Breast Cancer Bill

House of Commons, 20 January 2006.

Shailesh Vara (Conservative, North West Cambridgeshire)

I beg to move, That the Bill be now read a Second time.

During my speech, I propose to set out the current position of the national health service breast screening programme as well as explaining my proposals. I shall also try to deal with other important issues, including funding and resources.

The Bill has cross-party support and acknowledges that the United Kingdom has one of the highest breast cancer death rates in the world. One in nine women in the UK will suffer breast cancer at some point in their lives. Every year, 41,000 women are diagnosed with breast cancer and, sadly, some 13,000 die of the disease.

We must not forget that there are other victims: husbands, partners, parents, children, other relatives and friends. I shall quote briefly from an e-mail that I received from somebody in Devon, who sums up the anguish caused to other family members. His wife died when she was 40. He says:

"it is more likely that there will be parents, a partner and children who will also suffer the impact of this disease. In our case our daughter was 4 when my wife died and both her parents still survive her . . . for my daughter to have been able to have spent a few more years with her mum would have been priceless."

Breast cancer also has a knock-on effect on everyday life. A diagnosis can, and does, affect relationships, employment, mortgages and life insurance. Prescription charges can be a long-term strain, and for those with children, child care can become a problem, especially for those with young children. Finding or being able to afford child care while having chemotherapy or radiotherapy treatment is neither easy nor cheap. Incidentally, it is a little-known fact that, every year, some 300 men suffer from breast cancer, of whom about 95 die.

The present policy is that women between the ages of 50 and 70 are invited to have a screening free of charge every three years. However, those over 70 have to apply for a referral themselves. My proposal is that the age spectrum be increased to cover women between the ages of 45 and 75—in effect, adding five years at either end. I want to put on the record the very valuable work that the staff involved in the screening programme undertake on a daily basis. We cannot praise highly enough their dedication and their commitment to their work. They are a tribute to the health service.

Philip Hollobone (Conservative, Kettering)

I congratulate my hon. Friend on introducing the Bill. Does he agree that the national health service should concentrate far more on the prevention and early detection of illnesses? NHS staff would far rather be involved in that kind of work than in administering extensive and expensive treatments later on.

Shailesh Vara (Conservative, North West Cambridgeshire)

My hon. Friend raises a valuable point, and I shall come to that subject later in my speech. We should indeed be in the business of prevention rather than cure. Prevention is always cheaper, and we are always dealing with limited funds.

No one doubts that early screening saves lives. Indeed, in her foreword to the 2005 annual review of the NHS breast screening programme, the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), said:

"By detecting breast cancer early we can give women in this country the best chance of recovery."

The need for screenings was recently highlighted in a survey carried out by the charity Breakthrough Breast Cancer, which found that 80 per cent. of the women questioned had not checked their breasts in the previous month, and that 47 per cent.—almost half—admitted that they did not know how to do so.

Andrew Dismore (Labour, Hendon)

I understand that the hon. Gentleman recently met representatives of Breakthrough Breast Cancer. Will he tell us whether they support his Bill, and in particular, his view that the lower age at which women are called for mammograms should be reduced to 45?

Shailesh Vara (Conservative, North West Cambridgeshire)

I am mindful of the fact that, in our earlier debate, the hon. Gentleman said that he would exercise restraint. I understand that that is a quality that he is not used to exercising in debates on private Members' Bills, but bearing in mind the time constraint under which we are working, I hope that he will continue to exercise it today. I shall address the issue of lowering the age limit shortly. Had the hon. Gentleman been paying attention earlier, he would have noted that I said that I would clearly set out my proposals, and that I would address the issues of resources and the lower age limit. I shall come back to the point that he has raised.

Brooks Newmark (Conservative, Braintree)

I, too, congratulate my hon. Friend on bringing the Bill to the House. I hope that he will also address the important issue of the frequency with which screenings take place. Further to the constructive point made by my hon. Friend the Member for Kettering (Mr. Hollobone), I hope that women will be able to have screenings more frequently than once every three years—perhaps every two years, or even yearly—especially women over the age of 70, for whom this is an important concern.

Shailesh Vara (Conservative, North West Cambridgeshire)

I am grateful to my hon. Friend for raising that point and I agree that the more frequency we can have, the more detection we can have. Detection means prevention, and I will address the issue of the over-70s.

Andrew Dismore (Labour, Hendon)

The hon. Gentleman made a rather unjustified personal attack on me in response to an intervention. I simply say to him that my shortest speech on a Friday lasted three minutes and my longest three hours and 17 minutes. I hope to be able to speak for rather less time than that, but that depends on whether he deals with all the arguments. I speak to the issues, and some issues take longer to speak to than others.

Shailesh Vara (Conservative, North West Cambridgeshire)

I am grateful to the hon. Gentleman for putting that on the record. I am sure his record in previous debates speaks louder than any response that I can give.

Lee Scott (Conservative, Ilford North)

I, too, congratulate my hon. Friend on introducing the Bill to the House. As he knows, I have first-hand experience of the issue, having lost my mother, at far too young an age, to breast cancer. The statistics show that, up to the age of 40, one in 200 people have a chance of contracting breast cancer, but the figure is one in 50 at the age of 50, which makes the Bill so much more important. Does he agree that it should be supported on both sides of the House?

Shailesh Vara (Conservative, North West Cambridgeshire)

I am grateful to my hon. Friend for raising that point. Yes, as a woman's age rises, so the risk of getting this dreadful disease increases. I shall also come to that in due course.

When screening is done at an early stage, it can reveal breast cancer before the onset of symptoms. It means fewer mastectomies, less cost of treatment, and less pain and suffering. In 2003–04, the programme detected more than 11,200 breast cancers, more than 3,000 of which were very small and would have been impossible to detect through self-examination. Incidentally, a petition presented in the Scottish Parliament calls for the age at which screening should commence to be lowered to 30. Let me assure the Minister of State that I am in no way advocating dropping the age to 30. I am confining my limit to 45.

As for the upper age range, from 70 to 75, women can volunteer and request a screening every three years, but the simple fact is that many do not. Some women believe that they are safe because they are no longer routinely invited for screening. The reality is that the risk of breast cancer increases with age.

Mark Lancaster (Conservative, North East Milton Keynes)

Does my hon. Friend agree that one of the principal problems is that in areas of high population mobility such as Milton Keynes, women simply move on too quickly and do not always go for screening? How would his Bill help, and what can we do to increase the frequency of screening?

Shailesh Vara (Conservative, North West Cambridgeshire)

I agree with my hon. Friend that mobility and a host of other factors contribute to the fact that women do not follow things up. The best solution is to ensure that women are given a reminder. There are other reasons why people post-70 do not volunteer themselves. I will come to those.

Angela Browning (Conservative, Tiverton and Honiton)

As a sponsor of my hon. Friend's Bill, I am pleased that we have time to debate it today. On the question of women aged over 70, I have read that the NHS reason for not offering them screening is that should breast cancer present at that stage, it is not considered an early death and that other diseases start to kick in. I really do not agree with that. Quite clearly, if somebody develops breast cancer post-70 and it is not detected, it will spread to other parts of the body and become a terminal illness. Surely we are not only talking about preventing early death, important though that is, but trying to consider preventing death by cancer per se.

Shailesh Vara (Conservative, North West Cambridgeshire)

I am grateful to my hon. Friend for those comments. I agree that one of the reasons that has been given for the situation is co-morbidities—that, I think, is the technical term referring to other diseases and conditions. But women are now living healthier, longer lives, and that has to be taken into account with reference to what my hon. Friend said. We must also recognise that if we are to treat the elderly in our society as equal citizens, our policies must reflect the fact that they are living healthier, longer lives, which includes having routine screening for women aged between 70 and 75.

Society puts a certain amount of pressure on the elderly. They are made to feel that they are a burden on the state, so many women are reluctant to make a self-referral, feeling that they would only add to that burden. Elderly people can be forgetful, and if we in this Chamber are often forgetful and need to carry pieces of paper to remind us of things, who is to say that, with the onset of age, women will remember to make a self-referral every three years? Many elderly women who have a lump in their breast may simply say, "It is just another thing that you get when you get old," and simply dismiss it rather than taking it seriously.

Routine screenings for women between 70 and 75 should not be a problem. From an administrative point of view, those women are already in the system. Screening is technically easier, as the breast tissue is not as dense as that in younger women. Mammograms are therefore easier to read, and false negatives and false positives are rarer. Put simply, women are living longer; they have healthier lives; and the cancer is easier to detect.

With reference to the lower age group, 45 to 50, the obvious statement is that women do not have to wait until they are 50 before the dreadful disease of breast cancer can strike. Much is made of the fact that, comparatively speaking—the key word there is "comparatively"—80 per cent. of all diagnoses are for women over 50. That is not to say that the other 20 per cent. is not a significant number in its own right.

Jo Swinson (Liberal Democrat, East Dunbartonshire)

The hon. Gentleman rightly points out the higher incidence of breast cancer in older women. On detection, although screening is important, does he agree that there are many cases of younger women contracting the disease—including the recent high-profile cases of Kylie and Anastacia—so it is important for all women, regardless of age, to be aware of any changes in their breasts, because that, too, will facilitate early detection?

Shailesh Vara (Conservative, North West Cambridgeshire)

I am grateful to the hon. Lady for highlighting that very relevant point. I mentioned earlier the recent survey by the charity Breakthrough Breast Cancer, which found that 47 per cent. of women do not know how to perform a self-examination, and 80 per cent. certainly had not done so in the previous month.

I return to the 20 per cent. of women with breast cancer who are dismissed, on a comparative basis, because they are under 50, meaning that the under-50s are not given due consideration. Of the 41,000 women who are diagnosed every year, the 20 per cent. of those aged under 50 number 8,200. In 2003–04, about 1,400 of those women died.

I welcome the present policy of allowing annual screenings for women aged between 40 and 49 for those who have a family history of breast cancer. But we need to go further. I am encouraged by the trials in Sweden that screened women between 40 and 50 in 2003. Certainly, that has encouraged some of the charities.

Andrew Dismore (Labour, Hendon)

I get the impression that the hon. Gentleman is about to move on to another point, but, having just mentioned charities, he will recall that I asked in my earlier intervention whether Breakthrough Breast Cancer supported his Bill's proposal to reduce the age range of women being called for mammograms. Perhaps he will confirm whether that charity supports the pitch that he is making to the House.

Shailesh Vara (Conservative, North West Cambridgeshire)

I repeat the answer that I gave the hon. Gentleman earlier. I appreciate the concerns, but I shall address them. Breakthrough Breast Cancer has reservations, but that is not to say that it has not sent me a letter encouraging the debate in which I am engaging. The hon. Gentleman will doubtless be aware of charities other than Breakthrough Breast Cancer. I have had a letter from Breast Cancer Care saying that, in the light of the Swedish experience, it welcomes the proposal to screen women aged 45 to 50. I remind the hon. Gentleman that the issues related to breast cancer are not to be dictated by one charity alone.

Stewart Jackson (Conservative, Peterborough)

I congratulate my hon. Friend and neighbour, and praise his consistency and hard work in bringing the Bill to the House. For the benefit of the hon. Member for Hendon (Mr. Dismore), irrespective of the efficacy or otherwise of the current clinical trials and research for women aged between 45 and 50, does my hon. Friend agree that giving his Bill a Second Reading would raise the issue and have a positive impact on engaging women in the hard-to-reach category for breast screening, such as those in ethnic minorities or lower socio-economic groups?

Shailesh Vara (Conservative, North West Cambridgeshire)

I am grateful to my hon. Friend and constituency neighbour. He made a valid point, and the debate has certainly been raised. While there are reservations, which I shall seek—indeed am seeking—to address, the fact is that there will never be 100 per cent. certainty in the field of medicine. At times, we have to take a view when certain factors are present. We must also recognise when excuses are being made for not having the will to take matters forward. I shall certainly address that.

Angela Browning (Conservative, Tiverton and Honiton)

Does my hon. Friend think that the reservation about extending the age range in either direction is perhaps influenced by the shortage of radiographers around the country?

Shailesh Vara (Conservative, North West Cambridgeshire)

Certainly that is one of the issues that has been raised. As well as a lack of funds, there is a lack of technical equipment and of specialist staff. The Government have a record: when issues need to be addressed and they have the will to do it, they are prepared to make long-term plans. In the 2001 manifesto, for example, Labour thought that there ought to be more hospitals. It said that by 2010—a five year plan—there would be 100 more hospitals. It is somewhat inconsistent that the Government are able to be far sighted in some areas and think of a programme, yet for this issue, which affects one in nine women in the country, the excuse is often made that there is a lack of resources, and the arguments stop at that point. I am grateful to my hon. Friend for raising the point and allowing me to make matters a little clearer.

What is the value of a life? The terminology is crude, but the reality is that we talk of money. No precise value has been put on a life, but I understand that the Department for Transport made an effort and in 2004 valued the lost economic output of an individual who dies in a road traffic accident at slightly less than £1.4 million. I repeat, £1.4 million is the value that the DFT puts on the life of someone who dies in a road traffic accident. It is fair to say that the value of a life lost to breast cancer is similar. That £1.4 million covers lost output, medical costs and human costs—an amount to reflect grief, pain and suffering.

My proposals would cost a mere £40 million. The breakdown is simple: I advocate four more screenings, two at the lower age range and two at the upper age range; each screening round costs £10 million, so the total cost of the extra screenings would be £40 million. It is clear that not many deaths would have to be prevented to justify the expenditure of £40 million.

Some people argue that there should be annual screenings for women aged 45 to 49 to take account of breast tissue being more dense and the fact that tumours progress more rapidly in younger women. In an ideal world, that would of course be preferable; but until the ideal is attained, the two screenings that I propose must be preferable to the none that women in that age range currently receive.

I am mindful of the age trial—a survey that has been in progress since 1991 and is considering annual screening for women aged 40 to 50. Like the Minister, I look forward to seeing the results, which I understand are due very soon.

My hon. Friend the Member for Tiverton and Honiton (Angela Browning) alluded to the argument that there is a lack of the resources, equipment and specialists necessary to do as I propose in my Bill. The answer is not to use the lack of resources as a reason not to act; it is to provide the resources. Those resources do not have to be provided tomorrow. There is no reason why a plan cannot be put in place for the future—for five, seven or 10 years hence—which would allow time to train specialists, obtain equipment, find accommodation and deal with all the other requirements. It is a matter of the Government having the political will to recognise that there is an issue to be addressed and to commit themselves to dealing with it.

In the context of breast cancer screening, that is precisely what happened in 2000. In a statement on 5 December 2000, the then Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), made financial provision for a breast cancer screening programme that was implemented four years later in 2004, in effect, extending screening to women aged 65 to 70. I also remind the House of the words used by the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), in her foreword to the breast screening programme's 2005 annual review. She wrote:

"It is important . . . that we continue to invest in research and new technologies."

We must also recognise that the technology is changing. The traditional mammogram X-ray is slowing making way for the digital mammogram. That point is well made in the annual review of 2005, which states that new technology is easier to use, more reliable and quicker for all concerned. The view has also been put forward that it is better to concentrate on increasing take-up in the 50-to-70 age range. I am not against that—far from it—but there are also other vulnerable groups, and we should not exclude them.

It is difficult to argue against the extension of routine screening for women between the ages of 70 and 75. Breast tissue is less dense, the cancer is easier to detect, women are living longer and more healthy lives, and the risk of breast cancer increases with age. For the 45-to-50 age range, I accept that it is more difficult to detect cancer. That does not mean that it cannot or should not be done, however. Early detection saves lives and substantially reduces the cost of lengthy treatment. As the lost economic output has been valued at £1.4 million per life, such a programme would clearly be cost-effective, and the cost of increased screening can be justified. Moreover, the latest technology allows for greater capacity.

We are talking about saving lives—nothing more and nothing less. We must be ambitious. Yes, in this country, we do have one of the finest screening programmes in the world. Considering Britain's economic strength in the world, it would be surprising, and a shame, if we did not. The challenge, however, is to refrain from comforting ourselves that we have a successful programme, and instead to strive to make that programme even better.

Mark Simmonds (Conservative, Boston and Skegness)

I congratulate my hon. Friend the Member for North-West Cambridgeshire (Mr. Vara) on introducing his Bill, which, to his credit, he did with great articulation and passion. The Bill addresses a subject of great importance to many thousands of women.

I am extremely aware of the prevalence of breast cancer. East Lincolnshire, the area of the country that I represent, has one of the highest incidences in the country—152.9 cases per 100,000 people, compared with a national average of 137.7 cases per 100,000. That is 200 new cases of the disease being diagnosed every year in the East Lincolnshire primary care trust area alone. I have met many of those involved in local support groups in my constituency who do excellent work supporting women during and after this traumatic illness. I want to place on the record my thanks for their excellent work both in my constituency and elsewhere in the country.

My colleagues and I are broadly sympathetic towards the aspirations of the Bill—to build on the success of the NHS breast screening programme introduced by a Conservative Government in 1988. Since that time, the programme has been instrumental in catching breast cancers early and saving lives. In 2003–04, approximately 1.5 million women were screened and more than 11,000 breast cancers were detected through screening—approximately a quarter of all breast cancers diagnosed each year.

That success has contributed to a substantial fall in the number of UK women dying from breast cancer since the scheme was introduced. Between 1993 and 2002, deaths from the disease among women fell by 12 per cent. Sadly, however, the annual figure still stands at around 13,000. What is more, almost two thirds of women diagnosed with breast cancer are now likely to survive for at least 20 years, according to Cancer Research UK. Ten years ago, that figure was only 44 per cent. Clearly, extending the scope of the programme and improving take-up could improve health outcomes further.

I must, however, express some reservations about my hon. Friend's proposals. The scheme currently operates for women aged between 50 and 69; it was recently extended from 64 on the basis of the issuing of an invitation to attend a screening once every three years. Above the age of 70, women are entitled to request a screening but invitations are not issued as a matter of routine. Conservative Members welcomed the increase from 64 to 69 in the upper range of the programme. In addition, we called for all national guidance on cancer, including appraisals of drugs such as Herceptin, to be fully implemented.

The National Institute for Health and Clinical Excellence has recently issued guidance in respect of women with a family history of breast cancer, many of whom are at a significantly increased risk of developing the disease. NICE recommends that women in that category aged between 40 and 49 should be entitled to annual screening in view of their increased risk. Again, we support the extension of screening for women with a family history of this terrible disease.

There are, however, good medical reasons for being wary of extending routine screening at the lower age range for all women. Clinically, the case is yet to be proven. As my hon. Friend has said, pre-menopausal breast tissue in younger women tends to be denser, making it more difficult to obtain an accurate and reliable mammogram. The value of routine breast screening for that category of women, without the high risk associated with family history of cancer, needs further research and analysis. Long-term studies are considering what benefit, if any, can be derived from inviting women for screening from the age of 40. My hon. Friend's proposals would benefit enormously from an encouraging report on that matter, which clearly warrants further examination in Committee.

Meanwhile, our priority must be to see that NHS breast screening is rolled out across those ages already specified and to ensure that NICE guidance is fully implemented. According to Breakthrough Breast Cancer, in some parts of the country the scheme is failing to meet the minimum take-up standard of 70 per cent. In October 2004, the all-party parliamentary group on breast cancer produced an extremely valuable report highlighting inequalities in the uptake of NHS breast screening among women. The report found that one in six women did not attend their screening appointment because it was inconvenient for them to do so—a point highlighted by my hon. Friends the Members for Peterborough (Mr. Jackson) and for North-East Milton Keynes (Mr. Lancaster). More therefore needs to be done to promote awareness of breast cancer and to encourage an understanding of the importance of early detection. More could also be done to locate NHS breast screening facilities closer to women's places of work. That would increase the convenience of daytime appointments, which it is often difficult for women to get away from work to attend.

There is also a challenge to improve take-up of screening in communities with little tradition of accepting invitations. The all-party group's report highlighted the fact that areas with a highly mobile population, such as Milton Keynes, or with a significant ethnic minority population are likely to be affected by low take-up. Women over the age of 70 are entitled to attend a screening once every three years. It might be advantageous to extend the age range further. However, improving the effectiveness of existing arrangements must be the health service's priority, so we should be extremely careful when imposing additional duties.

Conservative Members hope that the Bill will be considered in Committee and look forward to seeing how the new requirements could be made easier or phased in. Meanwhile, we remain convinced of the importance and impact of cancer screening services. I commend the staff working to save lives by detecting cancer early and look forward to the day when cancers in addition to cervical and bowel cancer, which are both subject to screening schemes, can be detected in that way.

Breast cancer is a killer. Nearly 13,000 women die from the disease each year. We should investigate all proposals to raise awareness, increase education, improve early detection and ultimately save lives. Therefore, notwithstanding the reservations that I have expressed about my hon. Friend's Bill, we believe that it warrants further scrutiny in Committee, and I therefore commend it to the House.

Rosie Winterton (Labour, Doncaster Central)

I congratulate the hon. Member for North-West Cambridgeshire (Mr. Vara) on securing a Second Reading for his Bill. He set out very clearly the devastation that breast cancer causes to women, families, friends and society more widely. I agree that it is important that the House should discuss the issues and use such debates to raise awareness of the value of breast cancer screening programmes. Women should be aware of the need for self-examination, but should also participate in those programmes.

As hon. Members are aware, reducing deaths from cancer is one of the top three priorities of the Department of Health. As the hon. Gentleman and the hon. Member for Boston and Skegness (Mark Simmonds) both said, breast cancer is the most common form of cancer in England, and more than 36,000 new cases were diagnosed in 2003. However, major progress has been made in tackling the disease and, since 1997, breast cancer mortality in the under-75s has fallen by 13 per cent., which means that 43,000 lives have been saved. Nearly 80 per cent. of women survive the disease for at least five years. Breast cancer screening has made an important contribution to that progress. May I add my thanks to everyone in the NHS whose dedication and hard work have led to those improvements?

The national computerised call and recall scheme for breast screening was introduced in 1988, and was the first such programme in the European Union. Women aged 50 to 70 are invited for free breast screening every three years. Breast screening by mammography is an X-ray examination of the breast, and can show breast cancers at a very early stage. Early detection is important, and that system in particular can show breast cancers when they are too small to see or feel. If changes are found at that early stage there is a good chance of a successful recovery.

The NHS breast cancer screening programme is a great success, and it is regarded as one of the best breast screening programmes in the world. I am pleased to inform the House that in 2003–04, 1.3 million women were screened for breast cancer in England. Over 11,000 cancers were detected, 42 per cent. of which were small cancers that could not have been detected by hand. Of course, we wish to make further improvements to our breast screening programme, which I shall outline later. However, first I shall deal with the measures in the hon. Gentleman's Bill, particularly his wish to extend breast screening to women aged 45 to 50, and 70 to 75. He and I had an interesting and informative meeting about those issues in December, when we discussed many of the points that he has made today. I hope that he found that discussion helpful. Since that time I have had further meetings with Breakthrough Breast Cancer. As we discussed at the meeting, the Bill is an important way of raising awareness of the issues.

I hope the hon. Gentleman will accept that a number of the reasons that I set out at that meeting, which were echoed by the hon. Member for Boston and Skegness from the Conservative Front Bench today, still stand. The Government's stance is supported by organisations such as Breakthrough Breast Cancer. I reiterate that that does not mean that there will not be improvements in future, but it is important that any changes are based on the available evidence supporting them, so that we can ensure that the existing programme for women between the ages of 50 and 70 is the most effective and of the highest quality before we extend it. I hope the hon. Gentleman will accept the need for an evidence base strong enough to support any extension.

Shailesh Vara (Conservative, North West Cambridgeshire)

The Minister mentions Breakthrough Breast Cancer, but I hope she will acknowledge that a number of charities do an enormous amount of work. I have a letter from Breast Cancer Care, which states:

"Following the publication of results by Cancer Research UK of a Swedish trial that screened women aged 40–50 in 2003, Breast Cancer Care believes screening women between the age of 45 and 50 can be successful in detecting breast cancer."

The charity goes on to list various caveats, including a reference to resources. Those are legitimate concerns, but it is important to remember that charities that are doing very worthwhile work are slowly moving towards the 45 to 50 age group, although, as I say, they do have reservations.

Rosie Winterton (Labour, Doncaster Central)

I accept that there may be slightly different views. I am certainly not insinuating that Breakthrough Breast Cancer is against screening in the longer term for that age range, if it was supported by evidence. The trials being undertaken should be allowed to finish and report before further decisions are taken.

I understand that the Swedish study to which the hon. Gentleman refers was a review of previous trials. There are indications—he refers to the caveats—that the results were not necessarily statistically significant for women in that age group. I am prepared to write to the hon. Gentleman with more details of that study. I shall return to the studies that we are undertaking and hope that will reassure him that we are not turning our backs on the idea, but we need to follow up the progress that has already been made to ensure that existing programmes are of the highest quality. We will look at the evidence and move on to further consideration of extension of screening.

Shailesh Vara (Conservative, North West Cambridgeshire)

For the record, the caveats to which I referred were not to do with the survey in Sweden. They were to do with resourcing, manpower and so on.

Rosie Winterton (Labour, Doncaster Central)

Let me explain some of the programmes that are in place, because, as the hon. Gentleman said, at the moment all women aged between 50 and 70 are entitled to free breast screening on the NHS every three years. Women aged 50 to 70 are invited as part of the national programme and women aged over 70 are encouraged to consider self-referring for screening every three years.

I will draw hon. Members' attention to the evidence bases that we are looking at and set out how we are taking forward some of the research. The International Agency for Research on Cancer, which is part of the World Health Organisation, evaluated the evidence on breast cancer screening in March 2002. It concluded that trials have provided sufficient evidence for the efficacy of mammography screening of women between 50 and 69 years of age. It also concluded that the reduction in mortality among those women who choose to participate in breast cancer screening programmes was estimated to be about 35 per cent. The agency's working group consisted of 24 experts from 11 different countries.

For women aged between 40 and 49 years, the agency concluded that there is only limited evidence for a reduction in mortality, but that in no way means that we are complacent about the issue. The advisory committee on breast cancer screening, which is appointed by Ministers, keeps the screening of women aged over 70 and under 50 actively under consideration based on the evidence as it emerges. As I have already said, women aged over 70 are offered three-yearly screening on request, and those who have already participated in the breast screening programme are informed of that right after the age of 70.

The hon. Gentleman and the hon. Member for Boston and Skegness referred to the need to increase awareness, and I can reassure the House that we have taken a number of measures, including working with Age Concern on a leaflet informing those over 70 that they are still entitled to breast screening. That leaflet is widely available in GP surgeries, health centres, breast screening units and Age Concern outlets, and about 2,000 are requested every month.

It is important when considering the extension of any of these programmes to ensure that we have properly researched how people will react to being invited. The advisory committee on breast screening has therefore commissioned a research report from the cancer screening evaluation unit of the Institute of Cancer Research to try to answer that very question. That report is due to be discussed by the committee in the summer.

With regard to women aged between 40 and 49, those with a moderate or high family history of developing breast cancer should be offered annual mammography outside the NHS breast cancer screening programme, but to an equivalent quality and standard. That, as the hon. Gentleman said, is in accordance with NICE guidance that was published in May 2004. The guidance is currently being implemented, and the Healthcare Commission will assess the progress made by trusts in implementing it. In particular, the Healthcare Commission will consider how to identify the women in that age group who are most at risk from breast cancer. As I have said, all the evidence points to the fact that that is an effective way of ensuring that those women come forward.

It being half-past Two o'clock, the debate stood adjourned.

Debate to be resumed on Friday 3 March.