The Government attach particular importance to reducing death from breast cancer and cervical cancer. In both cases early detection can lead to successful treatment. Breast cancer is the commonest form of cancer among women in this country. Each year there are something like 24,000 new cases, and 15,000 deaths, from the disease. In July 1985, the Government appointed a working group under the chairmanship of Sir Patrick Forrest to consider the position. I am today publishing its final report and I would like to express the Government's thanks to the group for its work.
The report has concluded that screening by mammography—X-ray of the breasts—will enable us to reduce deaths from breast cancer. The Government accept the proposals made in the report and accordingly have decided to implement a national breast cancer screening service. This will provide for screening every three years for all women between 50 and 64 throughout the United Kingdom. My colleagues, the Secretaries of State for Scotland, Wales and Northern Ireland, will be putting into effect proposals broadly similar to those I am announcing. We are determined that breast cancer screening should be implemented as efficiently, as effectively and as quickly as possible. This will need careful planning to ensure that all the necessary back-up facilities, as well as the screening centres, are available. It will mean assessment and diagnostic facilities, treatment facilities, counselling and after-care and training for key groups of staff. We have, therefore, decided to provide additional funds for each regional health authority to have at least one centre in operation within the next 12 months. The funds will also enable four of these centres to provide a training facility for the whole country. We shall expect the locations of the first centres to be announced by May of this year. An extra £6 million will be provided in 1987–88 for the first centres.
In addition, I shall shortly be sending to the professions and to health authorities a draft circular containing my detailed proposals for implementing breast cancer screening in England. I shall be calling for plans before the end of this year from each region to extend the service over the next three years to cover all women in the age groups concerned. The report envisages that up to 100 centres are likely to be needed in England. I shall also be setting up an advisory committee to advise on the development of screening and to monitor its effectiveness and efficiency. Breast cancer is a major scourge. We believe that these measures will achieve a substantial reduction in the mortality from this disease among women of this age group.
Cervical cancer kills 2,000 women each year and we are no less committed to reducing that figure. The great majority of those 2,000 deaths are among women who have never had a cervical smear under the existing screening programme. We have already taken urgent steps to increase the effectiveness of that programme and, in particular, to increase the proportion of the population at risk who are being screened. Computerised call and recall systems should be operating in 109 health authorities in England by next month and in the remaining 82 over the next 12 months. They will enable women to be sent personal screening invitations, usually from their own general practitioners.
Our first priority is to persuade more women to come forward for screening. We shall closely monitor the success of the system and we shall keep under review ways of making further improvements. In addition, I shall be asking health authorities to make two specific changes. First, since the number of cases among younger women has been increasing, health authorities should rationalise existing arrangements for screening women under 35 by ensuring that the call and recall system begins at the age of 20. Second, I shall be asking each health authority to make a specific named individual responsible and accountable for the organisation and effectiveness of screening.
Our proposals for both breast and cervical cancer screening take account or the wide range of evidence available from other countries. I am convinced that these proposals will make a substantial contribution to the cause of women's health, which is a key priority for the Government.
On AIDS research, as the House is aware, there is at present no vaccine against the virus or cure for AIDS. It is for that reason that the Government have mounted their major public education campaign. It is also important, in addition, that we in this country should make an effective contribution to the international effort to develop a vaccine and a cure.
In recognition of that need, the Medical Research Council has recommended a new directed research programme aimed both at developing a vaccine that will prevent infection and also at new anti-viral drugs to treat people who are already infected. The research would be directed from the centre by two scientific steering committees, which will consist of some of the country's leading scientists. There will be two specially appointed full-time directors and the programme will be built up by letting specific contracts to the most appropriate laboratory—public or private. That proposal goes beyond the usual approach of research initiated by the investigator.
The Government are extremely grateful to the MRC for taking a lead in formulating those proposals, which are based on wide consultations among outstanding British scientists by Sir James Gowans, the secretary of the MRC, with Sir David Phillips, the chairman of the Advisory Board for the Research Councils. This country has scientific strengths that should enable it to make a distinctive contribution to those important lines of research. The Government commend the readiness of the scientific community to collaborate in tackling this major problem.
Accordingly, the Government welcome the proposal and accept it in full. We will, therefore, launch in 1987–88, through the Medical Research Council, a new directed research programme on the lines that the council has proposed. For this purpose my right hon. Friend the Secretary of State for Education and Science will increase the grant in aid to the MRC by £14½ million over the next three yeas. The grant in aid will go up by £2·5 million in 1987–88, by £5 million in 1988–89 and by £7 million in 1989–90. The programme will be closely monitored by the council, with my Department and the Department of Education and Science. This will enable us to review progress against results. I should make it clear that the directed research programme will not affect or hinder any research initiatives by pharmaceutical companies.
The new programme should not be seen as an isolated venture. It is not. It will be part of an international research effort. We will build on the work already done, especially in the United States, and in turn contribute to the international body of research information that is being built up. In the United States, all the medical scientists whom I met in my recent visit were unanimous in their view that the United Kingdom could indeed make a distinctive contribution to AIDS reseach.
The House will appreciate that it is impossible to predict the progress of that research. In earlier statements I have made it clear that we cannot expect a vaccine or cure to be generally available within five years. But this programme will help us to make progress in three ways. It will enable this country to make a full contribution to AIDS research; it will mean that we are better placed to collaborate with, and benefit from, work that is being done in other countries; and it will increase the chances of developing a vaccine and finding a cure. I hope that the House will welcome the new proposals.
Is the Secretary of State aware that, while we certainly welcome the increase in AIDS research moneys now being made available, even with that new input, it is still far, far less than other countries—[Interruption.]—it is still far, far less than other countries are allocating for this purpose, and also far, far less as a proportion of the health budget than public concern demands in this country? Is the right hon. Gentleman aware that the United States is currently spending over $340 million on AIDS research, while his own parliamentary answer to me a week ago said that AIDS research so far in this country totalled precisely £⅓million?
Is the Secretary of State aware that, even after today's increase, expenditure on AIDS research in this country will still constitute less than one 20th of 1 per cent. of the health budget, which is far, far less than the priority allocated to it in other countries? Is he aware that the Medical Research Council has stated that £20 million funding is required to find a vaccine and to develop new drugs, and that the MRC's budget could not cope with that? Will he give an assurance that the extra funding for AIDS announced today will not have any knock-on effect in reducing medical research in other areas?
What positive action are the Government taking to develop and distribute the drug AZT, where some promising trials have halted virus replication? What other specific research will be directed at a therapy to regenerate the damaged immune system? Will the right hon. Gentleman also say what action the Government propose to take to overcome the reluctance of drug companies to undertake the necessary research work because of the dangers of litigation if the vaccine has unforeseen effects?
On breast cancer screening, is the Secretary of State aware that the extra funds announced today, again very welcome as they are, will fund only about seven new centres to add to the present two? Is he aware that that is a grossly inadequate response to the Forrest report, when 5,000 women have died of breast cancer while the Government have been sitting on that report since last year? Is the right hon. Gentleman further aware that when one in 12 women get breast cancer, and when it is the leading cause of death among 35 to 54-year-olds, the £6 million announced today will fund only a very small part of what a potential effective screening programme could achieve? What specific commitment is the right hon. Gentleman making today for the vast bulk of the extra funds that will be needed.
Is the Secretary of State aware that the £6 million announced today will not even fund screening for all women over 50 when the success rate from screening is as high as 40 per cent? Is the right hon. Gentleman further aware that one third of the mammogram machines in this country are obsolete, and the Government currently provide only one 10th of German provision? Is the right hon. Gentleman aware that the £6 million cannot possibly fund the training and employment of the extra radiographers, the doctors to analyse the X-rays, the laboratory staff to test the tissue, and the female counsellors needed?
Is the Secretary of State aware that when, six years ago, the Government instructed district health authorities to set up call and recall systems for cervical cancer but failed fully to fund the development, by last year only one-sixth of those authorities had done so? Is it not clear that underfunding today will have the same tragic consequences?
That was a disappointing and grudging response. The hon. Gentleman will not have the support of any informed commentator outside the House for what he said about AIDS and breast cancer, and some of the charges that he made are simply untrue and misleading. If the hon. Gentleman reads the Forrest report, he will find that what we are doing is exctly in line with what the Forrest committee has proposed. I shall take the hon. Gentleman's points, such as they were, in turn.
The hon. Gentleman asked about finance. We are making available £14·5 million over the next three years. That is additional money for the Medical Research Council, which is exactly what it has asked for. In other words, we are responding in full to its request. If the hon. Gentleman wants to challenge that, I suggest that he checks with the Medical Research Council. He is misleading himself and the House.
The United States has a bigger overall research budget, but a comparatively small percentage of that budget is going into vaccine development. In other words, gaps in the programme have been identified, not least by medical scientists in the United States. My announcement today will put Britain in a leading position in Europe. I would have expected the Opposition to have welcomed that rather than criticised it.
The overall research budget of the private pharmaceutical industry is about £500 million. Not all of that figure, but an increasing percentage of it, will be spent on AIDS research.
With regard to breast cancer, I repeat that we are meeting in full what the Forrest committee has put to us. In 1987–88, £6 million will be available. In 1988–89, a further £13 million will be required. In 1989–90, £22 million will be required. Those resources will be made available so that we can have a screening service throughout the country. I ask the hon. Member for Oldham, West (Mr. Meacher) to understand that what we are announcing is a major step forward for millions of women in Britian. The hon. Gentleman's response to both parts of the statement was inadequate and totally worthless.
Will my right hon. Friend tell the House a little more about the sum that is to be spent—I think that he said it was £14·5 million over three years— on AIDS research? He mentioned international co-operation. Will he tell us whether, and to what extent, there is international coordination, or will we be spending part of that £14·5 million on carrying out the same research that is being done in other countries?
There is co-ordination between the World Health Organisation, Governments and organisations in different countries. On medical vaccine, we will want to keep closely in touch— as will the Medical Research Council—with the World Health Organisation on what is happening inside the United States. We will take every precaution to prevent duplication of research.
I understand that my right hon. Friends the Secretaries of State for Scotland and for Northern Ireland will make announcements, probably in the form of written answers, which will be based on what I have announced on the Floor of the House.
Is my right hon. Friend aware that, in contrast to the churlish response from the Opposition Front Bench, his announcement was welcomed on this side of the House on all three fronts? Is he further aware that in my constituency there is some concern at the delay in results from cervical smear tests? To what extent will what he has told us help to accelerate the results of those tests for women who spend an anxious time waiting for the outcome? Is my right hon. Friend aware of the work done by the organisation Quest for a test for cancer, which has developed an automated form of testing? To what extent, if any, will what he has announced this afternoon assist that organisation, either directly or through the MRC, in evaluating that test?
I would need to give consideration to my hon. Friend's last point. On the first point, I accept the backlogs to which he refers as being one of the problems that we have had to encounter. The backlogs are being tackled by the districts, and they are recruiting more staff. The latest information that we have appears to show that the backlogs are decreasing. Clearly that is important. The priority must be not only to increase the numbers coming for tests but to improve the cervical cancer screening system overall so that we get a better system. It is worth remembering that annual deaths from cervical cancer have reduced by almost 10 per cent. since 1978. That is an improvement, but we want to decrease the number of deaths still further.
Any advance in cervical and breast cancer screening is welcome and overdue. Is the Secretary of State aware that the other major killer of women is lung cancer? He will be aware that most cigarette advertising is aimed at women. When will he move to ban all cigarette advertising?
Yesterday I had a letter from a haemophiliac man in Birmingham saying that he and three members of his family, who are also haemophiliacs, are AIDS-positive. Is research or action needed better to protect haemophiliacs who are being given AIDS by contaminated factor 8? We have known this for a long time, so why cannot action be taken to prevent it from continuing?
Action has been taken, and the tragic cases, which everybody regrets, are resulting from what has happened in the past. Action has been taken to ensure that factor 8 is heat treated. There is no evidence of new cases through infection over the past few months.
I share the hon. Lady's anxiety about lung cancer, and her concern that we should try to dissuade people from smoking. The way that we and successive Governments have tackled this is the best way. There has been no compulsory ban on advertising but a sensible agreement between the cigarette industry and the Government on what kind of advertising can be permitted and in what form.
Both aspects of my right hon. Friend's statement are welcome by practically every hon. Member, and certainly by all those in the health and caring professions. What my right hon. Friend has announced about cervical cancer screening is a further step towards turning the National Health Service from being a sickness service into being a genuine health service in which prevention plays a much bigger part than it has in the past. Is not the ability of the MRC to come forward with this ambitious programme on AIDS due to the immense strength of our basic life sciences in our universities, particularly in molecular biology? Will my right hon. Friend talk with my right hon. Friend the Secretary of State for Education and Science to ensure that we maintain that standard in our universities?
I strongly agree with my hon. Friend's last point and certainly I shall talk to my right hon. Friend about that. In addition, I pay tribute to Sir James Gowans who has taken a leading role in this field.
My hon. Friend asked about health education. I hope that it is common ground that the Health Service should concentrate more and more on health education. That is precisely what we are trying to do through the kind of preventative measures that I have announced.
On behalf of my alliance colleagues, I welcome entirely and unreservedly the Minister's statement. However, I should like to ask one or two questions.
First, can the right hon Gentleman tell the House by how much his Department's budget and the Department of Education and Science budget will be increased to pay for these necessary preventative campaigns and courses of action? Secondly, will we see proper co-ordination between the work of the academics and that of the clinicians so that there can be maximum immediate use? Finally, in order to ensure a quick take-up by the maximum number of women of the tests for cervical and breast cancer, can the right hon. Gentleman assure the House that the Health Education Council and others will be given adequate budgets immediately to make sure that all women are aware of the opportunities as soon as they are available?
I am extremely grateful to the hon. Gentleman for the way in which he has responded generally to the statement about AIDS and breast cancer. The £14·5 million for AIDS will be in addition to what the Medical Research Council has already been promised. The £6 million for regional health authorities will also be in addition to what has already been promised.
The hon. Gentleman asked about co-operation. I hope that I can assure him on that point. In health education generally, one of our purposes must be to try to increase the numbers coming forward. To some extent, that has quite a lot to do with the computerised systems that we are putting in the family practitioner system.
Already 109 districts have computerised systems, and we hope that over the next 12 months the remainder of the districts will have them. In that way we will be in a much better position than previously to bring in people who were missed in previous years. Too many of the people who died in the past were missed in the screening process, and that is why I aim to improve the system.
My right hon. Friend has made an excellent statement which signals a major advance in the good health of the nation. The mean-minded carping by the hon. Member for Oldham, West (Mr. Meacher) is not justified by the statement. Will my right hon. Friend confirm that when the breast cancer screening facilities are fully operational we can look to the possibility of saving 2,000 to 3,000 lives a year? Will he also tell the House that, where possible, he will encourage the provision of screening facilities in the community rather than having them entirely hospital based?
I certainly agree with my hon. Friend's first point. He asked about breast cancer screening. Some 1·5 million women will be invited to use the system each year as soon as it has been developed. We are obviously aiming for maximum take-up, but Forrest estimates that the mortality rate in the 50 to 64 age group should be reduced by about one third.
How many extra staff in pathology and other paramedical specialties does the Secretary of State think will be covered by the £6 million for cancer screening? Is he not aware that in some areas where staffs have been cut administrative staffs have been cut by as much as 30 per cent? How does he envisage that it will be possible to designate people solely to deal with a subject of such urgency? Do we not urgently require a training programme now?
That is precisely what we are doing. One of the reasons why we are having to do this by stages is to build up the trained staff, not only the surgical staff and pathologists to whom the hon. Lady referred, but radiographers and radiologists. Obviously the system will need equipment and premises. I should emphasise that Forrest envisages a build-up of that sort and we are following it exactly in formulating our plans.
Does my right hon. Friend's announcement mean that research institutes involved in vaccine research may now submit new projects to the Medical Research Council? Does his statement on cervical cancer include any resources for getting rid of the backlog, which in some parts of the country is now severe?
We have sought to tackle the backlog through the district health authorities by recruiting more staff, and clearly that remains a priority. On the matter of research, it is important to underline what the concept of directed research is. The usual approach is for the investigator to initiate the proposal and submit it to the Medical Research Council. Under this proposal the Medical Research Council will initiate and decide which are the most promising areas for research. That is a method used with great success in the United States, but it has been used rarely in the medical research area since the war, but it underlines the importance that the Government attach to medical research on AIDS.
Can the Minister be more specific about laboratory staff? He has been asked several questions on it this afternoon and has been vague in his answers. Can he tell us how, when and where the laboratory staff will be increased, because in parts of Wales we are having to wait for up to three months for the results of cervical cancer tests? That is intolerable because it means that people will be dying unnecessarily because of that sort of delay.
It is not a question of being vague. There are two issues involved. On the matter of cervical cancer, the district health authorities are reducing the backlogs in the districts by recruiting more staff. That is taking place now and that is presumably what the hon. Lady wants.
On breast cancer, there is a need to train staff. I cannot give the exact figures for all 14 regions, but obviously, as the programme goes forward, we will be in a position to do that. The resources are being made available to the regions so that they can provide at least 14 centres by next March and then we will go forward over the following two years to provide 100 centres throughout England.
I think that the whole House, other than one hon. Member, welcomes the statement and would like to congratulate the Secretary of State on it. Does he recognise that, as some 4,000 deaths from AIDS are likely to occur by 1990, it is as serious as cervical cancer? Will he say that, in addition to the £14 million being spent in directed research from the Medical Research Council, it will increase the percentage it is giving in response to applications, which I gather is only £2·5 million out of a budget out of £150 million?
So far £2·5 million has been spent on more than 20 projects through the Medical Research Council. Indeed, until the autumn the Medical Research Council was basically saying that no worthwhile project had been turned away. The Medical Research Council then asked us for an extra £1 million. That was made available immediately. In addition, these extra resources for directed research are being made available. I emphasise that I believe that the series of measures that have been taken, particularly over the past few months, gives us the opportunity to take a leading position in Europe on AIDS research.
I welcome the provisions being made, but, like Oliver Twist, I hope that as the five years pass, there will be better funding. I should like to ask about mammography and cervical smears. Does the Secretary of State recall that we had a nationwide mobile system for the screening of tuberculosis, which only a few years ago most regional health authorities put into dry dock? Will his Department examine, as a means of easy provision of the facilities for screening, what the cost would be to resurrect that scheme which was, in its day, very effective?
Is the Secretary of State aware that, especially after the menopause, there is a tremendous impact of carcinoma, apart from cancer of the cervix, in the pelvic area? Will he look further at the possibility of screening, not just the priority groups, which he has mentioned and must obviously have in mind, but a much wider range, certainly up to the age of 65? Those women could be helped.
On the matter of AIDS research, has the Secretary of State noticed the bonanza that has been taking place on the stock exchange on the pharmaceutical companies' share prices? As there is heavy competition to hit the jackpot between each of the major companies, will he take steps to ensure that there is an exchange of information, not only with the Medical Research Council and the Secretary of State's Department, but within the pharmaceutical industry itself so that there is maximum knowledge?
On the first two points raised by the hon. Gentleman, I shall certainly consider the implications of what he is proposing. It needs to be said that the private sector of the pharmaceutical industry is doing a great deal of research in this area, and that should be welcomed on both sides of the House. An increasing percentage of research on AIDS is taking place. One of the benefits of a strong private pharmaceutical industry is that the research is taking place.
I warmly congratulate my right hon. Friend on his swift and generous response to the request of the MRC. Will he assure the House that there will be no let-up in the Government's efforts to educate the public about the ways in which the AIDS virus can be contracted? Does he agree that in the short term responsible attitudes towards sex can play the biggest part in reducing the number of deaths from AIDS?
My hon. Friend has made an important point, which I mentioned in my statement but which should be underlined. There is no immediate prospect of a breakthrough in that area and everything we say on public education still holds good and, indeed, should be underlined. I am glad to make that absolutely clear.
As someone who lost a close relative from cervical cancer, I welcome any measure that will help alleviate the problem. Many women do shift work in the catering industry and various other industries. May I ask the Secretary of State to give every encouragement to employers to ensure that those women are allowed time off for screening?
I add my warm welcome to my right hon. Friend's statement. Will he consider again the possibility of giving an absolute priority in breast and cervical screening to the back log cases, since I feel sure that one of the problems in this desirable area is that of public and patient expectation? One way of dealing adequately with that problem would be to deal with the backlog as a priority before moving on to the new and extended schemes.
Certainly, on the matter of cervical cancer, I agree with what my hon. Friend says. The priority must be to ensure that the system that we have now works well, and that obviously means tackling the backlog.
We will certainly seek to meet that sort of challenge. The best way of answering that question is by looking at what the Government have already done. We have made massive new amounts available for public education and we are now making new resources available for research as well. That underlines the importance given to AIDS policy, not only by the Government but by both sides of the House.
May I join right hon. and hon. Members on both sides of the House in welcoming the statement and the way in which it rises to the challenge— something which the Opposition Front Bench seems too churlish to recognise? Can my right hon. Friend assure me that the £14·5 million towards research is in addition to the moneys which are already being spent or will be spent by the pharmaceutical industry in the same cause? Will he stress once again how important it is that we give higher priority even than this to education and prevention because they are the most important factors in dealing with AIDS in the short term?
I confirm both points. First, this is additional money for the MRC and it is certainly additional to anything that the pharmaceutical industry is spending in this area. Secondly, I stress the importance of public health education. Indeed, at the end of this week we shall see a major campaign by the television companies, both the British Broadcasting Corporation and the independent television companies. I take this opportunity to welcome their initiative. Not everything can be done by the Government or through advertising.
Is not the question hanging over the statement how much the Government are willing to spend to prevent death? Although the statement is welcome, does the Secretary of State understand that large numbers of people will consider that the money for cervical cancer screening is too late and too little? Is it riot cautionary to remember that the total sum that he has mentioned is less than what was spent on selling the gas industry to Sid and a tiny fraction of the tax handouts given to the rich in the past seven years? Can the right hon. Gentleman say specifically when the age groups of women for screening will be extended both to a lower and to a higher age group? What additional resources are to be given to local health authorities, including my authority in Bradford, to deal with unbudgeted expenditure on AIDS care? Will additional resources be made available?
If the hon. Gentleman is rehearsing his constituency speech on the Floor of the House, he has chosen the wrong issue to do it on. We have responded in full to what the MRC has asked for on AIDS. On breast cancer, again we are implementing the Forrest report. In 1987–88 the cost will be £6 million, which, again, will be in addition to the budget. It is not remotely a question of being too little; it is what the bodies have sought and asked for and the Government are responding to it.
Is my right hon. Friend aware that, while many of us warmly congratulate him on his announcement of funding for AIDS research, we all agree that there must be further public education? Is he aware that we would like him perhaps to have a word with the television authorities on the timing of the AIDS programmes and request them to delay the programmes for a couple of hours, from 5 pm to 7 pm, to avoid young children seeing them and their parents being embarrassed? Could he give some guidance to the television authorities on that point?
I am sure that the broadcasting organisations will have heard what my hon. Friend has said. I understand his point. However, I must say that both the BBC and independent television have responded magnificently to the challenge of AIDS. They have responded exceptionally, and I praise their action, which has been invaluable.
My right hon. Friend can be assured of the warm welcome of all reasonable people inside and outside this place and he has been most kind to consider some papers on AIDS research from a British team recently. In his busy day, will either he or one of his junior colleagues agree to meet members of that team to ensure that this encouraging opportunity is not missed and the British team receives the fullest possible support?
May I add my congratulations to my right hon. Friend on his statement and point out that in Bolton, where a breast scanner was bought last year following a successful charitable appeal and where there is wide experience and expertise among the local medical profession, his announcement of a national screening programme will he extremely welcome?
I am grateful to my hon. Friend; I know that he has a close interest in this area. He has raised the issue as it affects Bolton in an Adjournment debate and, certainly, I hope that Bolton will benefit in the same way as the rest of the country.
Will my right hon. Friend do something about the dreadful AIDS advertisement that starts with the words, "Gay or straight", which seem to invite any adolescent who may read it to an equality of choice? Does he agree that, while he, as I, might like to he looked on in our private and public life as being straight in our dealings with people, in our sexual proclivities we would rather be looked on as being normal? Should not the sensibilities of the majority be more important than those of the minority?
That takes us a little onwards from the issue of AIDS research, but I take my hon. Friend's point. However, I must say that the advertising must get its message over as directly as possible, not only to the general public but to the high-risk groups. Obviously, I regret it if any advertising offends individuals and the public generally, but the greater need and demand is to get the message over to the public.
In joining the applause for the significant steps forward in research and preventive medicine announced by my right hon. Friend, may I invite him to remind those, such as the hon. Member for Workington (Mr. Campbell-Savours), who call for unlimited research expenditure on AIDS, that there are other extremely debilitating, terminal diseases which are not self-inflicted and for which cures are desperately needed?
What are the reasons for the age limit between 50 and 64 for breast screening? Does the report conclude that the incidence of the onset of breast cancer before that age is so insignificant as not to deserve the full scheme? If so, is there not in any case some opportunity for those who would nevertheless like to have the breast screening service to have it on demand?
I am grateful to my hon. Friend for raising that important point. Obviously, the MRC has health and medical priorities other than AIDS. The Forrest report proposes an age range between 50 and 64 for breast cancer screening. One third of the 15,000 deaths are among women between the ages of 50 and 64 and research has shown that screening that group would be by far the most effective measure. Forrest proposes more research in the 40 age group and we accept that. Screening is also available on demand for those over 65. That, too, is proposed by Forrest and, again, we accept that.