that this service is widely publicised. I am glad to say that figures published last week show that the number of older women taking this up has risen from 39,000 in 1995 to 57,000 last year.

We are funding pilot schemes to evaluate the impact of extending the routine recall screening programme to include women aged 65 to 69. The first of these studies will be completed next year, and the others by the year after. The Government will base any changes to policy on the evidence emerging from the pilot studies. We must also ensure that any decision to extend the breast screening programme in this way does not jeopardise the existing programme.

My Lords, I thank the Minister for that reply and I congratulate her, given that half of the 30,000 women suffering from breast cancer are over 65 and given the problem that arose under the previous administration: the two pilot schemes in the Wakefield and South Thames area were a stalling measure owing to the funding involved. Secondly, given that the Gallup poll for Age Concern showed that most women over 65 are unaware of the risks to which they are exposed, why have no government leaflets been published—I congratulate the Minister if that is the case—to warn older women of the risks involved? Perhaps I may ask the Minister two or three questions. Is she aware that there is a higher detection rate for women suffering from cancer who are over 65? Secondly, is it not the case that the incidence of breast cancer increases with age? Is the Minister further aware that, in the case of older women, cancer is equally aggressive?

My Lords, I am grateful for the noble Lord's congratulations to the Government on their efforts to extend people's understanding of this very important service. I agree that it is extremely important that older women should come forward if they have any concerns. The number of women getting breast cancer each year peaks in the 60 to 64 age group; but that does not mean that the suffering of those in an older age group who get breast cancer is any the less. That is why we intend to make sure that the older age group are aware and, if necessary, extend the recall programme to them.

My Lords, is the Minister aware that we are grateful to the Government for making increased finance available, as announced in the Budget, to deal with this problem? It is still a very serious problem and, as I understand it, has slightly increased. The Government ought to be commended for making increased finance so quickly available.

My Lords, I am grateful to my noble friend. I believe he refers to the £10 million that we made available last year for breast cancer services almost immediately after being elected. The Chancellor of the Exchequer and the Secretary of State for Health announced the week before last that further money would be available to reduce waiting lists, and cancer will be given high priority in that area.

My Lords, is the noble Baroness aware that most of the mammographic X-ray equipment installed in the 1989–90 period to meet the Forrest plans is now reaching the end of its design life? Is she further aware that radiologists are now finding that X-ray film is reaching the limits of resolution, and that digital imaging is now needed to reduce the diagnostic uncertainties which lead to false negatives and false positives? Does she accept that there is a need to raise throughput? Will the Minister therefore agree that the time has now come for investment in an advanced equipment replacement programme to improve the National Health Service breast screening programme and help to reduce waiting times? Could some of the £10 million of extra money recently put into the services be made available?

My Lords, the Government are extremely aware of the concern felt about the need for high quality breast screening services. We announced last November an overhaul of breast screening precisely to enhance the existing quality control. That obviously includes a review of the machinery used, but we felt it was equally important to review the standards of screening of individuals within the service, and that is now being undertaken.

My Lords, is the Minister aware that Professor Fentiman of Guy's Hospital has estimated that the lives of up to 2,000 older women could be saved each year if that age group were routinely invited for screening? In the light of that, can the Minister say what kind of results from the pilot study would be conclusive enough to ensure that women of up to age 69 are included in routine screening or will the decision be determined by resources alone?

My Lords, I can assure the noble Earl that the decision will not be determined by resources alone. We are concerned to balance the needs of care and screening for women in all age groups. At the moment, the research project to which I referred, which is considering the necessity for screening those in the 65 to 69 age group, is also looking, for example, at whether there is a case to be made for lowering the age at which women are screened to 40 or for closing up the gap between screenings for individuals to fewer than three years. All these matters will be considered. They will obviously need to be looked at in terms of cost-effectiveness, but resources will not be the single determinant.