Orders of the Day — Testicular Cancer

– in the House of Commons at 9:45 pm on 10th March 1999.

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Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hanson.]

10 pm

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

It is estimated that a third of all men will develop some form of cancer. Worldwide, the number of cases of testicular cancer has risen: the number of cases has doubled in 20 years, and is expected to double every 20 years on the basis of today's trends.

The increased incidence of testicular cancer is linked to a decline in sperm count. Cases of prostate cancer are also increasing. Scientists have predicted that, in 20 years' time, one in four men may risk developing prostate cancer. That is double a woman's risk of developing breast cancer.

I decided to speak about testicular cancer in order to draw attention to the work of a charity called the Orchid Cancer Appeal. It was started by one of my constituents, Colin Osborne, who was diagnosed as suffering from testicular cancer in 1994. He was one of approximately 1,500 men who are diagnosed every year.

During Colin's treatment, his chance of survival kept falling. First it was 80 per cent.; then it was 40 per cent.; then it was 20 per cent. That was very worrying not only for Colin, but for his wife and family: his wife had become pregnant with their second child at the same time as his diagnosis. Through his determination and courage, however, Colin managed to get through all his treatments.

During Colin's treatment, he was aware of the financial crisis affecting the men's cancer unit that was treating him. The unit, led by Professor Tim Oliver, is based at St. Bartholomew's hospital, in the department of medical oncology. As well as providing care for patients in east London through its partnership with Oldchurch hospital, it has links with the major cancer centres in Essex and East Anglia as part of the Anglian germ cell cancer group comprising Southend, Colchester, Norwich, Ipswich and Cambridge.

Colin knew that, without the work of the unit, he would probably not be alive, and that inspired him to do something to help the unit. He started a fund-raising organisation—the Orchid Cancer Appeal. He gained great support, and the first event raised £20,000. In July 1997, the Orchid appeal was recognised by Diana, Princess of Wales, and a donation was made by the Princess of Wales's charities trust. The Orchid Cancer Appeal is now a registered charity. It has attracted a number of high-profile celebrity supporters, and boasts Michael Parkinson as its president, Steve Davis—the snooker champion—as patron, and other sporting stars as vice-presidents, such as 1966 world cup winners Sir Geoff Hurst and Martin Peters, and the former Wimbledon champion Pat Cash.

I have been very impressed by Colin's tenacity and commitment, and his fighting spirit. Ever since my invitation to the launch of the Orchid appeal in October 1997 at Planet Hollywood, I have been a firm supporter, attending fund-raising events and sponsoring a reception in the House of Commons in November 1998.

The aims of the appeal are to sponsor more research into the diagnosis, prevention and treatment of the cancers involving the male sex organs", such as testicular and prostate cancer, and to target aspects of cancer research and treatment. In comparison with women, men are not very aware of their risks of cancer. Many men do not know that they have a prostate gland, let alone what function it performs; yet cancer of the prostate is the commonest cancer in men after lung cancer, and its incidence is rising fast. The same lack of awareness is prevalent in young men with regard to testicular cancer.

Photo of Ms Jane Griffiths Ms Jane Griffiths Labour, Reading East

Is there not a pressing need for young men to become aware of the possibility of contracting testicular cancer, which, by and large, strikes young men? Should not parents and teachers instil that awareness in them, and encourage them to examine themselves?

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

I appreciate my hon. Friend's intervention. As she knows, testicular cancer predominantly affects men aged between 15 and 40, yet few regularly check for lumps. The fact that it affects 15-year-old boys makes it important that parents make their sons aware of potential problems. I pay tribute to my hon. Friend the Member for Reading, East (Jane Griffiths), who has started the all-party group on male cancers and is involved in the Everyman campaign to combat cancer.

The Orchid Cancer Appeal is raising funds to support three research developments. The first is to develop new diagnostic tools both to detect the cancer without needing to lose a testicle to make the diagnosis—which happens at present—and to investigate the cause of declining sperm count, which is now known to be a major precursor of the cancer.

The second is to support a combined clinical and laboratory programme aimed at translating new knowledge on the genes that are involved in making testis cancer sensitive to chemotherapy to develop a new approach to treating prostate cancer. The final programme is to support epidemiological research into understanding what causes the large difference in prostate cancer deaths between the west, which has intermediate incidence, the middle and far east, which has low incidence, and Africa, which has high incidence.

Testicular cancer, which starts as a lump in the testicle, quickly enlarges and then seeds to glands in the abdomen. It then seeds to other organs such as the liver, lung and, ultimately, the brain, via the bloodstream. If the cancer is caught early on, only one testicle may need to be removed.

The way in which to treat testicular cancer has, until now, been to remove the infected area, or to undergo a course of chemotherapy. Chemotherapy is often very distressing for the patients. Hair loss and severe infections can occur in the short term because of the treatment.

Recent research has involved developing ways in which to give shorter courses of chemotherapy to patients who have early highly curable diseases. There is now a one-day treatment without hair loss. That is proving to be as good as radiotherapy for stage 1 seminoma. New evidence shows that two thirds of patients may have damage in the other testicle, so attempting to conserve the

testicle with the tumour is becoming ever more important, especially as the victiMs of the disease are usually young, as my hon. Friend the Member for Reading, East (Jane Griffiths) has pointed out.

Testicular cancer is the most common form of cancer in young men aged 24 to 35. If the testicle were to be removed and the other testicle became infected, a young man could be left infertile. That could be very sad for the men affected, adding to the stress and worry already caused by having such a disease.

Testicular cancer is an unusual cancer because it can sometimes be eliminated very quickly; the cancer is particularly susceptible to treatment. The number of drugs that work when other, more conventional drugs have failed to work is increasing. That sets apart testicular cancer from other cancers, and scientists are asking whether they will be able to learn something valuable from a study of the cancer, which could help in the treatment of other cancers.

Photo of Ian Gibson Ian Gibson Labour, Norwich North

Does my hon. Friend agree that the work of BACUP—the British Association of Cancer United Patients—and the Cancer Relief Macmillan Fund in advising patients about the problems and looking after them in the traumatic period, has been important? Does she further agree that, because of the success in testicular cancer treatment, we now need to look at reducing the doses of drugs that are given to people because secondary cancers may develop later in life among those young people? It is a British success story in that our cure rates are as good as anywhere else in the world. Now we can think about reducing the number of drugs and the amount of drugs that are given to patients.

Photo of Ms Linda Perham Ms Linda Perham Labour, Ilford North

I thank my hon. Friend for making those points. I pay tribute to him as chair of the all-party group on cancer. I congratulate him on his inspirational, energetic work in focusing attention inside and outside the House on cancer issues.

One scientific discovery often leads to another. That has happened in the advance of treatment for testicular cancer. New knowledge from bone marrow transplantation and leukaemia treatment has led to a development. Patients can now be given double the dosage of chemotherapy that was previously considered to be acceptable. The research has helped patients who have not recovered after one or two conventional treatments, and has led to more research, which has opened up treatments for more common adult cancers, such as cancers of the breast and the bladder.

Currently, improving resistance to, and the early detection of, testicular cancer is regarded as the best way of improving long-term survival. Research is being conducted into screening techniques for testicular and prostate cancer, and into the genes involved in making testicular cancer so sensitive to chemotherapy—in the hope that scientists will be able to make prostate cancer, which is currently resistant to chemotherapy, respond like testicular cancer. If the relevant genes can be identified, potential hereditary risks can be recognised.

The Royal Hospitals NHS trust's men's cancer unit has conducted research into the part that diet plays in developing cancer. Poor nutrition, particularly lack of vitamin A, is increasingly thought to be a factor in many different types of cancer, which may help to explain the large number of deaths from cancer around the east end of London.

I am so impressed with what Colin has done with the charity. By learning from a cancer for which we have a 95 per cent. cure rate, we may learn to develop treatment for currently untreatable cancers.

The Orchid appeal is initially focusing on east London and East Anglia, not least because Colin Osborne is a north-east Londoner, but also because of the relative lack of funding in those areas in the past 15 years. There are plans, however, to work towards achieving national and overseas targets as part of the charity's research. That may be helpful in explaining why there is global variation in the incidence of testicular and prostate cancer. The funding issue is the obvious reason why the appeal has been started.

In a written answer given, on 9 November 1998, to my hon. Friend the Member for Bolsover (Mr. Skinner), central records showed that totals of over £18 million for breast cancer research, over £10 million for cervical cancer research, and a mere £265,000 for prostate cancer research were provided in the five-year period 1993–98. In the past few years, much good work has been done to highlight women's cancers. There is now a very active and well-supported all-party group on breast cancer. I am therefore very pleased, as I said, that a new all-party group on male cancers was formed on 17 November 1998.

I have already paid tribute to my hon. Friend the Member for Reading, East, who has been very active in working with the Everyman campaign of the Institute of Cancer Research. I should like to mention also the hon. Member for Mid-Dorset and North Poole (Mr. Fraser), who, on 12 May 1998, initiated a debate in the House on the subject of prostate cancer screening.

I am very encouraged by the interest and support shown by hon. Members. I hope that my hon. Friend the Minister will join me in congratulating my constituent, Colin Osborne, and all those who have been involved in the Orchid Cancer Appeal on their work in promoting awareness of male cancers. I should like my hon. Friend also to give some indication of the Government's view on the future of screening, treatment and research into cancers affecting men.

Photo of John Hutton John Hutton Parliamentary Under-Secretary, Department of Health, Parliamentary Under-Secretary (Department of Health) 10:13 pm, 10th March 1999

I warmly congratulate my hon. Friend the Member for llford, North (Ms Perham) on raising the subject today, and on her very thoughtful and constructive comments. I also join her in applauding and congratulating Colin Osborne on his strength and determination, not only in his fight with cancer, but in continuing the fight for all other men through the Orchid Cancer Appeal—a charity that Colin established and which raises considerable sums for research.

Little is known about the causes of testicular cancer. There may be a family history of testicular tumours, and northern Europeans have a greater incidence of the disease than do southern Europeans, with Denmark having the highest percentage of cases. The cancer is rare in non-Caucasians, except among Maoris in New Zealand. Similarly, the causes of prostate cancer are poorly understood—although we know that a family history increases the risk of developing the disease. There is evidence also that a high-fat and low-vegetable diet increases the risk.

Therefore, unlike lung cancer—of which we know that smoking greatly increases the risk—we are not yet able to advise men of ways in which they might reduce their risk of developing prostate and testicular cancer. There are other steps that we can and are taking, but, because so little is known about these cancers, the Government are committed to raising self-awareness of symptoms so that early diagnosis and referral can be made. I shall say a few more words about that in a moment.

My hon. Friend referred to the incidence of the disease and its mortality rates. Testicular cancer is the most common cancer in men in the UK aged between 20 and 34, an age at which cancer is comparatively rare. Around 1,000 new cases in total are registered each year, over half of which occur in men under 35. Incidence rates are rising for both testicular and prostate cancer, but it is encouraging that the overall mortality rate for both cancers has fallen. Indeed, for testicular cancer the death rate halved in the 20 years to 1992, and there has also been a welcome, but modest, fall in mortality rates for prostate cancer since 1993. However, the fact remains that prostate cancer is second only to lung cancer as a cause of cancer deaths in men.

As the Orchid Cancer Appeal recognises, research into the causes and treatment of these cancers is vital. The Government are firmly committed to encouraging research into the causes, prevention, early detection and treatment of all cancers, including testicular and prostate cancers. The Department of Health spent £8.4 million on cancer research in 1996–97. The Scottish Office spent a further £500,000 and, as part of the NHS research and development programme, an additional £1.2 million has been spent.

The research and development strategic framework for the use of the national health service R and D funding is being reviewed. As part of that review, five topic working groups have been established to consider research coverage in key areas. One such group is considering cancer. The outcome of the reviews will help guide future priorities for research expenditure through the NHS research and development levy.

The main agency through which the Government support biomedical and clinical research is the Medical Research Council. The council, as many hon. Members will know, is an independent body deciding what research to support according to its own expert judgment. The council spends, on average, £13 million a year directly on research into cancer, and much other research funded by the council is also relevant to our understanding of cancer—for example, research into genetics and health, the immune system and infections.

One area in which there is considerable scientific interest is recent evidence that has suggested a possible role for environmental oestrogens, which have been linked to falling sperm counts. As my hon. Friend mentioned, some reports suggest that there is a connection between low sperm counts and testicular cancer. The United Kingdom, I am glad to say, is playing an important part in international activities in this field, not least through the Medical Research Council's reproductive biology unit, and the Institute for Environment and Health. However, despite a lot of research, it is still not clear that sperm counts have been falling over the years and we know of no evidence that low sperm counts, as such, indicate a risk of developing testicular cancer.

In April last year, we announced a £1.7 million programme of epidemiological research over three to four years into the possible relationships between chemical exposure, sperm counts, and penile congenital abnormalities. This is a joint programme involving three Government Departments and the European Chemical Industry Council. We are also funding an 18-month epidemiological study of testicular cancer, prostate cancer and the condition now known as—I am going to have trouble with this one, Mr. Deputy Speaker— cryptorchidism, in which the testicles have incompletely descended, which is known to lead to an increased risk of testicular cancer.

On the subject of screening and awareness, there is currently no certain method by which a man can reduce his risk of developing testicular cancer. There is also no effective screening method for testicular cancer, so the focus must be on raising awareness, early detection and high-quality treatment.

The Department of Health launched a campaign to encourage testicular awareness in the hope of reducing death from this disease. The Department, in conjunction with the Imperial Cancer Research Fund, published the leaflet "A Whole New Ball Game" in the summer of 1995. Distribution of the leaflet is targeted on the age group most at risk, young men at universities and sixth form colleges, as well as GP surgeries, pharmacies and so on. The aim is to make men aware of what is normal and, when there are any unusual changes, to realise the importance of contacting a doctor early to ensure the maximum chance of cure.

There is also no method by which a man can reduce his risk of prostate cancer. Of course, there are calls for the introduction of a screening programme for prostate cancer. The Department of Health's standing group on health technology therefore made prostate cancer one of its original priority areas for health technology assessment. The Department commissioned two systematic reviews of the diagnosis, management and screening of early localised prostate cancer from the university of Bristol and the Institute of Cancer Research.

The results of the two reviews were published early in 1997. They produced a clear recommendation that the current evidence did not support the introduction of a national screening programme for prostate cancer with the available technology. I am well aware that that recommendation came as a disappointment to many, but it is important to understand the reasons for it.

Current evidence suggests that the introduction of a screening programme would result in unnecessary, painful and potentially harmful treatment for many men. Although prostate cancer can be a killer, the evidence suggests that many prostate cancers are slow growing and unlikely to cause clinically important symptoms during a man's life. Autopsy studies show that 30 per cent. of men over 50 who had no symptoms of prostate cancer while alive had histological evidence of prostate cancer at the time of death. That figure rises to over 50 per cent. in men over 80 years of age.

It is ethical to offer someone a screening test only when it is likely to do more good than harm. Given the lack of evidence of benefit and the possibility of harm, the reviews concluded that a national prostate screening programme could not be justified. It was on the basis of those studies that the national screening committee recommended that there was no case for a national prostate screening programme. Ministers accepted the recommendation, and guidance issued in June of last year advised health authorities that prostate cancer screening should not be routinely offered to patients.

However, prostate cancer continues to be a priority for the Department of Health. The Department's health technology assessment steering committee recently agreed to fund a £200,000, 12-month feasibility study for a trial of treatments of localised prostate cancer. It is expected that the study will lead to further research. The national screening committee continues to keep the position under close review.

I am aware of the excellent work achieved by Professor Tim Oliver of St. Bartholomew's Hospital, who leads the group that includes north-east Thames hospitals, hospitals in Ipswich and west Suffolk and Addenbrooke's. Professor Oliver, who specialises in cancer of the testis, has achieved a formidable 97 per cent. success rate in treating it.

We are continuing to improve cancer treatment and care. Fortunately, testicular cancer is highly susceptible to modern methods of treatment. The survival rate for those with early-stage disease is between 95 and 100 per cent. My hon. Friend the Member for Norwich, North referred to some important advances in treatment. Combination chemotherapy has proved highly successful for patients with metastatic disease and about 90 per cent. can be cured.

The Government are determined to improve services for all cancers, including men's cancers. A great deal of work has already been undertaken to implement the recommendations contained in the Calman-Hine cancer framework and supplemented by subsequent guidance. A key element has been the identification of cancer units and cancer centres and the local agreement about which cancers should be treated at each hospital.

The Government have signalled their commitment to making cancer waits a priority. The White Paper "The new NHS" guarantees that everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding that they need to be seen urgently and requesting an appointment. Those arrangements have been guaranteed for everyone with suspected breast cancer by April 1999 and for all other cases of suspected cancer by 2000. We recognise that that will be particularly challenging for urological cancers such as prostate cancer. Achievement of the target will bring about real benefit by enabling prompt diagnosis.

Cancer is one of four target areas in the Green Paper "Our Healthier Nation", which set out our aim to reduce the death rate from cancer among people aged under 65 by at least one fifth by the year 2010. Progress on those targets through local partnerships and healthy settings, involving business and workplaces, will have a major impact on the health of men. Health care services will be encouraged to respond to the needs of the local communities—for example, where needs are identified, consideration should be given to having well men clinics, which could bring male-specific cancer, such as testicular cancer, to attention earlier.

Photo of Mr Tam Dalyell Mr Tam Dalyell Labour, Linlithgow

How much money from the Wellcome foundation is involved here? Can we have an assurance that any lack of screening is not connected with a shortage of financial resources?

Photo of John Hutton John Hutton Parliamentary Under-Secretary, Department of Health, Parliamentary Under-Secretary (Department of Health)

I do not have the figures for the Wellcome foundation with me, but I can assure my hon. Friend that resources are not an issue in this case.

The Government welcome initiatives such as the Orchid Cancer Appeal and the Everyman campaign launched by the Institute of Cancer Research last year.

My predecessor—the current Minister of State, Home Office, my hon. Friend the Member for Brent, South (Mr. Boateng)—indicated our support to the first all-party parliamentary group for male cancer. It is through initiatives such as those that we can increase public awareness of the symptoms and need for early diagnosis for those cancers.

My hon. Friend the Member for Ilford, North has done a singular service to the House tonight in allowing us the opportunity to discuss these important issues. I am sure that she will continue to take a close interest in these matters and, together, we will continue to improve the services for our constituents.

Question put and agreed to.

Adjourned accordingly at twenty-six minutes past Ten o'clock.