Breast Cancer Awareness Month
The final item of business is a members' business debate on motion S3M-4493, in the name of Rhona Brankin, on breast cancer awareness month.
Motion debated,
That the Parliament notes with concern the increasing incidence of breast cancer in the NHS Lothian area, with nearly 3,000 women diagnosed between 2002 and 2006; further notes that breast cancer is the most commonly diagnosed cancer for women in Scotland; recognises that women experiencing breast cancer deserve appropriate diagnosis, services, treatment and support; acknowledges the invaluable work of breast cancer organisations in Scotland in the funding of research, campaigning for service improvements and better treatments, promotion of breast awareness and provision of support services and literature, and welcomes the role of Breast Cancer Awareness Month in October in raising awareness of the impact of breast cancer in Scotland.
I thank the members who have taken the time to attend and to participate in this debate on a hugely important issue.
I begin by remembering Margaret Ewing, the former and much-loved MSP for Moray, who tragically lost her life to breast cancer in March 2006. I am sure that she will be in the thoughts of members across the chamber. Of course, each of us will have been touched by breast cancer in some way. I have had the illness, and everybody in this room has a wife, a mother, a granny, an auntie or a sister who has been touched by the illness over the years. I welcome the opportunity to debate the issue this month. Today's debate offers us a platform to discuss the most prevalent form of cancer that is diagnosed in Scottish women, and further raises the profile of a disease that kills 1,000 women in Scotland every year. I thank the members of all political parties who have signed the motion in my name.
I will begin on a challenging note by setting out the scale of the problem that continues to face Scottish women, our health service and the voluntary sector. It is a hugely disappointing statistic that one in six women cannot name any sign or symptom of breast cancer, and it is more disappointing still that nearly a quarter of women cannot name a breast lump as a sign of breast cancer and that only a third of women regularly check their breasts or are breast aware.
Further, two thirds of women are not aware of the increased risk that comes with age, and a quarter of women over the age of 65 never check their breasts, despite that increased risk.
Those statistics need not be disheartening; indeed, they can embolden us. It is a necessary evil in all walks of policy making that we must sometimes reduce complex issues, including those that often yield devastating and unquantifiable personal losses, to a numbers game. The grim statistics that I have outlined should not mask the encouragement that one can take from the numbers. It is encouraging that up to 40 per cent of breast cancer cases could be avoided each year by leading a healthier lifestyle, which includes maintaining a healthy weight, exercising regularly and reducing alcohol consumption. That effect equates to around 1,600 cases per year, which is 1,600 fewer cases on the books of the national health service and 1,600 fewer women—mothers, daughters and sisters—who have to sit their families down and explain that they have been diagnosed with cancer. Despite improvements in survival rates in recent years—there has been a 12 per cent drop in the mortality rate in 10 years—it is tragically inevitable that too many of those families will be left without a mother, a daughter or a sister.
Although, on the face of it, leading a healthier lifestyle may seem to be one of the simplest approaches to tackling breast cancer and ill health more widely, it presents perhaps one of the most significant challenges that policy makers and the charitable sector face: getting a deep culture shift through a coherent and concurrent approach that threads together many areas of public policy and responsibility.
That challenge is not insurmountable, and the work of Breakthrough Breast Cancer, Breast Cancer Care Scotland, the Scottish Breast Cancer Campaign and others has shown to great effect that working together to create a coherent strategy can make all the difference. Awareness of breast cancer now enjoys a prominent public profile, for which we have the tireless work of those organisations to thank. As I am sure that they would be the first to tell you, however, there is still much to be done.
As I said, statistics are a necessary evil in informing us how to target policies more effectively, but I will leave them behind for a moment. To contextualise the statistics and drive home the debate I will highlight the case of a woman in my constituency. That lady, having sadly lost her mother to breast cancer, had a heightened awareness of breast cancer and was in the habit of checking her breasts regularly for any lumps or signs of change. When she found a lesser-known symptom of breast cancer, she was unaware that it was one, put it to the back of her mind and forgot about it.
Later that year, when she was out shopping, she picked up a Breakthrough Breast Cancer campaign leaflet. It listed the symptoms of breast cancer to look out for, some of which are commonly known, others less so. After finding listed the symptom—a wrinkling on her breast—that she had noticed in herself earlier that year, she resolved to get it checked, and she was diagnosed, as her mother had been, with breast cancer. Thanks to a relatively early diagnosis and treatment, that lady's long-term prognosis is now good. She admits:
"I was lucky because despite ignoring the first warning sign, when I did get diagnosed it was still early enough to remove the cancer before it could spread. Why I didn't get my first niggling doubt checked now seems unbelievable. I was someone who did all the checks. I am an intelligent person. Yet it was so small and I could not feel a lump. But now I know there are other signs and symptoms of breast cancer. It is not just about whether you can see or feel a lump. I strongly urge other women to regularly touch, look at and check their breasts and no matter how small or trivial their worry is to share it with their GP immediately."
That is good advice. All women—and indeed men—should be breast aware, and if they notice any change in their breasts, they should speak to their general practitioner.
I share with Breakthrough Breast Cancer the belief and aspiration that through research, campaigning and awareness, breast cancer can be beaten and the fear of the disease removed for good. That will be difficult, but it is not beyond our capacities. The Breakthrough Breast Cancer-funded research unit at the University of Edinburgh is the only unit in Scotland that is dedicated to researching breast cancer. It aims to improve breast cancer treatment and ensure that patients are treated in the most appropriate and effective way for their particular type of breast cancer.
The unit brings together some of the best Scotland-based scientists and doctors who are involved in treating breast cancer to develop a centre of excellence for world-class breast cancer research. It focuses on hormone-sensitive breast cancer, which is the most common form of the disease and affects tens of thousands of women—previously including me. Although there are some excellent treatments available for hormone-sensitive breast cancers, some forms become resistant to them. At Edinburgh, Breakthrough Breast Cancer scientists are looking for the causes of drug resistance and ways to overcome it.
Breakthrough Breast Cancer believes that the patient experience for breast cancer should be improved by NHS boards and hospitals, by listening and responding to the views of patients through models such as the Breakthrough service pledge. I am sure that all members are aware of instances in which people with breast cancer who have to attend clinics for difficult treatments have had problems with transport or whatever. It is not an easy disease and the treatment is very difficult in many cases. I certainly support Breakthrough Breast Cancer's call on the Scottish Government, NHS Scotland, local authorities, health groups and individuals to take action to increase awareness among women of the signs, symptoms and risk factors associated with breast cancer and to increase the number of women who attend breast screening appointments.
There was an announcement yesterday by Gordon Brown about making moves to take on the challenge, and I would be grateful if the minister could indicate whether, given the successful evaluation of the breast cancer screening programme, she will give a commitment to do what Gordon Brown has committed to do and extend the range for automatic call up for breast cancer screening to 73 years at the top end and 47 years at the bottom. Following on from my own experience of breast cancer, can the minister also provide me with the up-to-date guidance that is provided to women on what to do about hormone replacement therapy and the links between HRT and breast cancer?
I conclude by extending my thanks to Breakthrough Breast Cancer, Breast Cancer Care Scotland and the Scottish Breast Cancer Campaign for their ceaseless efforts. I particularly thank Breakthrough Breast Cancer for asking me to host this evening's debate; I was delighted to agree to do so. Once again, I thank all those members who have taken the time to attend and to participate in the debate. [Applause.]
I ask visitors in the gallery not to applaud.
I congratulate Rhona Brankin on bringing the debate to the chamber and I echo her fond recollections of my colleague Margaret Ewing. I do not wish to embarrass Rhona, but her own experience, in which she was so very dignified some years ago, gives her authority and a commitment to discussing the cause that I cannot begin to match.
I note the improvement that Rhona Brankin mentioned, but I also note the continued incidence of breast cancer and the annual rate of deaths. Each individual case is a family tragedy, but high-profile cases, such as that of Gloria Hunniford's daughter Caron Keating, who died so young from breast cancer, bring that home to many people. Of course, her death also spurred on her mother to campaign so well and so vigorously on the search for a cure for the illness.
Not so long ago, a member of the Parliament's security staff told me that his wife had been for a breast scan and that a lump had been detected. I disclosed to him that I had not been for screening for many years because I am a coward and I like to bury my head in the sand. Members might not think that, but I did not want to go. However, the news from him made me realise that that is a stupid attitude to take, so I immediately took up an appointment and went for a screening. I am glad to say that his wife is doing well and that I was given the all-clear. I can tell members that I will not wait another seven years before I go back.
I note that 4,000 cases are diagnosed each year, most of which are in women, although about 20 are in men. Sadly, 1,100 people die each year from breast cancer. As I said, their deaths are an individual tragedies and tragedies for their families and friends.
Research is essential. I commend the Breast Cancer Campaign, which with £1.57 million funds 13 projects in Scotland.
Many women think that the incidence of breast cancer is higher than it is, but that is not to say that they should avoid screening. As we all know, early detection is essential, so it is good to go for screening. However, I would like those who operate the system to speed up the letter that is issued after screening—it can be 10 days to two weeks before it arrives. Women who are to be recalled are waiting for the letter to be delivered, and during that time are in a great state of anxiety. Often, it turns out simply that the image was not clear. I do not know whether it would be possible technically, but it would be good if the person could be told whether they have the all-clear on the spot, when they go for screening. At present, people can become anxious during the period between the screening and the arrival of the letter, and if there is a further period before they are recalled, their anxiety can grow.
Apart from that, I am glad that we are making progress. I urge women not to wait until somebody tells them to go for a screening but to take up the opportunity of regular screenings.
I, too, congratulate Rhona Brankin on securing this important debate. Like her, I am fondly remembering Margaret Ewing on this occasion. First, I must apologise for having to leave after my speech, but I will be chairing a meeting of the cross-party group on cancer at 5.30 pm in TG.20. I invite members to come to the meeting after the debate, and to hear about the work of Macmillan Cancer Support. It is appropriate to mention that organisation, as the motion refers to the importance of the voluntary sector, particularly in relation to breast cancer. I am sure that we will all want this evening to pay tribute to Breakthrough Breast Cancer, Breast Cancer Care Scotland, the Scottish Breast Cancer Campaign and other groups.
We should also acknowledge the great progress that has been made in the treatment of breast cancer in the past few years and under different Governments. As Rhona Brankin pointed out, a higher percentage of women are surviving the condition. We should certainly pay tribute to all national health service staff. As an Edinburgh MSP, I pay tribute to the breast unit staff at the Western general hospital.
That said, many women are still dying from breast cancer, so we clearly have a great deal to do and many improvements to make. Rhona Brankin referred to one of the mechanisms for improvement—the service pledge, which is being developed in Scotland by Breakthrough Breast Cancer. Central to the pledge is a partnership between clinicians and patients to identify areas for improvement. I am told that it is being developed through SCAN—the south east Scotland cancer network—and I look forward to hearing about the pledges that patients and clinicians develop with a view to improving the service.
A similar partnership between patients and clinicians was evidenced in the "Standards of Care for people with secondary breast cancer" document, which was launched at the Scottish Parliament in June. I was very pleased to host the launch meeting. I would be interested to find out whether the Scottish Government has looked at, or has any comment to make on, those standards. They are designed to raise awareness of the care, treatment and support that a person who is diagnosed with secondary breast cancer should receive, and they stress the importance of co-ordination of care, access to a clinical nurse specialist, access to information and good psychosocial support. I find it interesting that when patients are involved in development service improvements, they always emphasise that broad agenda. Another demand that was made at that meeting related to the fact that we do not have accurate data on the number of women who are living with secondary breast cancer.
An issue that I have recently been approached about at my surgeries is lymphoedema. I have written to the Cabinet Secretary for Health and Wellbeing on the matter on behalf of a constituent who wanted to access the liposuction service for the condition, which is available only in Dundee. It is not a national service, but clearly many women want to access it. I would welcome the minister's comments on what is certainly an area of concern. I note that the Scottish Breast Cancer Campaign expressed in its submission general concern that services for lymphoedema are available in some parts of Scotland but not in others.
On research, Rhona Brankin mentioned the Breakthrough Breast Cancer research centre at the Western general hospital in Edinburgh. I was very pleased this summer to visit that outstanding facility, which opened about 18 months ago and is carrying out pioneering work, particularly on personalised care and on developing drugs to match patients' genetic profiles. We should welcome that and all the other contributions that Breakthrough Breast Cancer is making.
I thank and commend Rhona Brankin for securing the debate. It has, after all, been six years since Parliament last debated the issue. I also join the tributes to Margaret Ewing, who is very fondly remembered not only here, but in Moray.
This year, with a number of colleagues I took part in the Edinburgh moonwalk, helping to raise funds for, and awareness of, breast cancer. The enthusiasm and dedication of the 10,000 walkers are testament to the commitment of Scottish women to combating breast cancer. I also commend the Maggie's centres. Rhona Brankin talked about how difficult it is to sit down with the family—sometimes it is easier to talk to strangers than to the family.
Breast cancer is the most prevalent cancer in women. In 2006, more than 4,000 women were diagnosed, which accounted for almost 30 per cent of all cancers affecting women in that year.
When we talk about referral to treatment, we should ensure that all women who request reconstructive surgery are given it. Referral to treatment must include all treatment, when requested and when appropriate.
Under a female Prime Minister, the United Kingdom was one of the first countries in the world to establish a national breast screening programme, with the first screening centres being operational in England and Scotland in 1988. Since national coverage was attained in 1991, there have been more than 2.1 million screening episodes and in excess of 15,000 breast cancers have been diagnosed. The national screening programme has been an invaluable tool in reducing the number of deaths from breast cancer. I am pleased that the Highland NHS Board mobile unit was in Inveraray car park on Friday, which shows that the programme goes to every town and village in Scotland.
As Rhona Brankin said, 39 per cent of the 4,079 women who were diagnosed with breast cancer in 2006 could have prevented the diagnosis if they had maintained healthy weight, increased their physical activity and limited their alcohol intake. Unfortunately, only between 5 and 9 per cent of women are aware of those preventive measures. As with breast screening, women must be encouraged to go to their general practitioner as a preventive measure. It is disconcerting that, in deprived areas, the presentation rates for breast screening are much lower than the average and women present later and with more advanced conditions, which helps to explain why survival rates are higher in more affluent areas. The Government must address that.
I turn to treatment. The latest figures on waiting times after urgent referral to treatment in NHS Highland range from a minimum of 22 days—they can be long days, as Christine Grahame said—to a maximum of 92 days. The maximum wait in Lothian NHS Board is 101 days. In NHS Highland, there has been a 70 per cent increase in treatment for breast cancer in the past six years, so there is no doubt that staff are working hard to meet the targets. I welcome the review of staffing groups in the north of Scotland, which is addressing the resource and staffing needs for breast cancer patients. At present, only four health boards in Scotland exceed the maximum wait of 62 days. However, all health boards currently exceed the new target of 31 days that the Government has set for 2011. That highlights that many more resources are needed urgently.
The member should wind up.
Scotland does not fare well on survival rates for breast cancer. We have lower rates than England, Wales, Northern Ireland and almost every other country that is mentioned in "Better Cancer Care, An Action Plan", apart from Slovenia.
I welcome the opportunity to speak, and I thank Rhona Brankin for securing the debate. Given her experience of breast cancer, there is no more inspirational speaker on the issue in the Parliament.
Each year, about 4,000 women in Scotland are diagnosed with breast cancer. Throughout the UK, a diagnosis is made about every 11 minutes. Behind those figures and the other figures that we will hear about, we know that there are real women and families. There probably is not a family in the country that has not been affected by breast cancer. There certainly is not a workplace that has not been affected—I echo Rhona Brankin's comments about her former colleague, Margaret Ewing.
Screening, increased awareness and improved treatments are helping more people than ever to beat the disease. Advances in medical research continue to give hope that developments in understanding, prevention and cures will see that every person who is diagnosed makes a full recovery. However, as we have heard, we are not there yet. More than 1,000 women die from breast cancer every year in Scotland.
I pay tribute to the people who work in the health service and deal with breast cancer all the time. However, I echo Mary Scanlon's comments on the waiting times, which remain too long for women and their families to live with the worry of potential breast cancer.
I echo the comments of other members about the importance of the voluntary sector. Breast cancer organisations and charities in Scotland and throughout the UK do much to tackle the disease, raising the necessary funds for research, raising awareness and working with women who are affected by breast cancer and with their families. We owe them a great deal.
I also thank the many members who took part in the Scottish Breast Cancer Campaign's recent "wear it pink" photo call, which I sponsored. It was good to see so many colleagues there, supporting the campaign and looking particularly fetching in pink—I am not sure how many of them picked up the feather boa or how many played it safe with some of the other pink articles. It is important that we do all that we can to raise the profile of the illness.
We must also recognise our health care professionals, who provide treatment and support for people who are affected with breast cancer, and those who work in research labs. Over the summer recess, I too visited the Breakthrough Breast Cancer research unit, which is based at the Edinburgh breast unit at the Western general hospital in my constituency. It is a busy place. Researchers at the unit are currently working on the main challenges in breast cancer therapy and the causes of drug resistance. Its location in Edinburgh is a reflection of Scotland's excellent reputation in the field of scientific research, and it is a unique unit in Scotland, bringing together research scientists and clinicians. Although I can honestly say that, without a degree in chemistry, physics or the biological sciences, I was perplexed at times by some of the science involved, I was at all times absolutely inspired by the people who work in the unit.
I am also well aware of the excellent work that is done locally in my constituency, and I pay tribute to all the staff in the breast unit at the Western general hospital as well as the staff and volunteers at the Maggie's centre, which has been mentioned. Cancer is not just a physical illness, and the support that has been given by the Maggie's centre over the years has been crucial to many women and their families.
Despite better mortality figures, the incidence of breast cancer continues to increase year on year. Increases in the number of individuals who are diagnosed are always concerning, but those increases must be set against a background of better diagnostic techniques and understanding. Early screening programmes for women who have a history of breast cancer in their family afford the opportunity to catch the disease at the earliest possible moment. Catching the disease early is critical, in which context I echo the comments that have been made about our more deprived communities. It is important that the Government pursues the issue of there being a lower number of presentations and at a later stage in those communities, meaning that the women's mortality rate is higher.
It is particularly worrying that messages about the long-term impacts of lifestyle choices—the risks related to smoking, being overweight, not getting enough exercise and drinking too much—seem still not to be getting through. The figures that we have heard, relating to the number of women who do not know the signs of breast cancer, continue to be worrying. That is an issue that we require the Scottish Government to take on.
I, too, thank Rhona Brankin for bringing the issue to the Parliament for debate.
I state an interest as the patron of the Scottish Breast Cancer Campaign for about eight years—it just seems like 80. Some of its members are in the public gallery tonight. I was attracted to the SBCC because it is not just a shake-your-can voluntary organisation; it tries to shake the establishment and shake up the policies that affect breast cancer services. Partly because of its questionnaire 2000, which was a record that the SBCC compiled of the treatment and experience of every woman in Scotland who had been diagnosed with breast cancer over the previous two years, we were able to contribute to the improvement of services. However, as Christine Grahame pointed out, the letter still takes far too long to get to the women concerned—the letter that every woman dreads. Whether it takes a weekend or two weeks, it takes a horrendous time to arrive. Surely that could be bettered with today's instant communications.
Services have improved in other areas. Treatments have certainly improved—the better survival rates prove that—and the SBCC's focus has therefore moved to prevention. I take a bit of an issue with people who say, "If you just take your fruit and vegetables, exercise and lose weight"—that would be difficult for some of us—"you'll go a long way towards preventing breast cancer." People might go a bit of the way to doing that, as they will help their general health and be in a better position to resist breast cancer if they develop it, but I am interested in the possible connection between breast cancer and the chemical imbalances in our lifestyles nowadays. The SBCC is particularly interested in endocrine-disrupting chemicals that are found in plastics, cosmetics, body care products and cleaning products. We do not yet know whether there is a direct connection between environmental factors and the development of different cancers. We strongly suspect that there is such a connection, but we need much more research on that.
Does the member agree that we also need to look at the link between breast cancer and commonly used drugs in hormone replacement therapy?
I could not agree more, having had my own wee lump after trying HRT. However, that is another story. Some ladies in the chamber will probably know aspects of the problem from their experience.
Prevention is the big thing that we should be thinking about, and we could also think about lymphoedema services. There is now a lymphoedema nurse and, unfortunately, I have to use the service in Lothian, but I cannot speak too highly of it. There could be many more pilot schemes, and much more research could be done to discover the benefits of manual drainage. I am talking about the sort of thing that can be done by a helping carer or partner. Self-management would be involved, and people who have had cancer know that being on top of it and helping to manage it for themselves helps their general health and wellbeing. I urge the Government to consider more research on chemical imbalances and the environmental factors that may affect breast cancer, and to extend further the lymphoedema nurse service.
I again thank Rhona Brankin for lodging the motion.
I, too, commend Rhona Brankin for and congratulate her on securing the debate.
It appears to me that campaigns to raise awareness of breast cancer or to improve services for women are often led and championed by women. That is how things should be, of course, although the support of our male counterparts, whether they are doctors, researchers, campaigners or loved ones, is no less valuable. We must not forget that, although the number is comparatively small, men suffer from breast cancer too, as Christine Grahame intimated.
I welcome the high visibility and profile of the women's health campaign that we are discussing, but it leads me to reflect that there is perhaps more need for more men's health campaigns to be led by men in a way that has resonance for them. Many people enjoy the fun in the breast cancer wear it pink campaign, but different approaches may be needed for prostate or testicular cancer. I should not generalise too much about men and women: I mistakenly read "Men are from Mars, Women are from Venus" and found that, with my tendency to offer solutions at the expense of really listening to the problem, I am more akin to a man.
A constituent asked me to participate in this debate. She wrote to me to describe the tragic loss of her mother, who was only 56 when she died as a result of secondary cancer, after developing breast cancer for the second time. In her letter, she said that she has a teenage daughter and two young nieces, and that she wants them to have a future
"without the curse of breast cancer".
My constituent wants to know from the Government what it is doing to increase awareness of breast cancer, especially given the findings of the recent survey by Breakthrough Breast Cancer indicating that awareness is alarmingly low. We have already heard about some of the survey's alarming findings—one in six women are unable to name one sign or symptom of breast cancer. My constituent would also like to know what plan the Government has to ensure that more women participate in the breast screening programme. Around 30 per cent of women in Scotland do not attend screening, which is vital if they are to get the early diagnosis that will improve treatment outcomes. My constituent spoke of the importance of screening for her mother. I would be interested to know how the Government intends to reach harder-to-reach groups.
I thank Breakthrough Breast Cancer and the Scottish Breast Cancer Campaign for their briefings. I am sure that the authors of both documents will understand when I say that my copies are now looking a wee bit worse for wear, as my two-year-old son was also keenly reading them last night. Thankfully, he did not scribble over them—he usually saves that for correspondence from a cabinet secretary. Both briefings were not only informative but focused on how we can best prevent and, most important, beat breast cancer. Ultimately, the message was one of hope and aspiration.
I join other members in thanking Rhona Brankin for securing this important debate, in the 21st year of the NHS breast screening service. I remember Professor Forrest presenting the findings of research when screening was introduced. It is good that early doubts about it have been put to rest and that screening is now used by so many.
As other members have said, there are groups who do not take up the opportunity of screening. There needs to be retargeting, refocusing and outreach by the health service, so that screening reaches more deprived groups—to which Mary Scanlon and Margaret Smith referred—and black and minority ethnic groups, among which uptake is low at present. There is also some indication that uptake is dropping, which is slightly worrying. There needs to be a degree of renewal.
Members have mentioned research, which is important. Recently the British Medical Journal suggested that some early interventions after screening may not be appropriate. In the late 1980s and early 1990s, I was part of a research group, led by Dr Ian McIntosh, that carried out research into the psychological impact of screening. One concern was the time it took to get test results back. Margo MacDonald and Rhona Brankin have raised that issue—almost 20 years on, the concern is still the same. Anything that we can do to speed up the process would be welcome. That should surely be possible with the technology that we now have.
Misdiagnosis is a problem. One difficulty is that not all general practitioners emphasise the fact that an appointment is urgent, which would allow patients to benefit from rapid referral to the assessment that should take place. That can lead to delays. Recently a constituent wrote to my colleague Anne McGuire and me about her experience of misdiagnosis. During self-examination at the age of 40, she found a lump. The GP told her that it was a milk gland and nothing to worry about. Five months later, the lump was still there. She asked for a second opinion and was referred to Stirling royal infirmary, where she insisted on being given a mammogram. The single-view mammogram that she received was reported as negative, but she was offered a six-month review, at which the consultant undertook fine needle aspiration. She was informed that she had more than one malignant tumour and had a mastectomy, chemotherapy and radiotherapy.
The time from the original presentation to completion was one year. My constituent followed up the matter and took legal action. It was found that there had been negligence in her case—something that we would not wish.
Scottish intercollegiate guidelines network guideline 29 is clear: a woman with a lump should be assessed and, in almost every case, offered the triple assessment of clinical examination, imaging from mammography—preferably more than one view—and ultrasound or ultrasound and histology, where the lumps are taken by fine needle aspiration or core biopsy. If that does not happen, the result can be legal action. Between 2002 and 2008, legal action was taken in 30 cases. It is important to follow through in this regard; survival rates have improved, but we are still behind.
Further to my parliamentary questions of 11 December last year, I ask the minister for a response on the national advisory group's plans for digital mammography and the sentinel node biopsy programme. Like other members, I look for answers to the issues of retargeting outreach to BME groups, lymphoedema, reconstructive surgery and secondary cancer. All indicate that we still have some way to go, albeit that the situation is undoubtedly improving.
I welcome the debate and thank Rhona Brankin for bringing it to the chamber. I thank the member and others for their kind comments about Margaret Ewing. We remember her at this time.
Breast cancer awareness month gives us a real opportunity to highlight the actions that the Scottish Government and others are taking to raise awareness of breast cancer and improve cancer care across Scotland. As many members said, breast cancer is the most common cancer among women. Its incidence continues to rise—it is up 9 per cent over the last decade. In part, this is due to increased detection through the breast screening programme, but it may also be because of a higher prevalence of known risk factors and Scotland's ageing population. I will come on to say something on the known risk factors. On a positive note, breast cancer survival rates are improving, with five-year survival now standing at more than 84 per cent. That said, it remains important that we empower women with the knowledge to mitigate the risks of breast cancer while continuing to support innovation in treatment.
I turn to Mary Scanlon's comments on survival rates. We have to be cautious when comparing the figures for Scotland with those of other countries. As she will appreciate, the statistics that we gather, including on cancer survival rates, are accurate and good. I cast no aspersions on the statistics gathering of other countries, but making comparisons between countries as she did can be akin to comparing apples and pears. That is not to say that those statistics are not of relevance, but they should come with a bit of a health warning.
Mary Scanlon also raised the issue of waiting times. Obviously, much progress has been made around the 62-day target—performance was over 98 per cent in the last four reported quarters—but, as she rightly said, more work has to be done on the 31-day target. That said, performance in the last quarter was 87.6 per cent. More has to be done, but it is important to recognise that we are going in the right direction.
As Rhona Brankin said, men, too, need to be aware of the signs to look out for. There are around 20 new cases of male breast cancer in Scotland each year. The figure for men is significantly lower than for women, but it is equally important to ensure that men recognise the symptoms and that they are not overlooked in discussions about this disease.
I take the point that the minister made on waiting times. We are talking about the waiting time from referral to treatment. Will she confirm that treatment will include reconstructive surgery when the patient requests that and the clinician deems it to be appropriate?
As Richard Simpson said, the SIGN guidelines for breast cancer recommend the immediate offer of breast reconstruction to all appropriate patients, but we are aware of the variability in the situation. That is being addressed as part of the capacity-building work in implementing the new cancer access targets—indeed, it is very much an element of that work. I am happy to keep Mary Scanlon briefed on the matter as we take it forward.
Breast cancer awareness month is an opportunity for people to talk about breast cancer, to share their experiences and concerns, to find out about services on offer, to learn what steps to take to protect against the disease and, importantly, to learn how to recognise symptoms. I am pleased to state the Government's support for the initiative, and I encourage everyone here today to ensure that we make the most of the awareness month.
It is now nearly a year since the launch of "Better Cancer Care", our cancer action plan. In that year we have already made significant progress against many of the tough commitments that we set, but there is still more to do.
Prevention is an important issue. We have noted that breast cancer incidence is increasing, but a breast cancer diagnosis is, of course, not always inevitable; there is mounting evidence to suggest that women can help protect themselves in all sorts of ways. "Better Cancer Care" outlines lifestyle choices that can help reduce people's risk of cancer. It is not only about raising awareness of the known risk factors; it is now about targeting the risk factors for many cancers—including breast cancer—such as alcohol, diet, physical activity and smoking. Having said that, I recognise Margo MacDonald's point that there are complexities around causal links, whether it be hormonal links or the environmental issues that she mentioned.
I will talk about research shortly, but I want to mention the increasing awareness of the links between breast cancer and alcohol. The risk of breast cancer increases as a result of drinking as little as one to two units of alcohol per day. More than one in 10 breast cancer deaths are estimated to be attributable to alcohol consumption, which is a very high figure. That is one reason why we have launched a three-year alcohol health behaviour change campaign, which this year is focusing on women and is trying to get the message across about the links to breast cancer.
We are also aware that more needs to be done on raising awareness of cancer symptoms and preventive measures. The Scottish cancer task force, established to oversee the commitments made in "Better Cancer Care", has consulted the three regional cancer networks in Scotland and the Scottish cancer coalition, which includes representatives from Breakthrough Breast Cancer—I pay tribute to the important work that it carries out—Breast Cancer Care and the Scottish Breast Cancer Campaign, to see how we can work in partnership with the voluntary sector to improve awareness raising of preventive measures in the future. I hope that that, in part, answers Angela Constance's question on the issue.
Although prevention is the first step to reducing the incidence of breast cancer, screening for early signs of the disease is equally important. As part of our breast screening programme, we are now screening more women and detecting more cancers earlier than ever before, which will save even more lives.
In response to Rhona Brankin's question about automatic call-up, we obviously take our advice from the United Kingdom screening advisory group, which considers the best evidence, but we will ask the Scottish national advisory group to consider the announcements made down south and what they mean for Scotland. The Scottish national advisory group is also undertaking a scoping exercise about lymphoedema services in Scotland, and I am happy to keep members informed about that.
Supported by £11 million of additional funding, two-view mammography is being rolled out nationally, and NHS boards are preparing to treat the additional breast cancer patients that will be diagnosed as a result of the programme. That partly answers Richard Simpson's point about accurate diagnosis.
I am sure that everyone in the chamber agrees that women with breast cancer deserve the highest standard of care. That is why we have committed to ensure that patients have access to the most up-to-date treatments and technology, no matter where they live in Scotland.
We have invested £4.1 million to support vital cancer research projects, some of which have a specific focus on breast cancer. There are currently 15 multicentre clinical trials on breast cancer, including the post-operative radiotherapy in minimum-risk elderly trial—PRIME II—which aims to assess clinically the role of post-operative breast radiotherapy. In Scotland, the PRIME II study is located in Edinburgh and supported by £145,000 of funding from the chief scientist office.
I will speak now about living with cancer. The increase in the five-year survival rate is excellent news, but it means that more and more women are living with, and beyond, a breast cancer diagnosis, which presents new challenges for patients, carers and families. We are working with health care providers in both the statutory and voluntary sectors to find ways of empowering and supporting patients, giving them the confidence and tools to maintain the level of independence that they desire.
In August, we hosted the big cancer conversation, an event for patients to tell us about issues that they are facing or have faced as a result of a cancer diagnosis. The outcomes from the event are being used to develop the work plan of the living with cancer group, which aims to address patients' physical, emotional, practical and financial needs post treatment.
At the launch of "Better Cancer Care", we announced the Scottish Government's investment of £500,000 to extend Macmillan Cancer Support's work, including its network of benefits advice services and its trialling an employability programme to support people with cancer in returning to work when appropriate.
Better treatment options, early detection and a successful breast cancer screening programme are reflected in Scotland's improving breast cancer survival rates. I am pleased to note that we are already exceeding our target to reduce overall cancer mortality by 20 per cent by 2010, and we are confident that the steps that we are taking will help us to aim even higher.
Despite the early successes, we are by no means complacent. We are working to raise awareness of the small changes that can be made in everyday life to reduce the risk of developing breast cancer. We very much recognise that there is work to do to target some harder-to-reach communities—and we are working on that.
Of course, we would not be taking any of that action had it not been for the effort and contributions from patients, carers, voluntary groups, professional organisations and—importantly—NHS staff. I am very grateful for all their contributions, both in breast cancer awareness month and during the rest of the year.
Meeting closed at 17:52.