Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, November 24, 2021

Official Report 891KB pdf

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Mouth Cancer Action Month 2021

I remind members of the Covid-related measures that are in place and that face coverings should be worn when moving around the chamber and across the Holyrood campus.

The final item of business is a members’ business debate on motion S6M-01700, in the name of David Torrance, on mouth cancer action month 2021. The debate will be concluded without any question being put.

Motion debated,

That the Parliament recognises that November 2021 is Mouth Cancer Action Month; acknowledges the work of the Mouth Cancer Foundation and the Oral Health Foundation in raising awareness of mouth cancer; understands that mouth cancer is the sixth most common cancer worldwide, with over 8,300 new cases diagnosed in the UK each year; believes that nine out of 10 mouth cancer cases could be prevented by adopting lifestyle changes; understands that, while mouth cancer is twice as common in men than women, an increasing number of women are also being diagnosed with the disease; welcomes the increased education of the risks, signs and symptoms of mouth cancer, in order to encourage everyone to discuss these with their dental professional, and commends the efforts of all organisations and campaigners that continue to raise awareness of mouth cancer and aim to make a difference by saving thousands of lives through early detection and prevention.

17:01  

I thank all my colleagues who signed the motion, enabling me to bring to the chamber this debate on mouth cancer action month 2021. I also say a heartfelt thank you to Barbara Boyd, who is a trustee of Let’s Talk About Mouth Cancer, which is a Scottish charity that was set up by a group of healthcare professionals with the aim of improving the prognosis for patients who are diagnosed with mouth cancer. The charity is dedicated to spreading awareness of the condition, and of the signs and symptoms and associated risk factors, and it aims to equip the public with the knowledge to facilitate self-examination and to encourage early presentation to healthcare professionals. Barbara is a patient champion for the charity, and a mouth cancer survivor. She is described by the rest of her team as a force to be reckoned with, and, having met her, I can confirm that that is true.

Shortly after moving into my constituency, Barbara came to see me, and I was privileged to hear her story and learn more about the charity’s work. She is a retired physical education teacher, and she told me that she did not know much about the condition until 2019, when she was diagnosed with tongue cancer. Thankfully, it was caught early and her treatment was successful, but she will require significant surgery and rehabilitation. Since her recovery, she has gone on tirelessly to campaign and educate others about the symptoms. Simple self-examination, and a basic knowledge of the symptoms that are associated with the condition, can mean the difference between life and death. Although anyone—even those with healthy lifestyles, like Barbara—can develop mouth cancer, nine out of 10 mouth cancers can be attributed to particular lifestyle factors that could potentially be prevented.

There is evidence to suggest that people who have certain habits or infections are at increased risk of developing the condition. Those include smoking, as around 65 per cent of mouth cancers are associated with smoking, and drinking alcohol, as around 30 per cent of mouth cancers are associated with alcohol intake. Drinking and smoking together can mean that mouth cancer is up to 30 times more likely to develop. A poor diet that is low in fruit and vegetables, poor oral hygiene and infection with human papillomavirus are all associated with mouth cancer. We also know that social deprivation and low socioeconomic position can play a role, and people from deprived communities in Scotland are twice as likely to die from oral cancer.

Dentists and their teams continue to have a vital role to play in ensuring that oral cancers are detected early, and we all have a duty to work together to ensure that the effects of the pandemic do not allow the inequalities gap to increase. The majority of deaths from mouth cancer occur because of late detection as a result of low public awareness of the signs, symptoms and risks. Early detection is key to improving survival rates for those who contract oral cancers, which means that dental attendance, and accessing dental treatment, is vitally important.

“The Scottish Health Survey: 2019 edition”, which was published last year, showed oral cancer to be

“the oral condition of greatest concern due to its seriousness and increasing incidence.”

It went on to say:

“Head and neck cancer, of which oral cancer and”

throat

“cancer are types, account for around 3% of total cases of cancer in the UK.”

In addition, it stated that somewhere in the region of

“530 people per year are diagnosed with oral cancer in Scotland”.

In September this year, the Health, Social Care and Sport Committee, of which I am a member, invited a number of witnesses representing national health service stakeholders to provide evidence to help inform what the committee’s agenda for the coming years will look like.

One of those witnesses was Donald Morrison of the British Dental Association, who gave evidence on behalf of the dental profession and outlined the challenges facing dentists and patients in Scotland. During the session, he talked about the knock-on effect that he believes the backlog across primary and secondary dental care, which has been caused by the pandemic, will have on oral health inequalities, as well as on early detection and survival rates for oral cancer. He stressed that, for health professionals,

“one of the most important things ... is that oral cancer is one of the cancers that is picked up asymptomatically”

or “through regular screening.” He went on to say that although

“The treatment of the cancer in its early stages is relatively simple”,

its after-effects can include

“disfigurement and quite drastic and difficult surgery.”—[Official Report, Health, Social Care and Sport Committee, 21 September 2021; c 41.]

The condition and its treatment can cause several complications, including changes to the appearance of the mouth, difficulty in swallowing and speech problems.

It cannot be denied that the pandemic has had a massive effect on the sector. It was reported that there were as many as 3.5 million missed dental appointments last year. We must help our dental services to recover and clear the patient care backlog, to which end I am pleased to see the Government’s commitment to moving forward with NHS dental recovery, and that it is supporting the sector to build back to pre-pandemic level activity. I believe that the additional funding of up to £12.5 million that has been made available to NHS dentists to enable them to remobilise services and see more patients, and help them to meet safety standards, alongside the removal of all dental charges for young people, represents a clear commitment in that regard. The Scottish Government is committed to scrapping NHS dental charges for everyone in Scotland, and removing them for everyone aged under 26 is the first step in that journey. The removal of those charges means that 600,000 young people now benefit from free dental care.

All those measures are important because mouth cancer does not discriminate—we are all at risk of being affected. We all know that early detection is key. By spotting the signs and symptoms early, we can prevent some cases from happening and improve early diagnosis rates. Self-checking for mouth cancer takes just two minutes, but it could save your life or the life of someone you know. If we all know what is normal for each of us, we are better placed to spot changes more quickly and seek early help. I urge everybody to join the British Dental Association, the Mouth Cancer Foundation, Let’s Talk About Mouth Cancer, the Oral Health Foundation, our dental professionals and all the Barbaras out there in helping us to raise awareness of the signs, symptoms and risks and encourage self-examination.

17:07  

I welcome the opportunity to speak in the mouth cancer action month debate, and I congratulate my colleague David Torrance on bringing it to the chamber. He has already done an excellent job in highlighting the issue. Mouth cancer action month is Scotland’s biggest charity campaign for mouth cancer awareness, and it is organised by the Oral Health Foundation. During November, mouth cancer action supports thousands of people to go out into their communities to raise awareness of mouth cancer and share the important message of being mouth aware. That is especially important right now, as we move through and out of the pandemic. I thank all the staff and volunteers for all that they do to raise awareness of, and support those with, mouth cancer.

Each year, on average, 530 people across Scotland are diagnosed with mouth cancer. Between 2014 and 2018, 2,360 people died of cancer of the mouth. However, that does not have to continue to be the case. According to research from the University of Edinburgh, early detection results in a survival rate of roughly 90 per cent for people with oral cancer, in comparison with a 50 per cent survival rate when diagnosis is delayed.

It is important, therefore, that regular checks take place, which includes checking the inside of the mouth for any lumps, bumps, red or white patches and any sores or ulcers. People sometimes cannot even feel that there are problems, as they are not always obvious. The advice is to use a mirror to help with checking gums, tongue, and cheeks. Over the past 30 years, I have participated in many oral cancer surgeries in my work as an operating theatre nurse, and many of those operations were really challenging and difficult. If symptoms are found, and if they occur for more than?two weeks?without improvement, people should make an appointment to see their general practitioner or dentist.? For this month, the message is, “If in doubt, get it checked out”, as detecting the symptoms early may save your life.

Minimising risk factors is also crucial to reducing the incidence of mouth cancer in Scotland. Around 65 per cent of mouth cancers are associated with smoking; 30 per cent with alcohol intake; and around 56 per cent with a poor diet. Stopping smoking, ensuring responsible alcohol intake and promoting the benefits of a healthy diet are really important. I therefore welcome that the Scottish Government is proceeding with its work on the Good Food Nation (Scotland) Bill, minimum unit pricing of alcohol and the extension of funding to NHS boards to support stopping smoking, as all those steps are very important.

I want to briefly mention lichen planus, which is an inflammatory disease of the skin that can also occur inside the mouth. Although researchers do not know the exact cause of lichen planus, we know that it is a non-infectious disease, and it is classified as an autoimmune disease. Autoimmune diseases occur when the body’s defence system—our white blood cells that usually fight off infections—instead attack parts of the body. Oral lichen planus that appears as white spots or fine lines is probably not related to mouth cancer but, in about 40 per cent of cases, a more serious type develops. That erosive lichen planus causes painful sores and ulcers in the mouth.?

Research by the University of Oxford shows that around 5 per cent of people who experience that type of lichen planus develop oral cancer. That was the case for a close friend of mine who had what she thought was a simple sore and raw mouth. Her perseverance in dealing with what she thought were wee white ulcers led to a delayed diagnosis of oral cancer. Following a partial glossectomy—removal of her tongue—she then had a tracheostomy and a gastric feeding tube inserted. She endured so much and ultimately did not survive, due to complications from the interventions and treatment.

I mention that to show the importance of raising awareness and self-checking, and the utmost importance of the role that dentists can play in assessing and diagnosing oral sores, ulcers or abnormalities. We should remember that early diagnosis can lead to 90 per cent survivability and that it gives the best possible chance that treatment will work. I ask the minister to support measures to raise awareness of oral cancer and the risks of lichen planus, and to support the continued research that is needed into that condition.

17:11  

I thank David Torrance for lodging the motion and for bringing mouth cancer action month to the Parliament’s attention. I also thank the Oral Health Foundation for its efforts to raise awareness. Many fantastic charities provide support and guidance for those with mouth cancer, including Macmillan Cancer Support and the Mouth Cancer Foundation, as well as local cancer support organisations such as the cancer support network in East Lothian, in my region.

A mouth cancer check can be done at home. One minute is all it takes for people to check themselves for mouth cancer. That is a minute to potentially save their own life or a member of their family’s life. Currently, over 500 new cases of oral cancer are diagnosed each year in Scotland, which is significantly higher than the comparable figure for the United Kingdom as a whole. We have already heard that most cases of mouth cancer are preventable and that, if it is identified early enough, it can be stopped.

Despite that, and despite Scotland having the highest rate of mouth cancer in the UK, the Scottish public have lower exposure to awareness materials about mouth cancer than people in any other part of the UK. Around nine in 10 Scots cannot recall ever seeing any public health messages on mouth cancer, which is significantly worse than the figure for the UK as a whole.

That is why the Government needs to do more to focus on awareness. It truly is one of those areas where the Government should put its money where its mouth is. Ministers have admitted that there is a need for funding to expose the public to campaign messages about public health continuously over time. Those messages act as a way to reduce health inequalities, raise awareness of important health issues and improve patient outcomes. Mouth cancer is one area where more could and should be done.

I appeal to the minister to look again at the Government’s support for national health service dentistry after the Covid pandemic. We know that dentistry is about more than drilling and filling. Dentists play an important part in screening for a wide range of conditions, and lockdown will have stored up problems for the nation’s oral health. Reports of a mass exodus of NHS dentists should be a cause for concern and are pertinent to the debate, given the important role that dentists play in tackling and detecting mouth cancer.

In the Parliament, we have the power to make a difference and to make the public aware of the risks of, for example, excessive drinking and smoking, and their contribution to mouth cancer and other cancers. We can also play a role in raising awareness of mouth cancer action month and of what we can all do to check ourselves for mouth cancer. If in doubt, get it checked out. We need to make NHS dentistry easier to access for more people so that we can maximise professional screening.

The debate is an opportunity to raise the profile of the symptoms of mouth cancer and other cancers and to encourage greater fundraising and funding where possible. Together, we can make a difference. We can help to reverse the shocking trend of oral cancer in Scotland and ensure that fewer of our constituents suffer the pain of losing a loved one to this dreadful disease.

17:15  

I thank David Torrance for bringing the topic to the chamber for debate. On behalf of Scottish Labour, I recognise mouth cancer action month and acknowledge the crucial work of the Mouth Cancer Foundation and Oral Health Foundation in raising awareness of mouth cancer.

The NHS advises that we cannot be certain what triggers the DNA changes that lead to mouth cancer but makes it clear that smoking and alcohol consumption are the leading causes of the disease in the United Kingdom. That highlights a further need to reinforce messaging regarding smoking and alcohol intake.

I appreciate the task that is ahead of us but, too many times, we discuss in the chamber the impact of conditions and life-threatening diseases that have avoidable causes. We must match our words with definitive action. There are clear links between the intake of the harmful products that I mentioned and life-threatening illness. We must go further in our efforts to reduce that impact.

I welcome the Scottish Government’s plan to create a smoke-free generation by 2034 but we must act with greater purpose and, indeed, urgency to address the prevalence of smoking, particularly in deprived areas, where it is at its highest. Only by doing so will we start to weaken the link between deprivation and serious ill health or, in fact, early death.

In short, much more has to be done to address Scotland’s significant health inequalities. I will continue to raise that point in the chamber, as I am sure members can imagine. I hope that the minister appreciates—I know that she does—that the need for action is urgent because some communities, including ones that I represent in South Scotland, are disproportionately impacted by those factors.

Moreover, a significant problem that we face when seeking to raise awareness of conditions and illnesses such as mouth cancer is a lack of knowledge surrounding the early symptoms and when to seek medical attention. Emma Harper raised that. The NHS advises that the most common symptoms of mouth cancer are:

“sore mouth ulcers that do not heal within several weeks ... unexplained, persistent lumps in the mouth that do not go away”

and

“unexplained, persistent lumps in the lymph glands in the neck that do not go away”.

It is crucial that we highlight those symptoms in the Parliament. I have repeated them so that people are aware of them because, if they are caught early, a complete cure is possible. According to some research, that can be done using surgery alone in nine out of 10 cases of mouth cancer.

The importance of early detection cannot be overstated. It can increase the chances of survival by 50 per cent to 90 per cent. That is why it is crucial that any changes to an individual’s mouth are reported to a dentist or doctor if they remain for longer than three weeks.

We must commend the work of the Mouth Cancer Foundation and other organisations but, more importantly, we must act with purpose to spread their message further and ensure that the symptoms of cancer—of which there are more than 8,000 new cases a year in the UK—are well known and prominent throughout the country.

I reaffirm a key point that I have made in previous debates and that other members have made: despite being under pressure and strain, and despite the difficulties that the pandemic has imposed on it, the NHS is still functioning and people should make contact with their general practitioner and dentist whenever they feel that they need to. The reduction in the early detection of cancers has been one of the most devastating impacts of the pandemic and, as a result, lives will be lost. However, as we hope to turn a corner and continue our progress, it is crucial not only that the Government addresses the urgent cancer backlogs but that people feel that they can come forward.

I thank members for participating in the debate and commend the work of mouth cancer action month.

17:19  

I thank David Torrance for bringing the motion to the chamber, and I thank my colleagues for their important contributions. It is a great opportunity to reflect on what we have achieved so far and what further work there still is to do. Unfortunately, oral cancers continue to be prevalent throughout Scotland, which has more cases per head of population than any other UK nation. The incidence rate in Scotland is expected to rise by 37 per cent in the next 20 years.

Raising awareness of mouth cancer and its common symptoms, which have been outlined by members, is absolutely crucial in detecting the cancer early. We know that the earlier that cancer is detected, the easier it is to treat. That is why we continue to invest in our £44 million detect cancer early programme, with an additional £20 million committed over the parliamentary session. The programme has traditionally focused on bowel, breast and lung cancers, but head and neck cancers have been added to it recently. As a result, a number of projects have been funded through DCE to date.

In recognition of the importance of primary care clinicians in finding cancer early, a clinical review of the Scottish referral guidelines for suspected cancer was completed and updated guidelines were launched in early 2019. Eight pathways were part of the refresh, including head and neck cancers. One key change emphasised the important role of dentists in recognising and referring patients.

During the pandemic, referral rates in cases of urgent suspicion of cancer fell below pre-Covid levels. In order to increase that rate, public awareness campaigns and messaging have run throughout the pandemic to encourage those with possible cancer symptoms to seek help. I encourage any individual who might be experiencing common symptoms of mouth cancer to present to their GP or dentist. Regular self-examination is absolutely vital. If you find anything concerning, it is important to get it checked out and it would be a reason to make sure that you see a dentist early. This week, the Let’s Talk About Mouth Cancer charity launched a helpful self-examination video to explain the approach to being mouth aware.

Despite prioritising cancer patients throughout the pandemic, the dental sector has been disproportionately impacted by it. Pre-Covid levels of patient volume are currently not achievable, with physical distancing and other health protection measures in place, yet dental care is a key component in our fight to identify oral cancers early, and it is essential that we support our NHS dental teams.

From February 2022, we will bring in new and increased fees for dentists for a range of treatments, supporting them in their efforts to clear the backlog that has built up during the pandemic. That includes a new enhanced examination for all patients, adults and children that will incorporate a more extensive oral health assessment, which will drive NHS care in a more preventative direction. In fact, the enhanced mouth examination that is being brought in will enable a discussion between the dentist and patient on risk factors for mouth cancer.

The Scottish Government is committed to improving oral health in our most deprived communities through the success of prevention-based oral health programmes, and we have made a commitment to abolish all NHS dental charges in this parliamentary session. We have also provided £50 million of financial support payments throughout the pandemic, and an additional £30 million-worth of personal protective equipment to ensure that the NHS dental services emerge well-placed to care for the oral health of the whole population.

Not only is it important for those with symptoms to come forward; it is equally important for us to change our lifestyles in order to prevent mouth cancer. There are clear inequalities in the burden of oral cancer, with those from our most deprived communities having substantially higher incident rates. Tobacco, alcohol consumption and socioeconomic status are key risk factors. Smoking and alcohol have been shown to have an attributable risk of 61 per cent in relation to oral cancer.

Our 2018 action plan commits us to interventions and campaigns aimed at discouraging smoking. In 2022, we will introduce an offence of smoking near hospital buildings. We will also continue to promote our free stop smoking services. Our social media and marketing campaigns are aimed at communities with high prevalence of smoking in a bid to reduce the inequalities. We have also committed to a refreshed tobacco action plan, which will include several new actions and interventions, as we continue towards our goal of raising Scotland’s tobacco-free generation by 2034.

In the past, we have taken bold action to combat alcohol-related harms by banning irresponsible promotions and lowering the drink-drive limit. Our refreshed 2018 alcohol framework builds on a decade of progress and sets out 20 further actions. Those drinking at harmful levels are more likely to fall ill or die from alcohol-related harm if they live in the most deprived areas of Scotland than those who live in the least deprived areas.

We continue to take a whole-population approach when it comes to reducing alcohol consumption and the risk of alcohol-related harms. Despite delays caused by the pandemic, I can confirm that a review of the level of minimum unit price to build a robust evidence base is now under way. We are also determined to cut down on the volume of alcohol marketing that young people are exposed to, which is why, in 2022, we will consult on a range of proposals to restrict alcohol marketing in Scotland.

Lastly, I want to touch on the human papillomavirus vaccine. The vaccine provides protection against four HPV types, including the high-risk type 16, which is strongly implicated in oral cancers. We are now offering both doses to all males and females starting in secondary 1, with very high uptake rates.

Alongside our work, the Scottish Government works closely with a number of organisations to raise awareness of mouth cancer, such as the Oral Health Foundation and the Mouth Cancer Foundation. All those partners are key contributors in raising awareness and support for those suffering from or at risk of oral cancers, as well as providing assistance, education and information to those who need it most. The work that they do is invaluable, and I take this opportunity to acknowledge and thank all those involved. It is also appropriate to acknowledge the continued hard work of our health workers, who throughout the pandemic have continued to provide quality care and attention to those who have suspected cancer.

As we have heard this evening, along with all of us here, the Scottish Government is committed to increasing awareness of mouth cancer and improving cancer patients’ experience and outcomes. I thank all our partners that help us in achieving those goals. Together we can improve and achieve our ambitions.

Meeting closed at 17:26.