Cervical Cancer Smear Tests

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.

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.

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.

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?

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.

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?

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.

Will the hon. Lady give way?

I will give way one more time and then I must make some progress.

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.

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.

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.

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.

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.

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.

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.

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.