Cervical Screening — [Mark Pritchard in the Chair]

– in Westminster Hall on 19th July 2021.

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Virtual participation in proceedings commenced (Order, 25 February).

[NB: [V] denotes a Member participating virtually.]

Photo of Mark Pritchard Mark Pritchard Conservative, The Wrekin 4:30 pm, 19th July 2021

Hon. Members will be aware that social distancing is no longer in operation. I remind hon. Members that Mr Speaker has encouraged us all to wear masks. I also remind hon. Members that there have been some changes to normal practice in order to support the hybrid arrangements that we have today. I remind colleagues participating both physically and virtually that they must arrive for the start of the debate, as I think they have today, and Members are expected to remain for the entire debate, please.

I must also remind Members participating virtually that they must leave their camera on for the duration of the debate and that they will be visible at all times, both to each other and to those of us here in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address, which is westminsterhallclerks@ parliament.uk. Members attending physically should still clean their places when they leave, to ensure that other hon. Members can come into a place that is clean.

Photo of Tonia Antoniazzi Tonia Antoniazzi Labour, Gower 4:31 pm, 19th July 2021

I beg to move,

That this House
has considered e-petition 317336, relating to cervical screening.

It is a pleasure to serve under your chairship, Mr Pritchard, for this really important debate. I apologise for not being able to be there in person today, but I thank the House for these hybrid proceedings because I was pinged last week.

I will begin by putting on the record my huge thanks to Caitlin, who is Fiona’s sister, for speaking to me last week about Fiona’s case and the way that it has affected her whole family. I also thank Fiona’s friends, Melissa Macdonald and Niamh Foley, who started the petition, and all those who have signed it, which led to this debate being held today.

As a woman, I know that we all sort of dread getting the call-up for our smear test. For most women, it is not painful, but it is uncomfortable and awkward. What can someone even chat about when the nurse is having her little look? But why should it be like that? We have all been there; the nurse has seen it all before. It is just not spoken about, so we feel a sense of shame about it. It is time we stopped being so coy about it, because that may well persuade more women to go for screening and ultimately it may save lives.

Cervical cancer is one of the most common cancers in women under 35, and 99.7% of cervical cancers are caused by human papillomavirus, or HPV. In recent years, testing for HPV has meant that it is easier to identify who is at greater risk from cervical cancer at the earliest stage.

During covid, England had an attendance rate for smear tests of 72%, which means that more than one in four women are not going for screening when invited to do so. The wonderful charity Jo’s Cervical Cancer Trust has a number of ideas to increase the uptake of smear tests, and I suggest that the Minister meets it to discuss ways of increasing the number of women being tested; I know that she has a keen interest in women’s health.

I was really moved when I spoke to Caitlin, because I got a real sense of how difficult it must be to lose a sister, especially at such a young age. Fiona was only 30 when she died. She was married to Andrew and was the mother of two young children. When Fiona died, Ivy was only four and Harry had just turned two. As Caitlin said, Fiona used all her strength to stick around for Harry’s second birthday.

Fiona was called for her first smear test in 2015, but she was pregnant with Ivy and so was told not to go. When she was called again, she was pregnant with Harry, but there was no follow-up to the first appointment. Fiona never received a reminder to go to her smear test in the interim. This situation is not about someone missing appointments when called to attend them; Fiona went to every appointment that she was meant to go to.

Fiona’s cancer was finally diagnosed after a routine smear test in 2018. She did not have any symptoms, but there seemed to be a lot of hold-ups and delays before her cancer was diagnosed. Caitlin mentioned that it could perhaps have been because of Fiona and Andrew moving from England to Scotland that Fiona received her first invitation. That raises questions about communications between the devolved Administrations and about what procedures are in place to make sure that communication between different trusts and devolved countries is clear.

A hysterectomy was performed and Fiona then went through chemotherapy and radiotherapy as a belt-and-braces approach to dealing with the cancer. After that, Fiona had a number of visits to A&E, including one where the doctor later admitted that she knew the problem was cancer and not a hernia, but did not say anything as Fiona was seeing a specialist soon after.

Most of us are not medical experts. We rely on doctors to tell us the truth because we do not know what is going on, and that vulnerability is really exposed when we hear such stories. I know it is extremely rare to hear stories such as Fiona’s, and the vast majority of our doctors, nurses and other health service staff really care, but it is shocking none the less.

Before covid hit, cancer services were already struggling due to severe staff shortages. Despite the incredible efforts by staff, a backlog has built up. Relying on current staff, who again have not had a pay rise, to clear the backlog on top of delivering regular services will only lead to burnout. It is just not sustainable. Research from Macmillan Cancer Support in 2017 showed that 2,500 specialist cancer nurses were needed to maintain cancer services. By 2030, we will need 3,700 new nurses—an increase of 124% on 2017 levels. Those figures will also have been hugely impacted by the pandemic. The Government have come forward with their own cancer workforce strategy, which is inadequate, and I implore the Minister to reconsider the plans that they have and come up with something that will really help those living with cancer.

Everything that happened to Fiona came before the pandemic hit last year. We have heard countless times about the delays in diagnosis and treatment that the last 16 months has caused. Approximately 1.5 million smear tests take place every year. With the pressure on the NHS since March 2020, that could mean 1.5 million women missing out on a vital tool in diagnosing cervical cancer.

We know that the rates of covid infection are on the up. Hospitalisations for covid are rising, and some NHS trusts across the UK are already cancelling operations as they are at capacity. The recklessness of so-called “freedom day” in England and the removal of all the measures that have been in place to keep us safe is therefore unbelievable. Putting the immunosuppressed at risk, such as those going through cancer treatment, is downright dangerous, and I am glad that the devolved nations have taken a more cautious approach.

What will the extra pressure on the health service mean? Another delay in getting a smear test. And what will that do to the outcomes for so many young women? What will the Government do to make sure that those women who miss out are not left behind, and to stop a knock-on effect on testing? We are looking at new ways forward. Fiona’s case has highlighted some of the gaps that were there before the pandemic started, and things have only deteriorated since covid hit. We must work together to make sure that cancer services are the best that they can possibly be, and that our cancer workforce is protected and given all the tools that it needs to continue to save lives.

When Fiona got really ill, her daughter Ivy used to ask why mummy had to spend so much time in bed. To stop another family having to answer those questions, I want the Minister to answer the questions that Fiona’s family and friends, and all of those who have lost someone to cervical cancer, need answers to. What procedures are in place to make sure that women like Fiona do not fall through the cracks? How does that work across the devolved nations? What is the current screening backlog? What plans to increase the cancer workforce are currently in place?

Caitlin finished our meeting by saying that any change that could come from this debate—if one life is saved, or if one family does not have to go through what her family have been through—would make it worth it.

Photo of Mark Pritchard Mark Pritchard Conservative, The Wrekin

Before I call John Lamont, I have to say that even though the attendants have been fantastic in helping with the air conditioning, it is still very warm, so if hon. Members want to remove jackets, they should feel free.

Photo of John Lamont John Lamont Conservative, Berwickshire, Roxburgh and Selkirk 4:39 pm, 19th July 2021

It is a pleasure to serve with you in the Chair, Mr Pritchard.

I am pleased to speak in today’s important date, which has attracted so much support from my constituents in the Scottish borders, with almost 3,000 signatures coming from Berwickshire, Roxburgh and Selkirk—the highest number across the United Kingdom. This can be explained by the fact that the petition was launched by borderer Andrew Mathewson, who lives in Kelso, in my constituency. As we have heard, Andrew tragically lost his wife Fiona, mother of Ivy and Harry, when she died after battling cervical cancer for 17 months, aged just 30.

I have met Andrew, and I admire the way that he has campaigned tirelessly for cervical cancer screening, in memory of Fiona, and dedicated his work to ensure that other families do not go through what they had to. Fiona’s story is close to the hearts of many people in the Scottish borders who know the Mathewsons, and indeed many people far beyond and across the country, with over 146,000 signatures recorded in total for the petition.

The NHS and this policy area are devolved to the Scottish Parliament, and my comments will have a distinctive Scottish slant. Around 850 women die from cervical cancer each year in the UK. Sadly, that is more than two women every day. Yet cervical cancer is one of the most preventable cancers for two key reasons. First, cervical screening tests check for abnormal changes in sample cells from the cervix. Cervical screening is not a test for cancer, but early detection allows action to be taken to prevent cervical cancer from developing.

Second, the HPV jab is on offer to every child between 12 and 14 in Scotland. For girls, it is designed to protect against types of HPV that cause around 70% of all cases of cervical cancer in Scotland. In most people, HPV does not cause harm and the infection clears on its own, but in some cases HPV infection can lead to cell changes that progress into cervical cancer. Taken together, cervical screening and the HPV vaccine mean that cervical cancer can be avoided.

Cancer Research UK has stated that cervical screening is the best protection against cervical cancer, yet in Scotland it is offered far less frequently than in the rest of the UK. In England, Wales and Northern Ireland, women between 25 and 49 are screened every three years, but women in Scotland face a five-year wait between each screening. Over the past year, some women were notified that their waiting time of five years would be extended as NHS Scotland rightly diverted time and resources to tackling covid-19. However, I am pleased that the resumption of cancer services, including cervical screening, are now being treated as a priority by NHS Scotland.

Alarmingly, this transparency from NHS Scotland was not mirrored by the Scottish Government, who failed to reveal that a number of women had developed cervical cancer after being wrongly excluded from the screening programme following a hysterectomy. One of those women tragically died. The SNP Government were made aware of the errors back in a December audit, but waited until the last day before the summer recess to reveal the scale of the problem to the Scottish Parliament.

This debate is not about party political point scoring, but it would be wrong of me not to highlight the concerns of anxious women, their families and the wider public, who were left in the dark by Scottish Ministers who prioritised their political campaign and attempted to avoid scrutiny. These serious errors have affected hundreds of women, with more cases potentially still to be identified.

The crux of this debate on cervical screening is about the opportunity to reduce the number of women who tragically die from cervical cancer. In my closing remarks, I would like to address some ways in which we can reduce this number of preventable deaths. Evidence shows that the women most likely not to attend a cervical screening appointment are those between the ages of 25 and 34. Yet the evidence also indicates that cervical cancer is the most common cancer in women in this age group. Awareness needs to be raised among women. There is a real incentive to ensure that resources are dedicated to this cause, since cervical cancer can be prevented.

One method that has been trialled in London has involved GPs sending text messages about cervical screening appointments, instead of relying on sending letters through the post. Stigma also needs to be addressed: personal barriers such as lack of knowledge about the purpose and benefits of the test, as well as fear and anxiety about the procedure itself, can play a role in women not attending their appointments. Finally, the Scottish Government should listen to the worries of some Scottish women, who say that they are concerned that they would develop cervical cancer within the five years and just would not know about it.

I end by again paying tribute to Andrew Mathewson and his family and friends, who have been at the forefront of this petition and have ensured that we are debating this important issue today. Andrew continues to selflessly battle on behalf of women he does not even know so that fewer families will have to lose a wife, a mother, a sister or a daughter to this cancer.

Photo of Alex Davies-Jones Alex Davies-Jones Shadow Minister (Northern Ireland) 4:45 pm, 19th July 2021

It is a pleasure to serve under your chairship today, Mr Pritchard, and I am incredibly grateful to be called to speak in this debate on a topic that, as colleagues may know, is extremely close to my heart. It is also a pleasure to follow John Lamont.

Fiona’s story is tragically similar to so many other women’s stories across the country, and my thoughts and condolences are with the whole Mathewson family. As elected representatives, we have the great fortune of being able to speak up on a huge range of the issues that matter most to the people who live in our local communities. It is a fantastic privilege, and one that is not at all lost on me, but there are still certain debates that speak to us as people, not just as politicians. I will always be a vocal and loud champion of cervical screenings, and I am grateful that we are taking the time to speak about this important issue today.

We know that cervical screenings are the best way to protect against cervical cancer: the numbers speak for themselves. Indeed, cervical screenings can prevent more than seven in 10 diagnoses. Those who know me well will know that I speak about cervical screenings whenever and wherever I possibly can, mostly because a delayed cervical screening changed my life almost overnight. Like many others, I put off having my first cervical screening at the age of 25 for all the usual reasons: I was too busy, I did not have the symptoms, and I simply had other priorities. After many conversations with friends, most of whom gave me a good telling-off when I shamefully revealed that my screening had been delayed, I booked my appointment and thought nothing more of it.

While most of us will agree that cervical screening is probably not up there with our top 10 favourite things to do on a morning, the test itself is relatively quick and simple, but as many of us will know, the wait for the results—for that NHS letter arriving on our doorstep—can feel genuinely endless. In my opinion, it is the hardest part about being tested.

Fast forward to a few months after the screening, and I was sat in my local hospital undergoing a colposcopy after my initial test results came back abnormal and further examinations were required. I was genuinely terrified. Everyone had told me that a routine screening was nothing to be concerned about: that it would just be five minutes of awkward conversation with the nurse at my local GP practice, and it would be job done for the next three years in Wales. Sadly, that was not the case for me. I was told that I had abnormal CIN 3 cells that, if left undetected and untreated over a number of years, could develop into cervical cancer. We always think it will not happen to us, but there I was at the age of 25, diagnosed with CIN 3 on a large area of my cervix.

The next few weeks were a complete blur. I became obsessed with googling everything I could about abnormal cells, potential treatment and cervical cancer. I became a prolific poster on, and reader of, the excellent Jo’s Cervical Cancer Trust forum, and I found comfort in talking to others who had gone through, or were going through, exactly the same thing. Thankfully, the staff at my local hospital were incredible, and almost immediately I underwent LLETZ—large loop excision of the transformation zone—treatment to burn off the abnormal cells on my cervix. I went to that appointment alone. It was one of the most surreal moments of my life and one that, try as I might, I will never forget. After the doctor had finished—which felt like an eternity at the time—she did not look happy. More treatment was needed. She told me that on closer inspection, the abnormal cells on my cervix were embedded deeper and looked more challenging than initially expected. I will never forget those words.

The next stage for me was a cold knife biopsy. Thankfully that minor operation went smoothly, and a few weeks later I got the call that I had desperately hoped for: the clinicians were confident that all the abnormal cells had been removed. The damage was quite severe, and if I had put off that initial cervical screening test any later, the situation would have been very different. The extent of the treatment meant that I was now without the majority of my cervix. Of course, having that treatment comes with risks, such as a slightly increased chance of giving birth prematurely, but by that point I did not really care: I just wanted the nightmare to be over.

I was without the majority of my cervix, but my life was saved. Sadly, for many—as we have heard, tragically, in Fiona’s case—that is not the case, and I count my lucky stars that my friends gave me the push I needed to book my cervical screening when they did. After receiving treatment, I attended screenings every six months to ensure the abnormal cells did not return. Even now, years down the line, my screenings are more common than most, and I go on an annual basis.

It would be wrong of me to pretend that I have not been impacted on by the ordeal I went through. The physical scars might be internal, but I will always grapple with the mental effects. Even years on, I still get that nervous feeling in my stomach before I go to my screening. However, we have all seen the numbers—my hon. Friend Tonia Antoniazzi touched on them in her opening remarks—and we can all recognise the devastation that cancer, in its myriad forms, can have on those suffering and on their close friends and family. It goes without saying that we should be doing everything we can to protect those who may be particularly at risk of developing cervical cancer, and regular cervical screenings are absolutely key if more lives are to be saved.

Although I am pleased to say that there has been progress on specific incentives to encourage more people to attend their screenings, cell changes such as mine often fall through the gaps, along with HPV. HPV diagnosis is still associated with high levels of fear, confusion and stigma and a lack of understanding, despite it being an incredibly common virus. Jo’s Cervical Cancer Trust recently surveyed its community of users who have HPV and found that one in two people said they knew nothing about HPV prior to receiving a diagnosis. Interestingly, people with recurrent or persistent HPV report feeling let down by their bodies and anxious about the ongoing and uncertain nature of the condition, and they often feel that there is no support or information for them either. There is clearly a need for increased education when the vaccine is first given, greater awareness of how common it is and how it affects the body, and greater information and support for those affected.

The same goes for cell changes such as mine. Around 220,000 women each year will be told that they have cell changes, and many will be treated to prevent the potential development of cervical cancer. There are opportunities to improve the care that is offered. We know that treatment for cell changes is highly effective at preventing the development of cervical cancer, the impact of which can be truly devastating, but more must be done to ensure that women diagnosed with cell changes are properly supported before, during and after treatment. Research from Jo’s Cervical Cancer Trust found that 20% of women said the possible impacts and side-effects of treatment were not explained to them beforehand. Even more shockingly, 60% were not told about the different types of treatment that were available to them. It is clear that although progress has thankfully been made on the dialogue around cervical screenings, we still have a long way to go to change the situation more broadly.

I am hopeful that today’s debate will send a reminder to those who, like me, put off their cervical screenings. I also hope that by touching on issues such as HPV and cell changes, people can learn about the broader benefits of screening too. Although health is of course devolved to the fantastic Welsh Labour Government, I truly believe that this is an issue that crosses the political divide. Indeed, I look forward to hearing from the Minister about the work that she is doing, including across Government Departments and the devolved nations, to encourage better understanding of the widespread benefits of cervical screening.

Photo of Margaret Ferrier Margaret Ferrier Independent, Rutherglen and Hamilton West 4:52 pm, 19th July 2021

It is a pleasure to serve under your chairmanship, Mr Pritchard, and an honour to speak in this important debate. It is an absolute pleasure to follow Alex Davies-Jones and hear her personal story. I am sure we are all glad to see her today.

The petition is a proposal to introduce yearly cervical screenings for all women. As we have heard, the campaign for Fiona’s law was launched after the untimely death of 30-year-old mum Fiona from Kelso in the Scottish borders. Cervical screening is unequivocally the best method of protection against cervical cancer, and I think I speak for us all when I say that I hope to see greater uptake of screening. Unfortunately, prior to the pandemic one in four women across the UK did not accept their invitation for screening. The figure is higher in areas such as London and Glasgow, among women under 30 years of age, and among groups who face additional systemic barriers to their attendance—for example, this issue disproportionately affects LGBTQ people, with 40% of lesbian and bisexual women in the UK having been told that they do not require cervical screening. Experience of trauma or violence can also deter women from attending, with 72% of women who have experienced sexual violence delaying or cancelling their appointments.

Most clinicians would largely disagree with the proposal to make cervical screening annual. The UK National Screening Committee sets the eligibility criteria for screening programmes and makes recommendations about changes in order to maximise the benefits and minimise harm. Cervical screening starts at the age of 25, not 18, as HPV is very rare in younger women, with fewer than four cases per 100,000, due to the high uptake of the HPV vaccine. Around 90% of HPV infections are cleared naturally by the body in two years, and many cell changes return to normal without the need for treatment. Research generally suggests that a lower screening age does not substantially reduce cases and can in fact lead to over-treatment, which can have serious implications on physical and mental health, including on the ability to carry a child to term.

A more viable option for increasing the uptake of cervical screening would be to roll out widespread HPV self-sampling, which would allow women to enjoy the comfort and convenience of performing the test in their own homes. Research by Jo’s Cervical Cancer Trust suggests this would greatly increase uptake, with 47% of women who rarely or never book a test preferring self-sampling to clinician-led screening. Only 9% preferred clinician-led screening, while 50% of women who are overdue for an appointment and 34% of women from black, Asian and minority ethnic backgrounds also preferred self-sampling. Some 63% of those living with a physical disability have noted that their disability made it impossible for them to attend screening. Making self-sampling possible would put the screening process into women’s own hands.

For that to be recommended by the UK National Screening Committee, far more research into this procedure is required. At the moment, only a few pilot schemes are being run: one in Scotland, in Dumfries and Galloway, and another in London. It is essential that progress on these vital studies continues. It would be helpful to know whether the UK Government plan to increase support for such schemes, to accelerate studies into the viability of HPV self-sampling nationwide, and to give an estimate of when the necessary research will be collected by NHS England.

While annual cervical screening may not be realistically viable or desirable, we can take concrete steps to ensure that access is widened, risk is adequately assessed and appointments are not missed. I hope the Department of Health and Social Care will take on some of these considerations, especially with regard to advancing the research into, and roll out of, home HPV self-sampling.

Photo of Taiwo Owatemi Taiwo Owatemi Labour, Coventry North West 4:57 pm, 19th July 2021

It is a pleasure to serve under your chairmanship, Mr Pritchard, and to follow Margaret Ferrier, who spoke with great passion about this crucial issue. Cervical cancer is something that all women fear. It is not only a deadly disease but one, like breast cancer, that strikes at the heart of how we view ourselves as women.

The petition that we are discussing on Fiona’s law received more than 146,000 signatures, with many from my constituents. That figure represents a groundswell of people who are concerned that not enough is being done to ensure detection of cervical cancer for women in the UK. We cannot ignore them. To detect cervical cancer early, we have developed highly accurate screening tests that enable women to know whether they have pre-cancerous cells, and if so, to receive the proper treatment. In fact, women will be tested for HPV before they get cervical screening, because 99.7% of all cervical cancers are caused by HPV. Simply put, thanks to our researchers and all the medical professionals across our NHS, tests for cervical cancer are more accurate than ever before.

There is much debate in this country about how early and how frequently women should be screened for cervical cancer, but women are only able to have their cancer detected if the screenings are successfully performed. Research on how often women access existing appointments should give us real cause for concern. We all know that the pandemic has had devastating effects on women’s ability to access life-saving cervical cancer screening. Jo’s Cervical Cancer Trust estimates that around 600,000 tests failed to go ahead in the UK in April and May 2020, and figures show that cancer screening for women in the 25-to-64 age group—the most vulnerable age group—decreased by nearly 7% from the previous year. These figures are completely unacceptable and show that the recent physical barriers to screening have a strong negative impact on women’s access to preventive services.

However, figures also show an equally strong mental impact. Unfortunately, this life-saving smear test remains a source of great anxiety to many. Earlier this year, it emerged that around one in four women eligible for smear tests do not take up the invitation. New research has found that, among those who do not go for their cervical cancer screening, 75% are scared at the thought of going and 81% are embarrassed to go.

The Government must do more to create public awareness about the test. They must normalise it, so that women do not feel embarrassed to seek this vital service, and bust other myths that induce anxiety about it. Perhaps most worryingly, Jo’s Cervical Cancer Trust has published a study that reveals that women from black, Asian and minority ethnic backgrounds are twice as likely to be strongly worried about contracting a virus at their cervical cancer screening as their white counterparts, and a third more likely to feel unsafe visiting a doctors’ surgery than white women.

It is vital that the Government look more closely into the cultural and mental barriers preventing black, Asian and minority ethnic women from accessing life-saving screening in much higher proportions. They must dedicate more resources to learning why women, especially those from minority backgrounds, are not taking up their testing appointments. That is crucial to achieving a reproductive health programme that is not only thriving but equal. I look forward to hearing from the Minister on the work that she is doing.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 5:01 pm, 19th July 2021

It is pleasure to serve under your chairmanship today, Mr Pritchard, as I often have in this Chamber, and I very much look forward to the Minister’s response. I very much look forward to speaking in this debate on cervical cancer screening.

I stand here to speak on behalf of my female constituents, whom this directly affects, and I speak in complete support of the e-petition, which had 146,000 signatures. Cancer is a tragedy that all of us know only too well. I am sure it has touched the lives of everyone in the room today. I am sure the Minister will not mind me saying that she has been directly affected, and we are very pleased to see her here as a survivor.

We must take every necessary step to catch cases sooner rather than later. The petition for Fiona’s law applies to women in England. However, I speak on behalf of my constituents and the women of Northern Ireland. It is estimated that some 3,200 women will be diagnosed with cervical cancer every year in the UK. Eighty people in Northern Ireland are diagnosed every year, and roughly 20 to 30 of those women will, sadly, pass away from the disease. The Public Health Agency in Northern Ireland has said that early detection and treatment can prevent seven to 10 types of cervical cancer. As John Lamont mentioned, Northern Ireland offers screening every two years. I would like to see it done better. I would like to see it every year; that is the best way to do it. The request is for early detection and treatment as the way to prevent cervical cancer.

It is important to remember that screening is not a test for cancer; it is a test to help prevent it. That is what we are trying to do, and that is why, to assist in preventing cervical cancers, we must do more to ensure that women have screening appointments regularly. Current legislation states that women between the ages of 25 and 49 will be invited for screening once every three years, and those aged 50 to 64 every five years. That is in line with the NHS’s long-term plan to detect 75% of cancers at stage 1 or 2.

I cannot stress enough the importance of screening appointments for women. First, I can only imagine that it is not a comfortable or easy procedure to go through, but I do believe that the prolonged interval of three years only increases the anxiety. Secondly, yearly screening would allow for more effective diagnosis, but it also provides an opportunity to make a procedure that a lot of women dread having more familiar and comfortable, if that is possible.

The UK’s leading cervical cancer charity, Jo’s Cervical Cancer Trust, report that 51% of women admitted to delaying their screening, that 24% delayed for over a year and that 9%, one in 10 women, have never attended a screening. Those are shocking figures, but they are understandable at the same time. These are lives being lost, and because of the frequency of cervical screening it is getting worse.

There needs to be more communication about screening so that people are aware of what they are going into. That would then provide confidence and would increase the numbers attending, which would ultimately result in lives saved: more mothers, more daughters, more sisters, more grandmothers and more wives living longer and healthier lives. My wife went through it. She did not for one second wish to go. She found the whole thing very uncomfortable and, honestly, a little embarrassing. Obviously, we encouraged her. My mother encouraged her, and I think that probably helped—from lady to lady is probably better. She went for the tests and got the all clear.

Cancer of all kinds has destroyed lives and families for too long. We must do all we can to increase early diagnosis, as the petition calls for, especially in the light of the impact of the pandemic, which has seen a further decrease in screening figures. We need to get back on our feet and allow women yearly screenings. I urge the Minister to undertake discussions with the UK National Screening Committee to ascertain why it feels that women do not warrant screenings every year.

To anyone who is offered a cervical cancer screening, I say please go. I say to the Government that the encouragement from the Minister will start here. More must be done to get more frequent appointments, more awareness of the benefits and more discussion around the appointment itself, because there is nothing more promising than the prevention of disease.

Photo of Mark Pritchard Mark Pritchard Conservative, The Wrekin

Before I call Mike Kane, there has been a slight adjustment to the call list. I will call Dr Philippa Whitford after Mr Kane, and then Alex Norris.

Photo of Mike Kane Mike Kane Shadow Minister (Transport) 5:06 pm, 19th July 2021

Thank you, Mr Pritchard. It is a pleasure to serve under your chairmanship. I add my congratulations to the petitioners on securing a debate in Parliament on such an important topic.

In January 2021, the Minister stated:

“While we do not hold waiting lists for National Health Service screening programmes, NHS England…are confident that no one eligible for cervical screening has missed an invitation for an appointment.”

An invitation is one thing, but being able to book and access a test can be quite a different matter. In the third quarter of 2021, no clinical commissioning groups in England achieved 80% coverage of women invited for a test. I am, of course, aware of the pressures placed on the NHS during the pandemic, and my speech does not denigrate it at all, but 600,000 cervical screening opportunities are estimated to have failed to go ahead in the UK just in April and May of last year.

In October 2019, NHS England commissioned an independent review of adult screening programmes. It highlighted that demographic factors—levels of affluence and deprivation, and ethnic diversity—have a huge impact on whether women take up the tests. For women who live in areas with higher levels of deprivation, such as parts of my constituency of Wythenshawe and Sale East, the coverage of screening programmes is lower than average.

Hologic, a fantastic innovative medical technology company in my constituency, focuses primarily on improving women’s health and wellbeing. It specialises in high-volume population screening. We know that more than 99% of cervical cancer cases are preventable and that, alongside HPV vaccination, cervical cancer screening is one of the most effective ways to prevent that cancer.

There are opportunities to improve screenings, both for clinicians and for patients, by adopting new innovative screening technologies. One such method is using HPV mRNA testing for primary cervical screening. The tests provide significantly higher clarity and would safely reduce the number of women who require a colposcopy, thereby reducing unnecessary fear, anxiety and stress for the women involved. It would also reduce the pressure on an already overburdened system, save the NHS an estimated £15 million a year, and potentially prevent 30,000 unnecessary colposcopy procedures.

Currently, just 54% of all samples in England are processed using that form of testing, meaning that 1.5 million women in England do not have access to the technology. England should move towards a system in which mRNA HPV primary screening is the gold standard used by all labs. With better co-ordination within NHS England, cervical screening would, for example, be commissioned by the same part of the NHS as colposcopies, enabling clinicians to work more effectively together and have a positive impact on patient experience and outcome.

Another innovative technological advance is digital cytology. This advanced imaging technology, used to identify lesions and pre-cancerous cells, which stores cervical images using cloud-based technology, would help maximise screening capacity, enabling any cytologist with capacity in the network to access a particular image. That would provide a much more flexible deployment of the workforce, would speed up time from result to treatment if necessary, and provide physical efficiencies, such as less need for storage and for the transportation of cervical images and slides.

Rolling out such technologies would save not only money and time, but would, in time, reduce the stress on women and girls at a worrying time, as has been pointed out today, as well as reducing the need for unnecessary gynaecological procedures. It would also provide a streamlining of these lifesaving services. I would welcome any comments that the Minister has about those suggestions.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care), Shadow SNP Spokesperson (Europe) 5:10 pm, 19th July 2021

It is an honour to serve under your chairmanship, Mr Pritchard. First, I want to extend my sympathy to Fiona’s family and friends, who were moved by her loss to set up the petition in her name. I have seen at first hand the impact of cervical cancer, as one of my friends lost her beautiful and vibrant daughter at the age of just 28 to this horrible disease. As a breast cancer surgeon for more than 30 years, I know the devastation caused by the death of any young woman.

Before we go further, I want to emphasise that any woman with symptoms of vaginal discharge or bleeding should not wait for a screening appointment, but should go and see her GP. There is usually a simple cause, but it is always important to get checked out.

Although the petition specifically calls for annual cervical smear tests, what we are all actually trying to achieve is the prevention and eventual elimination of cervical cancer, as called for by the World Health Organisation last August. For that we have to understand the cause of cervical cancer, and that is where our knowledge has developed considerably. We know that 99.7% of cervical cancers are caused by high risk strains of human papillomavirus, or HPV, and that is therefore the target of our efforts. This is through a two-pronged strategy, providing protection to the younger generation through vaccination against HPV and using more sensitive polymerase chain reaction testing to detect HPV on cervical smear samples to identify those at increased risk.

The HPV vaccine was introduced for young teenage girls in 2008 and initially included those up to 18 years, so that they would be vaccinated before leaving school. Research from the Scottish cervical screening programme in 2017 reported a reduction in the presence of HPV in the smears of vaccinated women from 30% to 4.5%, and by 2019 demonstrated an 89% fall in grade 3 cervical intraepithelial neoplasia—the cell changes that can evolve into cervical cancer if left untreated. That dramatic reduction in CIN 3 among the first cohort of vaccinated girls gives great hope that we will see a fall in cervical cancer in that age group in the coming years.

The vaccine is now also provided to boys, both to protect them from other HPV-related cancers and to provide additional protection to women by reducing how many men carry HPV in the first place. It is vaccination against HPV that really offers the chance to eliminate this terrible disease by the end of the decade. To achieve that, we need to vaccinate 90% of all teenagers, and our uptake rates have drifted below that level over the past five years. Some of that is likely due to fears that the vaccine was associated with health issues such as chronic fatigue or regional pain syndromes. However, a review by the European Medicines Agency found that those conditions were very common among teenagers generally, and there was no increase among those who had been vaccinated.

To reduce the risk of cervical cancer, we need to get rid of the stigma of HPV and ensure that all women and young people understand its importance in the development of cancer. It is a very common virus, which, in the vast majority of cases, causes no harm and is cleared by the body’s own defences, but some strains pose a higher risk of causing malignant change. After vaccination, the other critical approach to preventing cervical cancer is, of course, screening itself, but here too the focus is now on detecting HPV as the driver of cervical changes that can eventually lead to cancer. Classical cytology, which looks for abnormal cells within cervical smears, does not pick up every case, while PCR, about which we have heard so much during the pandemic, is more sensitive in detecting HPV and identifying the women at higher risk.

The UK National Screening Committee has therefore recommended changing to a two-step testing procedure, with the cervical sample tested for HPV first and then cytology performed on those samples that contain virus. Currently, that is carried out on one sample, which is collected in the traditional way—a clinician having to visualise the cervix directly. If the sample contains HPV, cytology is carried out on the cervical cells. If any changes are found, the patient is referred to a gynaecologist for a colposcopy, where the cervix is examined and biopsied to assess the grade of cell changes.

If the woman is HPV-positive but has no cell changes and therefore would never have been highlighted under the old system, she will undergo repeat screening the following year; if the virus persists after two years, even without cell changes, she will be referred for colposcopy. By focusing on the presence of the virus, women carrying HPV and at higher risk are provided with more intensive follow-up. It is the UK National Screening Committee that has recommended that women who are HPV-negative and therefore at very low risk are offered routine repeat screening every five years, from the ages of 25 to 65. That system has been fully rolled out in Scotland since March last year, but I highlight that the same approach is planned across all four UK nations once the PCR testing and data systems are in place.

Screening remains vital in detecting cervical cancer and its precursors in women who did not have the opportunity to be vaccinated against HPV. But uptake is at a 20-year low, with just over 70% of women attending overall. Attendance is even lower among younger women and those from minority ethnic groups or more deprived communities, as well as among lesbian or transgender people, who make mistakenly think that they are less at risk of HPV infections. The challenge is there for how to engage more women to take part in cervical screening. Changing to annual cervical examination might actually cause more women to withdraw from the programme.

HPV is found in only about 10% of cervical smear tests, so carrying out a simple vaginal swab to test for HPV could reduce the number of women who have to undergo a formal cervical smear with direct visualisation of the cervix. That would avoid the need to use a speculum and reduce the discomfort, which puts some women off taking up future appointments. It would also greatly reduce the difficulties experienced by those with physical or learning disabilities. Indeed, disabled women have been campaigning for years about the fact that those with the greatest physical difficulties often struggle to take part in screening at all.

A team at Dumfries and Galloway health board in Scotland established a trial in 2012 in which over 5,000 women took vaginal swabs themselves as well as getting a formal cervical smear done in the traditional way. That demonstrated both the accuracy and acceptability of this approach and the team is working with the Scottish Government to consider making that part of our routine screening programme. The UK National Screening Committee is still evaluating that approach, but research by Jo’s Cervical Cancer Trust suggests that this simpler method of sampling could get more women to engage and take up HPV testing as the first step of screening.

The issue is particularly important among groups that currently have a much higher risk of cancer but a lower engagement with a screening programme. NHS England has now begun a trial offering self-administered HPV swabs to 31,000 women in parts of London who have failed to attend their routine appointments. My one gripe with that excellent project was that the publicity and social media around its launch described the tests as self-administered smear tests instead of explaining that they were simple vaginal swabs, which a woman should easily be able to carry out at home. That caused a lot of consternation among women, who wondered how on earth they were meant to ensure that they visualised, or took a sample from, their own cervixes. It could put some off from trying to take the sample in the first place. Describing them as smear tests could also lead someone who is HPV-positive to fail to attend their GP practice for formal assessment, if they are under the mistaken impression that they have already had a cervical smear.

The NHS project in London is designed to engage those who have not taken up their routine invitations, but I hope that simple vaginal swabs to test for HPV will eventually become a routine step available to all women—whether self-administered in the privacy of their own home, or by a clinician in their local GP practice. HPV vaccination holds the potential to drastically reduce the number of young women who are even at risk of cervical cancer, but screening will always be important in order to detect cell changes or early cancer, and all of us need to encourage high uptake of both vaccination and screening. Although I recognise the anguish that led Fiona’s family to start the petition, I hope they can see that our understanding of this terrible disease and its cause opens up new and better approaches to eliminating cervical cancer in this coming decade, so that other families do not suffer the loss that they are going through.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care) 5:21 pm, 19th July 2021

It is a pleasure to serve under your chairship, Mr Pritchard. I would not normally make the Front-Bench contribution for the Opposition virtually, but I am afraid that I, too, have been pinged by the NHS app, so I am beaming in live from Nottingham. I thank my fellow pingee, my hon. Friend Tonia Antoniazzi, for securing the debate through her role on the Petitions Committee. The points that she made about testing have been a common thread throughout the debate, but she also mentioned the impact of covid, which I will reflect on shortly.

The petition has received close to 150,000 signatures, which is frankly an incredible effort. As well as showing the strength of feeling on this important topic, it is a physical demonstration of the legacy and impact of young mother Fiona Mathewson, who tragically lost her life to cervical cancer last April, at the age of 30. I send my best wishes to the Mathewson family—Andrew, Harry and Ivy. I lost my father to cancer when I was Harry’s age, and I know the impact that it has on a family. I hope the Mathewson family can take comfort from the incredible campaign that they have run, and from the way that they have been able to turn such awful grief into positive action. It is because of them and because of Fiona that we are here today. I hope they have seen that across the debate all four countries of the UK have been represented with very thoughtful and impressive contributions, starting with their own Member of Parliament, John Lamont. He mentioned the twin giants of prevention—screening and HPV jabs. I, too, will reflect on those.

My hon. Friend Alex Davies-Jones was very generous with her personal experience, and we are glad that it has had the ending that it has had. It might make people watching the debate think about a screening they have missed, whether it relates to their cervical health or otherwise. That is a really important lesson that people have taken from her, and I know that she inspires people in that way.

Important points were also made by Margaret Ferrier around health equity, particularly in the lesbian and bisexual community but also around those who suffer from sexual violence. We really must ensure that we tailor our messages and the way we contact people, in order to understand their different circumstances. They may present in different ways or need different support, and we would always want that support to be available to them.

As always, my hon. Friend Taiwo Owatemi brings her experience as a senior oncology pharmacist. She knows much about the impact of cancer on people’s lives and how to design cancer services. When we talk about covid in the cancer space, we generally talk about missed screenings, the backlog or late presentation, but she made an important point about the mental impact. It is hard for me to imagine what it is like to be called for a smear test, but she talked about hurdles getting in the way and said that this is very big hurdle that can make people set it to one side. That point was very well made and linked to what Jim Shannon said about the importance of effective communication.

Finally, my hon. Friend Mike Kane talked about the importance of brilliant British science, which is something we have seen clearly over the last 16 or 17 months. We need to back our brilliant British science companies, in order to get the best possible outcomes for ourselves here in Britain, and around the world.

As we have heard, every year in the UK around 3,200 people get cervical cancer and Cancer Research UK estimates that 857 people died of cervical cancer in 2018. While the incidence rates have not fallen significantly in the last two decades, the good news is that mortality rates have continued to fall, especially among older patients. Since the beginning of the 1970s, the mortality rate has dropped from 10 women per 100,000 to approximately 2.5 per 100,000. That is significant progress that has saved the lives of many women.

The NHS cervical screening programme is a huge part of this, with the NHS estimating that it saves 5,000 lives a year, which is truly wonderful. In 2019, HPV primary screening was added to the programme, replacing cytology, as Dr Whitford said—a major step that the NHS believe has the potential to eliminate cervical cancer by spotting earlier those 14 types in the HPV infection that combine to be the main cause of cervical cancer.

Earlier diagnosis makes such a difference; quite simply, it saves lives. Where the cancer is diagnosed at stage 1 or 2, one-year survival is over 90%, which drops to 75% at stage 3 and 50% at stage 4. Data from the National Cancer Intelligence Network also shows that the cervical cancer three-year relative survival rate is higher among people diagnosed by screening than by any other route. If there is a message to come out of today’s debate it is the importance of screening.

We know there is scope to improve in this area. Exciting new advances using mRNA, gene therapy, artificial intelligence, combination therapies, robotics and many more, such as those mentioned by my hon. Friend the Member for Wythenshawe and Sale East, will transform our care in cancer. As we restore services affected by the pandemic, we should not be looking to restore what we had 18 months ago, but to embrace new developments and build new pathways of care.

On screening frequency, which this petition relates to, cervical screening in England is offered to the cohort aged 25 to 64. While routine screening is now offered every three years up to the age of 49, and every five years between the ages of 50 and 64, the UK National Screening Committee has recommended that for those who test negative for high-risk HPV, the interval can be extended to five years. I understand that this will be implemented once necessary IT developments allow it. Can the Minister confirm when that is likely to be?

I fully sympathise with and appreciate the arguments for more screenings that have been made in the petition. Any lives saved strengthen the case far more than anything I can say, but I strongly believe that it is right that this decision is made by the experts on the UK National Screening Committee and not by us politicians. Where clinical evidence supports their decisions to screen at the intervals they say and not to extend testing to 18-year-olds, which I know there have been calls for, then we support that.

Beyond that, the Government must do more to increase take-up and ensure that all those eligible for a cervical smear test attend their appointments when they are invited or as soon afterwards as possible. We must also ensure that preventative measures, such as the vaccination, get out into secondary schools and are fully taken up. I would be interested to hear the Minister’s reflections about further plans to develop this, because we know we are not getting it quite where we want to.

The aim is for 80% of women to access their test, with 75% being considered acceptable. In the year prior to the pandemic, it was 72%, a little bit up from 71.9% the year before. That is not where we want it to be and we must do something different. As my hon. Friend the Member for Gower said, the pandemic has worsened the situation.

Jo’s Cervical Cancer Trust estimates that around 600,000 cervical screenings failed to go ahead in the UK in April and May 2020. NHS England’s own data shows that no clinical commissioning group screened over 80% of eligible women in the third quarter of 2021. These numbers are people who could be living either with high-risk HPV or with cancer itself and do not know it yet. I hope that the Minister will expand on the data to paint a fuller picture of the situation as she sees it and to share with us the steps for how these services will be caught up, so that we can reach those who have missed out.

To conclude, those who raised this petition deserve real commendation for their excellent efforts. I am sorry that perhaps the evidence is not pushing us in the direction that they have encouraged us to take. However, I hope that when Harry and Ivy are teenagers, they might look back on this debate—perhaps wondering why we are all beaming in from different parts of the country, in our own bedrooms or in other rooms in our homes—and see that this was a galvanising moment for politicians to come together across Great Britain and Northern Ireland to improve screening rates and the uptake of the HPV vaccine. I also hope they see that, as we went forward, we embraced improvements in technology and cancer care, and that, as a result, we got more and more brilliant outcomes for women in this country. I hope that when they look back in many years’ time, they will be very proud of their role, and the role of their family and their family friends, in achieving that.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care 5:30 pm, 19th July 2021

It is a pleasure to serve under your chairmanship, Mr Pritchard.

First, as I think everybody else has done, I thank those who initiated this petition in Fiona Mathewson’s memory, and I join others in extending my sympathy to Andrew, to Ivy, to Harry, to Caitlin and to Fiona’s broader family, as well as to the 3,000 individuals in Kelso and across the borders who signed the petition.

Like other hon. Members, for example, Alex Davies-Jones, I know how frightening it is to be given this kind of diagnosis, but I can only imagine the impact on Andrew and the loss that he feels. However, if I may say one thing, it is that this debate today is in itself a huge legacy for Fiona, because we are discussing sensibly what we need to do to help women. We are talking, as many people have said, about something that is often seen as a little bit embarrassing. In response to the points by hon. Members that we must improve take-up, I could not agree more. However, we will not achieve that by not talking about some of the challenges that exist.

Cancer screening is crucial and I thank each and every Member who has shown their support for it and contributed to today’s debate. It was eloquently introduced by Tonia Antoniazzi, as the Petitions Committee allowed us to have this conversation across the United Kingdom. The simple fact is that screening saves lives and that is why we need to drive uptake. As we have heard, screening can prevent cancer from developing. It can catch cancer earlier and, as we know, the earlier people are diagnosed the better the outcomes, because there is a greater chance that treatment can be successful.

Thanks to the tremendous work of dedicated screening staff up and down the country, the NHS cervical screening programme reaches about 4.6 million women in England every year and currently saves about 5,000 lives. However, we have heard repeatedly that only about 70% of women actually take up the opportunity, for a plethora of reasons. If everybody did attend, that number of lives saved would be closer to 7,000. More lives would be saved, so when a woman receives an invitation to attend a screening appointment, I encourage her to go.

As Dr Whitford said, if you notice anything amiss, such as bleeding after sexual intercourse, between periods or during menopause, discuss it with a medical professional. Do not wait—it is your body and just treasure it. I say that because screening is one tool, but that knowledge of yourself is another tool that you have to access treatment quickly. NHS services are open, safe and ready to help you. That is another thing that has come through: I want to reinforce the fact that the NHS is open and the services are safe. You must come forward when your invitation for an appointment.

Photo of Alex Davies-Jones Alex Davies-Jones Shadow Minister (Northern Ireland)

Margaret Ferrier talked about some of the challenges faced by the lesbian and bisexual community in accessing appointments, but we also need to recognise some of the challenges faced by our trans community, especially trans men, in accessing appointments. Many of them are not sent reminder letters because of administrative policies at GP services. Will the Minister look into that to ensure that everyone with a cervix who is eligible to attend a screening receives a reminder?

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

Indeed I will. I would be happy to write to the hon. Lady, because I have looked at that issue. If there is a chance that someone may have abnormal cells, they should get them checked out. Taiwo Owatemi spoke about making sure that we reach those communities who would not necessarily come forward, for a number of reasons.

Mike Kane spoke, as several did, about using technology better, and about the challenges of screening and the health inequality that there is in certain communities for access to screening. I have met NHS England several times about that, to think how we can use that technology and different avenues—I will speak in a minute about the self-sampling sample.

We have to think differently about how we encourage women, because not every woman will come forward in the same way. We have different pressures on our lives at different times. Perhaps we are not as good at the younger end, because people think, as the hon. Member for Pontypridd said so eloquently, “I didn’t think it would happen to me.” Perhaps they have a young family or are busy at work. All those things mean that we have to make it as easy as we possibly can to access screening wherever you are and in whatever form suits you, because there are also cultural barriers for some not only to cervical screening but to breast screening, where they are hesitant to come forward.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I referred to my wife, who had some difficulty making the appointment. What she did was talk to my mum. I feel women talking to women is much easier. We should not always push to the back of the queue, for instance, a family member having a substantial discussion. Sometimes it starts with a discussion, before they go to the hospital. It very important to have family members around to support and give advice.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

I could not agree more. We heard earlier that a good group of friends can give someone that nudge when they are feeling a little hesitant. As Members said, it is not the greatest outing of an afternoon, but it can be one of the most important appointments that you may keep, so I urge you to keep it.

I want to assure all women that screening staff are excellently trained to ensure that they feel reassured and comfortable. For those who feel anxious, there is information available online to help them plan their appointment. As many have done, I would like to commend the work of Jo’s Cervical Cancer Trust in raising awareness about what cervical screening entails and how important it is.

Let me turn to the nub of the debate—why screening is not offered on a yearly basis. Currently, cervical screening in England is offered to individuals between 25 and 49 every three years, and between 50 and 64 every five years. For those aged 65 and over, screening is offered if one of the last three results detected any abnormalities. Although health, including how screening is delivered, is a devolved matter, the debate has shown that wherever we are in the country, we need to ensure that health is a priority. We automatically transfer data on a woman’s history to the devolved authorities in Northern Ireland and Wales. I think it was the hon. Member for Gower who raised the question of how we work with devolved authorities: that information goes automatically to Wales and Northern Ireland, but it is still a manual process with Scotland, and work is in progress to make sure we get there.

As I have said, this matter is devolved, but as others have said, we all follow the expert advice of the UK National Screening Committee. The hon. Member for Central Ayrshire pointed out how important it is that we follow the advice of a central body, and in 2015, the UK NSC recommended that a test for HPV be used as the primary screen, because 99.7% of cervical cancers are caused by the high-risk HPV types. I could not agree more with one hon. Member—I apologise; I do not remember who it was—who said that we should talk about HPV in a normal, non-stigmatising way. We should have a conversation: it is important that we talk about those things that affect our bodies, to enable people to seek treatment and do something about them. If HPV is detected, you are referred for further testing. Cells are tested for abnormalities and, if present, you are tested again to see if treatment is necessary. If not, a follow-up appointment is always made for the following year, and if HPV is not detected no action is required, because it is highly unlikely that any abnormal cells are present and the chance of developing a cancer within five years is very small.

That process has been in place since December 2019, and since March 2020 in Scotland. It has made cervical screening more effective, improved detection rates and, crucially, requires women to be screened less frequently: there is a very salient point that the more often something is required, the risk that it is not taken up becomes greater. Making sure that we have the best tests at the best time interval, advised by the experts, is how we will proceed. However, that is not to say that all the technologies aptly described by the hon. Member for Wythenshawe and Sale East, as well as others that are available, are not being looked at all the time in all these areas. If there is a positive from the pandemic, it is that we have moved forward in many areas of technology, and as several Members have said, we need to harness that.

Given the strong link between HPV and cervical cancer, the national HPV immunisation programme is a key way to save lives. Introduced in 2008 and extended to boys in 2019, those vaccines have already led to dramatic reductions in HPV infections in England, and it is hoped that immunisation will eventually eradicate HPV and save hundreds more lives each year. The past year has been a challenging one, but as soon as the pandemic hit, we charged those in charge of the scheme with making sure that they had caught up with HPV vaccinations in schools by this August. They have used schools, community centres, and so on to make sure we do not fall behind on what is such an essential part of the programme—we know about the protection that it gives.

I do, however, acknowledge that screening is not perfect: HPV infection or abnormal cells can be missed, and can develop and turn into cancer between screening tests. That is incredibly rare, and the science supports the hope—I have this hope—that with the introduction of HPV testing and vaccination, many more cancers can be detected and prevented. Margaret Ferrier spoke of self-sampling, as did others. I am incredibly interested in this proposal. The YouScreen trial currently taking place in London is sending home-testing kits to some of those who have not taken up the offer of screening, making sure that we offer it to women who might find other environments difficult to be part of—because of time or a whole range of reasons—and who may prefer to do a simple swab test in their own home. That is what this trial is designed to do. It is particularly targeted at disadvantaged groups who may not have attended screenings.

As I say, there are busy lives, there is embarrassment and there are cultural barriers, so making sure we push that forward is important. There are plans for a nationwide trial to offer self-sample kits to women as an alternative to a nurse taking the sample. I have asked my officials to keep me informed of the trials. I eagerly await the UK NSC’s analysis once the trial is complete, and the subsequent recommendations on how self-sampling may be incorporated into the cervical screening programme.

I think we all agree on the need for women to come forward. I thank hon. Members for the tone of the debate and for how everybody expressed their concern that we make sure that we get to those women. I reassure people that, while we did indeed cancel those invitations early on in the pandemic, there is currently no national backlog of people waiting for an invitation to the NHS cervical screening programme. We have been working with and supporting providers to work above pre-pandemic levels to manage diagnostic backlogs. Waiting times for some appointments have increased in some areas, and in those areas specifically we are working with Public Health England’s screening quality assurance service and the relevant clinical commissioning groups. The problem is not everywhere, but I am aware that there is a problem in certain parts of the country.

I thank everyone for their contributions, and I express my sympathy—I know I speak for each and every Member here—to Fiona’s family and friends. The most effective way to prevent deaths from cervical cancer is for as many women as possible to attend their routine appointments, as opposed to yearly screening. Cervical screening undoubtedly saves lives, so once again: when you receive the invitation, please go, and if you notice any worrying symptoms in the meantime, contact your GP. NHS services are open, safe and ready to help you and help keep you safe. You have to help us by attending, so that the screening programme reaches as many as possible and we can drive that rate up into the sort of levels that mean we can prevent each and every woman from having what is, in effect, a preventable cancer.

Photo of Tonia Antoniazzi Tonia Antoniazzi Labour, Gower 5:48 pm, 19th July 2021

I thank the Minister for her response. I also thank John Lamont for his contribution. As Andrew Mathewson’s MP, he made a heartfelt contribution on behalf of Fiona’s family and all her friends. In the really powerful and very personal speech of my great friend, my hon. Friend Alex Davies-Jones, we heard about the serious risks that missing a screening can cause. Her story is a stark reminder of the importance of keeping appointments and being tested regularly.

Margaret Ferrier touched on many of the groups that are less likely to attend their appointments and the Government’s duty of care to improve messaging to those in harder-to-reach communities. In fact, in her intervention on the Minister, my hon. Friend the Member for Pontypridd highlighted the fact that non-binary and trans men should not miss their cervical screening appointment, and that it is important to record biological sex on medical records to ensure that that does not happen.

Jim Shannon was very clear in his message that screening is not a test for cancer but a test to prevent cancer. That is a really important message to get across to all women. My hon. Friend Mike Kane highlighted the fact that not one trust in England achieved 80% coverage of the test. He highlighted the work of Hologic, a cutting-edge company in his constituency that specialises in high-volume population screening. We need to take full advantage of that resource when beating cancer.

I echo the call of Dr Whitford: if you have vaginal discharge or bleeding, go and see your GP—not your MP—and do not wait for an invitation. She also mentioned the 30% to 4.5% reduction as a result of the HPV vaccine. She noted the difficulties that physically disabled people have in attending their cervical smears. The Minister spoke about the self-sampling project that is going to be rolled out nationwide, which is going to be key to getting as many women as possible to attend cervical screening tests. My hon. Friend Alex Norris drew on his vast knowledge of health issues and made a powerful case for building back better our screening capabilities and using all of the available technological advances that have been mentioned today.

In conclusion, I thank the Minister for her comments. I am glad that Members, cross-party and from all of the devolved countries of the UK have been able to discuss this issue sensibly. The bottom line is that we must improve take-up and we must talk about it, because screening saves lives.

Question put and agreed to.

Resolved,

That this House
has considered e-petition 317336, relating to cervical screening.

Photo of Mark Pritchard Mark Pritchard Conservative, The Wrekin

Would colleagues please leave the room via the door marked “Exit” and observe social distancing? Thank you again to our excellent technical teams.

Sitting suspended.