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Health: Hepatitis B

Volume 689: debated on Monday 5 February 2007

My Lords, we have one of the lowest prevalence rates of hepatitis B infection worldwide. Therefore, screening of the general population is not justified. Blood, tissue, organ and gamete donors are screened for hepatitis B. Screening is also offered to all pregnant women, so that babies of infected women can be protected. Hepatitis B testing is also offered to individuals at increased risk of infection.

My Lords, I thank the Minister for that Answer. What criteria are used to determine which screening tests should be introduced and whether they are matched by results—whether they prove to be successful? Is he concerned about the report in the paper that young women no longer want to face cervical smears? Is that a fact or is it just a scare story?

My Lords, clearly, there will be a number of criteria and considerations but it is essential that screening is proportionate and that there is deemed to be benefit by introducing screening and testing. An independent committee provides continuous advice to the Government. On cervical screening, we clearly share the concerns expressed about why there is a fall in the number of young women taking up an invitation to be screened. I understand that the NHS cancer screening programme is currently exploring the reasons why women do not intend to do so. That will be fed into the advisory committee on cervical screening. We are as concerned as the noble Baroness about that.

My Lords, is this not part of a general problem? Are not PSA tests a major expense for the health service? What sort of progress is being made when there seems to be so much waste?

My Lords, I hope that the NHS is not being wasteful. We are doing everything we can to improve its overall performance. I think that the noble Lord is referring to prostate cancer screening, which I know is of great interest. The Government's position on that is that we are committed to introducing a national screening programme for prostate cancer if and when screening and treatment techniques are sufficiently well developed. My understanding is that at present there is no evidence anywhere in the world that screening for prostate cancer would reduce mortality. At the end of the day, that must be the key consideration.

My Lords, what are the Government thinking of doing about hepatitis C as well as hepatitis B, given that its prevalence is expected to double in the next 10 years and given that the UK is the only country in the world with an upward trend in liver diseases at the moment?

My Lords, hepatitis C is of course a matter of concern. I understand that, based on an estimated general population prevalence, about 200,000 patients have a chronic infection in England. We keep the matter under review; we have expert advisory committees; we will be advised by them. We are certainly not complacent.

My Lords, is there a uniform policy on screening for prostate cancer in the sense that it applies not just to England but to the devolved areas?

My Lords, many of these matters are the subject of discussion with the devolved Administrations but, in this case, the Government are advised by the National Screening Committee. The clear advice at the moment is that there is simply no evidence that would warrant the development of the kind of national screening programme that some people argue for. That will continue to be the position. We will continue to be advised by the expert committees.

My Lords, would the very widest screening programme be the one used on every newborn baby, where blood is taken and assessed?

My Lords, the position on newborn babies is this: we are working with local primary care trusts to ensure that all women receiving antenatal care are offered antenatal screening for hepatitis B. In particular, this is for infected mothers. We do not think that a national screening test for all mothers is justified. It should be focused particularly on infected mothers. The programmes that have been instituted seem to be successful. We cannot be complacent, but the figures from September 2006 in relation to infected mothers show that coverage of three doses of vaccine in children aged one has reached 75 per cent. We are not complacent. Some PCTs with infected mothers have reached 95 per cent. That is encouraging, but clearly we can do more.

My Lords, do the Government have any plans to screen men over the age of 55 for abdominal aortic aneurysms, which, as the Minister will know, kill many hundreds of men each year and which can be effectively detected?

My Lords, we are moving quite well away from the Question. I have to confess that I do not know the answer, but I will certainly find out and let the noble Earl know.

My Lords, may I ask the Minister whether you get the evidence that is required unless you have done an experiment on an infected person which shows a blank? Then, perhaps, it is a lack of evidence. Is that what has happened and is that what he is referring to? It is difficult to understand.

My Lords, I am not entirely sure that I follow that, either. I am in danger of treading in deep waters. The Government have to be advised by the evidence that is available about whether a particular screening test would be clinically effective and cost effective. Where it is shown to be both and we have received the advice from the relevant independent body, the Government will consider introducing screening. That has happened in a number of programme areas but, as I have already indicated, when it comes to prostate cancer, the evidence simply is not there to support a national screening programme.