The matter I wish to raise is one which I would normally raise with some diffidence at this late hour, but I think I can claim that it is at least as important as anything which has been discussed in this Chamber during the last five hours. It is the problem of greater publicity in the matter of cancer treatment and of urging members of the public who may be afflicted with this disease to seek early diagnosis and advice.
Perhaps the word "education" would be a better word than "publicity" because it would be quite out of place to embark upon a spectacular campaign of publicity in the ordinary sense of that word. It is more a question of educating the public, and perhaps as much as anything a question of a change of attitude towards the whole problem of cancer.
There is little doubt about the gravity of this problem to the present generation. In many countries, at the beginning of the century, only one death out of every 20 was attributed to cancer. But over the last 50 years there has been a steady increase in the proportion of deaths caused by this disease, until, at the present time, the percentage has risen from one death in 20 to one death in seven, and in some countries it is as high as one death in six.
One of the most serious features of this increase is the fact that the largest percentage increase has occurred in cancer of the lung, and that form of the disease accounts in large measure for the very serious total increase which has taken place in the last half century.
In 1900 the number of persons who died from cancer in England and Wales was 26,000. Forty-seven years later it had increased to 80,000. If one includes Scotland, and takes the figures for Great Britain as a whole, deaths reached the alarming total of 90,000 per years. But the situation is not as bad as the figures might suggest at first glance, because in the early days of the century diagnosis was not as accurate as it is today, and an encouraging sign is that as a result of improved methods of surgery and the advances made in methods of healing people are cured of other afflictions and so reach an age when cancer is more likely to afflict them. Thus in 1948 out of 5,253 deaths in one area only 455 were of persons up to the age of 44, 3,159 were of persons between the ages of 45 and 64 and 1,639 were of people aged 65 and over. So that out of roughly 5,000 deaths 400 were of persons under 44, and 4,500 were of persons over that age.
Nevertheless, with such a serious rise in the incidence of deaths from cancer, however optimistically we may try to interpret the figures, it is clear that the policy of reticence about the disease needs to be reconsidered. There is not one of us, who has not with painful frequency heard of the death of some friend or acquaintance from this plague of the 20th century, this affliction which comes like a thief in the night.
There is still a great deal of secrecy which surrounds the question of cancer. People are reluctant to use the word: it has such an unhappy connotation, and this is in marked contrast to the normal reaction towards illness. There are many people, far too many, who are all too ready to talk about their operation, to the great discomfort of their friends and acquaintances, but there is no such willingness to talk about their operation if it has anything to do with cancer. This attitude of mind has not been counteracted by those in authority and only 18 months ago, the Central Health Services Council gave advice that it was undesirable for any general scheme of cancer publicity to be carried out by any central Government organisation.
There is also a widespread feeling that cancer is always fatal. There are millions of people who, when they hear that a person has cancer, regard it as equivalent to a sentence of death. If we can get away from the exaggerated feeling of apprehension, we may be doing positive good in more senses than one, and may be the means of saving thousands of lives. There is increasing evidence from doctors in general practice and from hospitals that reluctance to seek advice and consequently a delay in obtaining treatment is responsible for many deaths which otherwise could have been avoided.
I do not think it is yet generally realised what considerable progress there has been in the treatment of cancer in the last 50 years. In fact, such progress as has been made altogether has been mainly during that period, and we may now well be only at the beginning of great further advances. Not only by surgical means, but by means of radiotherapy, by the medical use of isotopes and by chemo-therapy many types of cancer are curable if they are taken in time.
I hesitate to use the word "cure" because that might appear to be making too large a claim, but I would like to quote from the British Medical Journal for 12th July, which used these encouraging words:
The results of treatment in certain sites continue to show steady improvement. Surgery, not necessarily more bold than in the past, but rendered less hazardous by modern methods, and radiotherapy applied by machines of increasing power and complexity, together hold out more hope for the sufferer, sometimes of cure, often of considerable palliation.
The Medical Society of London recently collected over 200 cases of one particular kind of cancer in which the patients were alive more than 10 years after the operation. Furthermore, the Minister will be aware that the ex-Minister of Health, in answer to a Question by the hon. Member for Newport (Mr. Peter Freeman) on 8th February last year, said that some types of cancer can be treated with very great hopes of success if treatment is sought early.
The balance against more publicity in the matter of seeking advice for suspected cancer has probably so far been tilted by the medical profession itself which, no doubt, fears a great increase in neurosis or cancer apprehension. But, with respect, I think this is a mistaken view, for two reasons. In the first place, the medical profession, with great credit to itself, is probably still dissatisfied that so little is known about the basic cause of cancer, or, rather, the basis of its cure or prevention.
Because no comprehensive form of cure has yet been discovered, the doctors are perhaps unduly modest as to what has already been achieved. But I think we are entitled to remind ourselves and the medical profession that a great deal has, in fact, been achieved, and as a result of the efforts of surgeons and physicians of superb skill there are thousands of people who have got rid of malignant cancers and are living a perfectly normal and happy life.
In the second place, the reason why I suggest that the attitude of the doctors needs to be looked at again is that the figures of cancer mortality are now so large that it is pointless to pretend any longer that the disease is something which affects only a small number of people and that the less said about it the better. In any case, we have so much to he apprehensive about in this particular day and generation that one more cause of apprehension can hardly prove fatal to our morale. Secrecy may save a certain number of people from worrying about cancer, but at the same time it is condemning thousands of people to die many years before they need. It has been estimated by a reputable investigator that there are every year 8,000 people whose lives could be considerably prolonged if they had only sought advice and treatment at the proper time.
A doctor who has given up a great deal of his time and energy to the study of this subject tells me that one of his hopes is that when the time comes, as I feel sure it must come, for a wider amount of education on this matter to be encouraged, he will be able to help to make an instructional film which will open with a crowd of people of all ages coming out of a building. The commentator will ask "Who are these people? What have they in common?" The answer will be that they are not actors and actresses or people taking part in a crowd scene. They will all be people who have been successfully treated for cancer at some time during the last five, 10, 15 or even 20 years, and have survived to live useful and happy lives. In that way he would be able to demonstrate clearly the fact that so much has been done in regard to many forms of cancer.
A question mark still remains over the general problem of the disease, but there is no reason to assume that the scientists and doctors will not ultimately find the cure. It is safe to say that if only a quarter of what is spent on nuclear research and only a quarter of the number of great scientists engaged on it were able to transfer their efforts so as to add them to what is being done by the men and women engaged in cancer research today, we would find the answer during this present generation. In this connection, it is only fair to say that out of the discovery of nuclear fission it may well be that knowledge will become available which in itself will be of great help in the treatment of cancer.
In conclusion, may I refer briefly to a book written by Professor Sidney Russ? He has written an invaluable book on the subject and he gives as the chief reason for writing it the importance of seeking early advice. He says:
It is still true today that many people have such a dread of the disease that they go all too late for medical advice; there is not only the testimony of the general practitioner to this effect, but over and over again in reports of treatment coming from the chief centres of radiotherapy does one find the lament that patients coming for treatment are found in an advanced stage of the disease; this makes treatment so much more difficult.
Lord Horder has written a foreword to the book, in which he says:
A policy of reticence in respect of a disease so widespread and so lethal as cancer has always seemed to me very foolish. Statesmen who adopt such measures when the body politic is in danger whether from the enemy within or without the gates are rightly severely censured by the thinking citizen. So should we be censured if we allow a false delicacy to screen us from telling the public what is the real position in regard to this particular menace to its life and happiness and from pointing out to the public how it can help to achieve victory.
The Parliamentary Secretary bas shown great interest in this subject and I hope that she will give a sympathetic hearing at least to the general principles underlying the ideas which I have ventured to lay before the House.
I welcome the opportunity provided by my hon. and gallant Friend the Member for Norfolk, Central (Brigadier Medlicott) to discuss this very important question.
We all recognise and appreciate the concern, which is very widespread, at the incidence of this disease, which is referred to in the Chief Medical Officer's report for 1950 as now second as a cause of death only to diseases of the heart and circulatory system. We have to bear in mind that allowance must be made for the increasing age of the population and to the fact that more people are surviving into the ages when cancer more commonly occurs. We should take into account the fuller and earlier diagnosis, which does increase the figures.
Three main points were raised by my hon. and gallant Friend: early diagnosis and treatment; the question of publicity for a cancer campaign; and the question of research. I would like to deal with the points in that order. Despite the very great improvements made in the methods of treating this disease, we are forced to admit that, short of some revolutionary discovery, our chief hope of improving present methods at the moment lies in earlier diagnosis and treatment.
I agree with my hon. and gallant Friend that treatment is often more successful in patients where cancer is found to be in its very early stages. That must be our main hope until, as a result of the very widespread research which is under way, and which is world wide, we are able to find a cure for this disease. As far as diagnosis and treatment are concerned one thing is extremely important, and that is that it is not really a disease which it is practicable to make notifiable. But we can and are encouraging full and most extensive registration of cases which come for treatment, because we cannot know anything about the incidence of cancer, as opposed to the mortality of cancer, until we have encouraged registration over a number of years. The radiotherapy clinics are gathering valuable information.
It has been urged from many quarters that much suffering could be saved by educating the public in the diagnosis and treatment of cancer; and I repeat that the emphasis is on education, rather than on propaganda. But the problem is not easy, because we are faced with deeply divided opinion from responsible medical quarters. The objections to a widespread direct education programme to the public are very weighty. It has been pointed out that publicity would greatly distress and alarm the public, and increase the already widespread fear of cancer; the consulting rooms would be swamped with frightened people wanting to know if they suffered from this dreaded disease, and the overworked general practitioners would have even more thrown upon them. The demand for beds in our hospitals would be increased, and this would present an intolerable burden on our resources.
It would be wrong to have a national campaign based on fear. The matter has been referred to the Minister's Standing Cancer and Radiotherapy Advisory Committee, but this body eventually advised against a cancer campaign addressed direct to the public. But that reply did not imply that local health authorities should omit reference to cancer in their general health propaganda; for, while it was felt to be highly undesirable to have a national campaign based almost inevitably on fear, yet in the field where local knowledge counts for so much, a great deal could be done by education through a more restrained type of information. That could be carried on by the local health authorities, and the very useful and now renowned voluntary associations.
We are considering what encouragement we can best give to the local authorities and voluntary bodies to help in exploratory work in seeing what can be done about this dread disease. There is a lot we should like to know about it. We want, for example, to know how great a strain a publicity campaign would place on the local facilities, and whether such a campaign would, in fact, achieve the results which we all have so much at heart. We are considering all these problems with our advisors, and are as anxious as any hon. Member that we should find a solution to this problem. So far as doctors and medical students are concerned, we have made a start with further education in the early recognition of cancer. We have six films for showing to doctors and professional audiences, dealing with cancer of particular sites.
I am aware of public concern at the amount of cancer research being carried out. Much of the criticism is based on ignorance of the work which is being done and the feeling that additional large sums of money on cancer research would necessarily bring results. I do not believe that the mere spending of money would bring results which we cannot at present attain. Cancer research is world-wide. Mercifully, there is no Iron Curtain in medical research. Vast sums have been spent by the United States, though they have brought them no nearer to a solution than our own research. It is fair to say that should any country discover a cure it would be internationally shared. This country is playing its part. It is quite impossible to give the House figures or to assess the total sum spent. There is extensive research in National Health Service hospitals. There are many teaching hospitals which are specialising in this work.
Exact figures are not available for research, because the cost cannot be separated from the general cost of treatment of cancer patients or distinguished from the cost of treatment and investigation into other diseases. A great deal of research is carried out directly through a large number of medical, surgical and scientific studies. The report of the Medical Research Council for 1950–51 says:
… the advance of knowledge in cancer research is dependent upon almost every branch of medical investigation and indeed upon many other branches of science.
Universities, too, have a very large share in cancer research. Three of our universities have specialised centres dealing entirely with cancer research. Also, the work of the Atomic Energy Research Establishment at Harwell in the development of radioactive isotopes shows how research into nuclear physics can provide an important method of treatment of cancer. Developments in nuclear physics have made it possible to construct new types of high voltage apparatus for research treatment and this has already been ordered for our National Health Service hospitals.
The British Empire Cancer Campaign and the Imperial Research Fund are voluntary bodies and supported by voluntary contributions. I am sure that the House will agree that cancer research is an excellent object for private generosity. The Medical Research Council is in the closest touch with all these bodies and, indeed, in touch with research all over the world. The Research Council has increased its expenditure considerably. In 1945–46 it spent about £6,000 directly on cancer research. In 1951–52 it devoted £340,000 specifically to cancer research and this year it will spend £410,000, the latter figure including £150,000 for financing the research activities of the Royal Cancer Hospital.
We are fully alive to this problem. Research on a very wide scale is continuing and unceasing consideration is being given to public education by local authorities and voluntary bodies and arrangements are being made to improve the all-important process of registration. We are taking the best advice available and we are as anxious as I know all hon. Members of this House are that all possible treatment shall be available and everything possible shall be done to wipe out this scourge.