Breast Cancer Awareness
The final item of business is a members' business debate on motion S1M-3485, in the name of Mr Keith Harding, on breast cancer awareness. The debate will be concluded without any question being put. I invite those members who wish to contribute to the debate to press their request-to-speak buttons now.
Motion debated,
That the Parliament congratulates all the voluntary and research agencies involved for their efforts in highlighting Breast Cancer Awareness Month; recognises the importance of continuing research into the diagnosis and treatment of breast cancer, building upon major advances achieved over past decades; records its thanks to all the medical and ancillary staff involved for their unstinting kindness and support to patients and their families, and considers that the Scottish Executive should ensure that funding is made available for increasing awareness, research, providing treatment and support and all other aspects of breast cancer care.
I am grateful that my motion has been selected for debate, as the scourge of breast cancer and the need to detect it require all the awareness they can obtain.
The motion came about following discussion with Margaret Ewing and Rhona Brankin who, with my wife Anne, launched breast cancer awareness month late last year. Margaret Ewing had hoped to contribute to the debate, but the tragic loss of her father-in-law means that she is not able to do so. I am sure that I speak for all members when I extend our heartfelt sympathy to her and to Winnie and Fergus.
My interest in the issue began seven years ago, when my wife was diagnosed as having breast cancer, and it is why I have participated in the cross-party group in the Scottish Parliament on palliative care. The Macmillan nurse who administered my wife's chemotherapy treatment had a positive and caring manner. He probably did more than anyone to help her fight and overcome the dreadful disease.
My wife is one of the lucky ones who have survived. Her survival was due not only to her determination and positive attitude, but to the excellent treatment she received in Stirling royal infirmary. As I have said in a previous debate, it took only two weeks between the detection of a lump and treatment. That should be the norm throughout Scotland but, regrettably, that is not the case. The distress that is caused by not knowing whether one has cancer while one waits for a biopsy can be fully understood only by those who are afflicted and their families.
Breast cancer is by far the most common cancer in women in Scotland and it is the fastest growing type of cancer among women here. It is estimated that the lifetime risk of developing breast cancer is one in nine.
However, the situation is not all doom and gloom. The good news is that mortality rates have decreased by 22 per cent in the past 10 years and the five-year survival rate in Scotland is 75 per cent. That is due to earlier detection and improved treatment, which is the result of the research that is carried out by Cancer Research UK and others.
When my wife was diagnosed, a friend and an acquaintance were also afflicted. Sadly, they did not survive. All three were in their mid to late 40s. Although the majority of women who get breast cancer have been through the menopause, more than 17 per cent are aged below 50. Therefore, I ask the minister to consider investigating the benefits of extending screening to those who are over the age of 40. At present, screening is restricted to women over the age of 50. Professor Stephen Duffy, who is professor of cancer screening for Cancer Research UK, says:
"Research both by Cancer Research UK and by the World Health Organisation indicates that screening reduces premature deaths from breast cancer by about a third and cuts the number of women needing mastectomies by 40 per cent."
I want to take the opportunity to place on record our thanks to the many voluntary and research agencies that are involved in tackling breast cancer. I thank those who provide the counselling and advice that is offered to victims and to partners and families whose lives are totally disrupted when the disease strikes. Finally, I thank all the medical and ancillary staff who are involved in the treatment of breast cancer for their commitment, kindness and support.
I ask the Scottish Executive to continue to provide funding for increasing awareness, for research and for all other aspects that are relevant to tackling breast cancer. Battles are being won, but the war is far from over.
I thank Keith Harding for initiating today's debate. It is not only those of us who have had breast cancer who feel that the subject is important, as it affects many people. Breast cancer affects not only those who have had it but those who have someone in their family or a friend who has suffered from it. The topic is important because it affects practically every family in the country in some way or another.
The first of the three issues that I want to touch on is the importance of having access to information, which was highlighted in the breast cancer care survey that was done in May 2002. The survey found that 84 per cent of people actively sought out health information, but that the proportion decreased among older respondents. In fact, people in the older age group relied entirely on health professionals for information. That is an interesting issue, to which I will come back.
The survey found that internet respondents accessed information by using both the web and the helpline—which is what one would expect—but it also found that the internet is more widely used than that. An increasing number of women and families now use the internet to access information. Indeed, 33 per cent of respondents had used the internet and the helpline as a source of information.
The important finding was that half of all respondents said that they would like help in interpreting health information. Thus, although we are becoming better and more literate in using the internet, we often need to have the back-up of our local general practitioner or—for those who are already attending breast cancer clinics—of our consultant. More women are accessing the wide range of information that is available through the internet, newspapers and television and radio programmes, but they need help interpreting it. The implication of that is that our GPs need to be able to access the most up-to-date information and training on breast cancer care issues.
In connection with that point, I also want to talk briefly about hormone replacement therapy. Given some of the recent research projects that have reported over the past 18 months, there is increasing concern about the possibility of a link between HRT and breast cancer. I am aware that local GPs received information on that from the Scottish Executive about halfway through last year—in July, I think. Will the minister give us an update on whether the Executive recognises the need to keep GPs regularly informed about the research information that is produced that regularly mentions a potential link between HRT and breast cancer?
Although we need to be careful about not frightening women, we must also be as honest and as up front with women as possible. I firmly believe that we have almost reached the stage where we can say to women that, although we are not absolutely sure, we think there may be a link between HRT and breast cancer. I will be interested to hear the minister's views on that. If people ask me whether, if I had my time over again, I would take HRT, putting my hand on my heart I would say no. We need to think carefully about the advice that we are giving to women.
Before I finish, I want to mention the importance of Maggie's Centres, which I have spoken about before. I was one of the lucky women because I was referred to Edinburgh's Western general hospital, where I was treated expeditiously, had access to breast cancer care nurses and was given a terrific level of care. For the particular kind of operation that I had, I was transferred to St John's hospital, where I also received wonderful care about which I have absolutely no complaints.
Edinburgh is lucky because it has a Maggie's Centre, which gives a huge amount of support to women and their families, whatever kind of cancer they suffer from. Many women with breast cancer use the Maggie's Centre, which was set up after Maggie Jencks sadly died from breast cancer. Increasingly, there is a network around Scotland for breast cancer sufferers and I am very much aware that the Executive has been supportive of that. However, I seek reassurance from the minister that the Executive recognises the value of the work that Maggie's Centres do and that it will continue to support Maggie's Centres in every way possible.
Once again, I congratulate Keith Harding on securing this debate.
I congratulate Keith Harding on securing this important debate and giving the Parliament an opportunity to recognise breast cancer awareness month and the efforts of the many staff and volunteers who are involved in supporting sufferers and their families. I would also like to echo Keith Harding's comment and say that Margaret and Fergus Ewing would have wanted to attend this debate, but were not able to for the reason Keith outlined.
The Parliament has shown a great deal of concern about this issue, which is reflected in the number of parliamentary questions about issues relating to breast cancer. Few people have not been touched by breast cancer. All of us have friends or members of our family who have had breast cancer. The condition has increased in the years 1989 to 1998 and it is the leading cause of cancer-related death among women aged 15 to 54. Although Keith Harding is correct in saying that survival rates are getting better in Scotland, they are still not as good as they are in many countries in Europe. As Keith Harding also pointed out, the key to getting better survival rates is to have earlier diagnosis and earlier treatment.
Although Scotland has the unenviable reputation of being the cancer capital of Europe, it is worth putting on record the fact that that is partly to do with the way in which our data are collected. We have a more robust way of collecting data than do some other European countries, which means that we have an accurate record of the levels of cancer. Nevertheless, we are faced with a major problem and must find ways of solving it.
Getting access to treatment is an important issue. There are far too many variations in access to cancer drugs across Scotland. The postcode lottery still exists, as is shown by the fact that drugs such as Herceptin are more readily available in some health board areas than in others. We cannot allow that to continue. No matter where they live in Scotland, women must have equal access to the drugs that are the best drugs for them.
The importance of continuing research cannot be underestimated. Much of it is funded from public subscription. Without the many charities and the people who shake cans on the streets, we would not have made some of the breakthroughs that there have been in cancer treatment.
Most of all, I want to praise the staff who are involved in supporting cancer patients: not only doctors and nurses, but the Macmillan nurses who do an important job. I echo the point that Rhona Brankin made about the work of the Maggie's Centres. I have spoken to people who have been in Maggie's Centres and I know how lucky we are that one is opening in Dundee. Someone told me that the centres provide an oasis of calm in which patients and their families can relax and get advice and therapeutic treatments in an atmosphere in which they feel at home. That is important when one is undergoing cancer treatment, which can be quite frightening.
I agree with what the motion says about funding. We still have too many vacancies for cancer consultants and specialist nurses. Funding is critical in that regard and I hope that the minister will be able to give us some reassurances on that this evening.
I join members in congratulating Keith Harding on raising this issue for debate this evening.
Although the Parliament has debated breast cancer before, it does no harm to remind ourselves of the frightening statistics to which Keith Harding alluded. Cancer Research UK has shown that breast cancer is by far the most common cancer in women and, with the exception of melanoma skin cancer, is the fastest growing cancer for Scottish women. As the research shows, one in nine women are at risk of breast cancer. We must never lessen our commitment to address that.
While we must not diminish in any way the serious impact that the disease has on women, we cannot ignore the much neglected fact that around one in every 2,400 men are at risk from breast cancer. My father-in-law died from breast cancer. Because of the difficulty in diagnosing and recognising the disease in men, by the time male breast cancer is diagnosed it has usually progressed to an advanced stage. It should be recognised that the treatment for men and women given such a diagnosis would be the same.
Male breast cancer is uncommon. It is equally true that the disease is less common in younger women. My wife was diagnosed when she was only 33. Most women are diagnosed after the menopause, but a staggering 17 per cent are aged below 50 when they are diagnosed. My point is that in addressing the overall effect of breast cancer, we must not lose sight of the minority groups among those statistics that are affected by the onset of the disease.
The good news is that, in general, mortality rates have decreased by 22 per cent in the last 10 years, and five-year survival rates in Scotland are at 75 per cent. That is due to earlier detection and improved treatment, which is the result of good research such as that carried out by essential organisations such as Cancer Research UK.
It is essential that funding is available for research into the importance of genetics, hormones and lifestyle, all of which control the development of the disease, with a view to developing better treatments, increasing the effectiveness of present facilities and finding new ways of detecting the cancer earlier. Investigating issues such as risk factors, prevention, treatment and drug therapy, earlier detection and screening are paramount. We must do everything in our power to ensure that those developments continue.
I cannot commend highly enough the medical and ancillary staff on their dedication, hard work, and relentless commitment to supporting patients and their families, which I have seen at first hand. Organisations such as Glasgow's Beatson Institute for Cancer Research, Cancer Research UK, CancerBACUP, Macmillan Cancer Relief, Marie Curie Cancer Care and more organisations besides are committed to research into diagnosis, treatment, clinical trials, alternative therapies and the psychological impact of the disease, to name but a few of the processes that are involved in breast cancer diagnosis, treatment and support.
I know from personal experience that those organisations, both voluntary and professional, are at the core of the treatment. I have met a plethora of organisations that provide treatment, support and guidance to patients and families of breast cancer sufferers, I know the high level of commitment and dedication of the staff involved and I wish to pass on my full support and thanks, and that of all members, to them.
It is with those thoughts in mind that I have no hesitation in supporting Keith Harding's motion. I thank him for bringing breast cancer to the awareness of Parliament again. We need to know more. We need to know the how, the why and the when. I fully support any funding from the Executive for increased awareness and research, and for the provision of treatment, support and all other aspects of breast cancer care.
I too thank Keith Harding for bringing this issue to the attention of Parliament once again because, unfortunately, it is an issue that just does not go away.
I speak in my capacity as the president of the Scottish Breast Cancer Campaign. Rhona Brankin and I launched a questionnaire, which was unique in terms of health care surveys in that it was organised by women, all of whom had experienced the breast cancer service because they had been sufferers. They questioned as many women as they possibly could in 2000 on their experience of the breast cancer regime in this country. Their findings have to be listened to, because they are not theoretical; they are a record of what happened to them as individuals.
One issue that came through clearly was the postcode lottery that Shona Robison referred to. However, it is not that there is a postcode lottery for treatment: once someone gets to the treatment stage it is usually uniformly good. It is getting to the treatment that involves a postcode lottery.
One suggestion from the survey was that the Government must never let up on the information that is provided for all women, which means public campaigns every so often and money for information campaigns. It is important that women, particularly women in rural areas—the survey bore that out—are well aware of treatments, where they can be obtained and the frequency of clinics, so that they take advantage of the available services.
I would not say that referral from general practitioners is lacking, but it is not uniform. Considering mandatory guidelines for GPs to follow might be sensible, because GPs still have differences of opinion about how to deal initially with a woman who complains of vague symptoms. I will say no more than that, because I do not want to castigate any group of people who are concerned with breast cancer care.
As for the general service provision and back-up support from the voluntary sector in Scotland, when the Scottish Breast Cancer Campaign's survey was taken to international conferences in Europe and other places, we discovered that Scotland is way ahead of almost everywhere on information dissemination among patients and in the voluntary and statutory sectors. Perhaps a few lessons might be learned. I urged the Deputy Minister for Health and Community Care's predecessor to examine that survey and to incorporate its findings into anything the Government promotes in Scotland.
I will pick up where Rhona Brankin left off on HRT and the fact that some women are scared and put off going for that first vital examination that might lead to earlier diagnosis and a less traumatic regime of treatment. When I inquired of my doctor—I have a personal interest—whether the HRT low-oestrogen pills had made any difference in my case and what I should say if people asked me about the matter in general, my doctor said that, first, what was involved was a particular trial of a particular brand of a particular type of HRT treatment, so drawing too wide a conclusion from that would be unwise and would certainly be scary for women. I am pleased to see the deputy minister nodding her head in agreement.
I am glad that we are debating breast cancer again. We have debated it before, but it cannot be debated enough.
I intend to make only a brief speech. I thank Keith Harding for obtaining the debate and I congratulate him on doing so. I am desperately sorry that the Ewing family cannot join us, because they have a huge commitment to the subject.
I did not know Keith Harding when I had a lump scare. During a routine self-examination, I detected an abnormality and telephoned my general practitioner immediately. I was seen within a couple of hours. Fortunately, it was a false alarm, but it brought home to me the need for regular self-examination and information for women.
I thank the Scottish Breast Cancer Campaign and Margo MacDonald, who is its president, for helping women to obtain information, for producing reviews of all the available information and for providing help and a listening service for people who think that they might have breast cancer and who do not want to trouble their doctor but would like some information.
I am sure that many members received the appeal that was circulated in September 2002 in a special edition of the "Scottish Breast Cancer Care newsletter". I responded to it and took the opportunity to participate in one of the Scottish Breast Cancer Campaign's stall-holding days. I womanned, rather than manned, a stall in the Howgate shopping centre in Falkirk, which is in the region that I represent. It was a joy to meet the women there who are committed and who readily give their time and effort to help others.
A wide cross-section of people visited the stall that day. Some of them were young and they were looking to get the pink tartan ribbon, which was fine. There were also some much older women, some of whom were guided to the stall by their husbands, who told them to come and ensured that they were given information on the subject.
In the past, I have been told that I should not bother getting myself involved in such things. In politics, as in everything, I totally disagree. If by being there, attracting people to the stall and giving out information I helped to save one woman, I consider that to be a bloody good day's work.
My mother was one of five sisters. Possibly the most interesting of them was Xandra MacIver, who was a laugh. She was in the Women's Auxiliary Air Force and, as one of the first 20 radar plotters in the Royal Air Force during the war, survived being bombed at Biggin Hill. She probably lived a bit on the edge in the war. Unfortunately, she died at the age of 53 or 54 and I attended her funeral in London in the early 1960s.
I know that times and attitudes have changed a lot since then and that the chances of survival are much improved. I mention my aunt, as she ignored the early signs. All that I want to say, in teacher mode, is that we should learn about breast cancer, look for the early signs, not miss screening opportunities and not fear the truth. It is better to know the truth and act on it than not to know it and put oneself at risk. I ask the minister to note those points.
I congratulate Keith Harding on giving us the opportunity to discuss this topic. I will shortly congratulate Michael McMahon on his contribution.
I have been in correspondence with Malcolm Chisholm on the system of calling in people for assessment. The system operates for people up to the age of 65, although new plans will extend it to the age of 70. With the increase in lifespan of people in our community, it is important that we do not stop there. We need to continue to invite people over 70 in for screening.
My mother died from breast cancer in her mid-70s at a time when she was over the age to be called in. She would not be alone in our community in not having that opportunity extended to her. As she was a doctor's wife, members might think it surprising that her breast cancer was not detected. However, that fact illustrates precisely the shyness about symptoms that people may feel.
Scotland has perhaps a greater number of risk factors than is the case elsewhere, one of which is a greater incidence of obesity. I draw attention to one factor in particular, which is that it would appear from research that, among women, there is a correlation between smoking around the age of puberty and the onset of breast cancer at a relatively early age—the 30s and 40s, which are under the age at which people are called in for assessment. The minister may care to reflect on that example.
I congratulate Michael McMahon on raising the subject of male breast cancer, about which I want to say a few words. I cannot bring personal experience to bear on the subject as Michael McMahon can, but I will raise some issues that he did not cover. In particular, in order to bring the subject home to the chamber, I note the statistical likelihood that, given the number of people who are employed in the Parliament, at least one of the men here will develop breast cancer.
Breast cancer is more common in men over the age of 60, but I have read case histories of men who have died of the condition in their 30s. As with women, there is a wide age range at which breast cancer can occur. I will read into the record one or two examples, which are given in a fact sheet. That will help to publicise some of the issues to a wider audience.
People who are at particular risk of male breast cancer are those
"who have had several close members of their family (male or female) who have had breast cancer, a close relative diagnosed with breast cancer in both breasts or a relative diagnosed with breast cancer under the age of 40. Having several members of the family with cancer of the ovary or colon may also increase a man's risk."
It is also worth saying that there appears to be an association between breast cancer in men and lower levels of testosterone. Infertility in men is rising relatively sharply. I speak from a personal point of view, being infertile myself. We are likely to see a continuation in the rise of breast cancer in men from that cause if from no other, as the main cause of infertility in men is a lack of testosterone.
I want to make a few points about the information that is available. Rhona Brankin rightly pointed out that the use of the internet is becoming important for women. I should add that it is also becoming important for men. However, I point to the NHS Direct website. Although it contains very good information on breast cancer, it assumes that the condition affects only women. One of the problems appears to be that GPs—and other men—are relatively insensitive to the possibility that a man might suffer from breast cancer. I make no claims to have made a comprehensive study of the literature. However, we should consider including in all the publications on the subject the possibility that men might suffer from breast cancer. In particular, we should draw attention to the curious symptom of inversion of the nipple, which as a possible indicator of breast cancer is not shared by women.
Finally, I draw attention to research that is being carried out on the subject at the University of Edinburgh and wish the researchers very well in their work. This year, 200 men in the UK will contract male breast cancer. That is a small, relatively unacknowledged but important part of the wider picture.
I congratulate Keith Harding on securing this evening's debate. The members' experiences that we have heard about this evening—we are a small group as some colleagues could not be with us—suggest the importance of this issue and the relevance of holding the debate.
I appreciate that under other circumstances Margaret Ewing and the other Ewings would have joined us. My sympathies are with them at this time.
Cancer in all its forms is a top clinical priority for the Scottish Executive and the NHS in Scotland. As has been said, the number of parliamentary questions and debates in Parliament has shown that the issue is a priority for members.
The Scottish Executive applauds the efforts of the voluntary groups that work tirelessly to raise awareness of breast cancer and to provide support for breast cancer patients, and to raise awareness of all cancers. NHS boards' health promotion departments are also involved in a variety of initiatives to make women breast aware, including providing information and advice, raising awareness throughout the year and participating in breast cancer awareness month. However, as members have said, we cannot be complacent, and information is crucial to tackling the disease.
We recognise the drive and enthusiasm of all NHS Scotland staff to secure continuous improvements to outcomes, treatment, care and the quality of life of all people with cancer. It was good to hear from so many members about the dedication of those staff.
Margo MacDonald mentioned GPs. In general, GPs are expected to participate in programmes of continuing professional development, which can include participation in conferences and meetings that explore improvements in treatment and general research developments, to ensure that their skills are kept up to date. We must continue to make progress on that.
Scotland's cancer strategy, "Cancer in Scotland: action for change", is currently being implemented and is backed by up to £60 million over three years to the end of 2003-04. More than £2.8 million of that investment has already been targeted at breast cancer services, including investment in new medical, nursing and radiography staff, mammography kits, additional clinics and breast cancer redesign initiatives.
I am pleased to say that there is growing evidence that we are beginning to win the battle against breast cancer. The five-year survival rate for breast cancer is now 79 per cent—an improvement on the period 1981-95, when only 64 per cent survived at least five years.
In her contribution, Rhona Brankin mentioned screening—I think that it was Rhona who mentioned it.
It was me.
Sorry. Keith Harding mentioned the age at which women are being screened. At present, women are not routinely offered breast screening under the age of 50. That is partly because so far, there has been insufficient evidence of the benefit, but I stress that any woman with concerns should see her GP.
A continuing 15-year trial is also under way throughout the UK. It is examining whether there would be any benefits from screening women between the ages of 40 and 49. The trial started in 1991, but the results are not expected until after the completion of the trial. The UK national screening committee reviews new evidence, such as the study that was carried out in America recently, and it will continue to offer advice to ministers should sufficient evidence be made available to change that position, which is kept under continual review.
The issue that Rhona Brankin raised, as did Margo MacDonald, was the possible links between hormone replacement therapy and an increased risk of breast cancer. The use of HRT is, as we know, intended to replace the natural hormones that are lost when ovaries stop working at the time of the menopause. Recently, there has been much conflicting news about the relationship between HRT and an increased risk of breast cancer, heart disease and stroke. However, as Margo MacDonald suggested, we must examine the detail below the headlines.
A two-day conference is being held this year by the Royal College of Physicians of Edinburgh. The conference will examine all the relevant clinical and research data with a view to achieving consensus on the clinical utility of HRT, which is consistent with the evidence base. Particular attention at the conference will be paid to the role of HRT in the prevention and treatment of disease in the skeletal, cardiovascular and central nervous systems. The conference will also examine the relationship between oestrogen and benign and malignant breast disease. From the evidence that is presented and open discussion, the conference aims to answer key questions, such as how HRT should be deployed in clinical practice and what the relationship is between oestrogen and breast cancer. Work continues to consider that position.
Continued improvement will also depend on reform—modernising the way we work to match up to the expectations of today's patients and their families. Those expectations are rightly demanding. Redesign of cancer services will play a big part in the reform. An example is the redesign at Wishaw general hospital in Lanarkshire. We have already witnessed changes in practice and women who are referred to the breast clinic now have their investigation undertaken in one visit—it is a one-stop clinic, which means that women no longer need to visit the hospital several times. It also means that women who do not have cancer—the majority—no longer have the burden of unnecessary anxiety over an extended period while tests are undertaken and results returned. Those women who, unfortunately, do have cancer have the support of an on-site multidisciplinary team, including specialist oncology and access to psychological support and nurse-led follow-up. There are many similar examples throughout the country, but we must ensure that everybody has that excellent practice.
The benefits are clear. More rapid diagnosis and improved services for patients through better use of our highly skilled and expert staff and equipment are essential. Additional moneys will continue to be made available to deal with the matter. In fact, an additional £1 million has already been made available by the Scottish Executive to support the establishment of a Scottish cancer research network. The aim is to at least double patient recruitment into cancer clinical trials. We know that outcomes from clinical trials are positive, so it is important to increase the numbers involved. Breast trials recruitment in Scotland is already successful, with 15.3 per cent of breast patients recruited to trials.
I am aware that time is limited, so I will make just one final comment about Stewart Stevenson and Michael McMahon's points about male breast cancer. Although I recognise that it is rare, I also recognise that it cannot be ignored just because of the numbers. It is being dealt with.
In closing, I pay tribute to everyone involved in developing cancer services in Scotland. It really is a team effort. By working together, we can mobilise the talent and investment to secure real and lasting improvements in services for all people with cancer and, in relation to today's debate, particularly for those with breast cancer and those who support them.
Meeting closed at 17:52.