Women's Health

Part of the debate – in the House of Commons at 2:13 pm on 10th June 1988.

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Photo of Dr Charles Goodson-Wickes Dr Charles Goodson-Wickes , Wimbledon 2:13 pm, 10th June 1988

I am glad to have been called to speak in the debate. While it may appear to be discourteous to make my contribution late in the day, I trust that the fact that I have been treating patients is an acceptable reason. That also registers my interest in the subject.

I think that this is the first general debate that we have had on women's health. Nowadays it seems fashionable to link women's interests to those of various minority groups. I speak as a member of a minority group—as a member of the male sex—and I have never quite understood the logic of that linkage. I certainly make no complaints and hope that with improvements in women's health care the present ratio and happy state of affairs will continue. Perhaps I could make a plea to my hon. Friend the Minister for a debate in due course on men's health or perhaps for a debate on some non-sexist subject such as geriatric health.

I am sure that the House approves of the unmistakable trend in the world of medicine towards prevention. The last century saw the first public health revolution and a reduction in the ravages of infectious diseases by means of better nutrition, cleaner water and air, and innoculation. We are now in the era of the second public health revolution and it is possible to educate people to reduce the risk of developing disease by modifying their behaviour and lifestyle. This is applicable in cardiovascular, respiratory and gastro-intestinal conditions and can be done without making life miserable.

When I became a medical student 24 years ago, teaching was virtually confined to the cure of disease. The notion of screening apparently healthy individuals was in its infancy. Specific tests were introduced gradually for presymptomatic disease. In addition to the admirable work of the National Health Service, the private sector is to be congratulated on pioneering the general screening of individuals. For many years I have been active in that work and in the identification of occupational hazards to the health of male and female employees.

Screening for cancer of the cervix and breast will clearly attract most attention in any discussion of women's health. However important those aspects may be, they represent too narrow a view of women's health generally. The effectiveness of cervical smear testing, which has been available for more than 20 years, depends on technical efficiency. I was alarmed recently by reports of deficiencies in the taking of such tests, which often impede sound diagnosis by yielding false positive results, which alarm patients unduly, or false negatives, which create a false sense of security. The credibility of the test depends on the technique of taking it so as to ensure that the laboratory interpretation is valid. I cannot emphasise enough the input that there must be in teaching hospitals to ensure that medical students are adequately taught.

All such efforts are useless if those at risk do not come forward. For 20 years, Sutton and Merton health education unit has pioneered increasing awareness among the public and encouraged people to come forward through the National Health Service, voluntary organisations, industry and schools. Screening is flawed—perhaps fatally, in the true sense of the word—if the administration of recall is inadequate. I congratulate the Government on the steps that they have taken to computerise the recall system.

Breast cancer has, to an extent, been the poor relation in public awareness and resources allocation. That is curious because, on a per capita basis, more lives are saved at less cost. The incidence of mortality from breast cancer is far greater than that from cervical cancer, with 15,000 deaths per year at all ages as opposed to 2,000—a sevenfold difference, which the House would ignore at its peril. Those statistics show the way forward for the future, and I am delighted that St. Bartholomew's hospital has been active in implementing the recommendations of the Forrest report. I hope that the Government will be flexible and examine the results in relation to the right age bracket. We must bear in mind that if women have a family history of carcinoma of the breast they are far more at risk than others who have palpable findings on clinical examination.

I am amazed in my consulting room, at the many bright female graduates, who often work in the financial world and are clearly better at examining balance sheets than their breasts. I hope that the statement, "Doctor, I do not know what I am looking for", will have no relevance in the 1990s, and there will be no repetition of the heroic but horrific surgery that was recommended by some of my teachers, which resulted in physical and psychological mutilations to so many women. I do not deny that lives were saved, but at what cost?