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House of Lords

Monday, 19th February 2001.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Birmingham.

Prostate Cancer

Baroness Howells of St Davids asked Her Majesty's Government:

    Whether they will now initiate a screening programme for prostate cancer for men aged 50 and above.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, the NHS Plan and the NHS Cancer Plan both committed the Government to introducing a prostate screening programme if and when screening and treatment techniques are sufficiently well developed. The evidence supporting the introduction of a screening programme will he kept under careful review by the National Screening Committee.

Baroness Howells of St Davids: My Lords, I thank the Minister for that Answer. Is he aware of research by King's College hospital and Lister hospital which suggests that black men are more prone to cancer and subject to the most virulent types of cancer? Is the department liaising with or supporting Gordon Muir? His research was drawn to my attention by my noble friend Lord Morris of Manchester.

Lord Hunt of Kings Heath: My Lords, I am happy to take my noble friend's suggestion back to the department. I understand--these findings are based on American data--that there are differences in instances of and mortality from prostate cancer between blacks and whites and other ethnic groups. The National Screening Committee has commissioned a review of the evidence for an increase in instances of prostate cancer in Afro-Caribbean men. If that is identified as a result of the review, we shall of course consider what action needs to be taken.

Baroness Gardner of Parkes: My Lords, does the Minister recall that on the two occasions on which I have raised this matter we were told that one of the problems was that screening was not satisfactory and that false positives were common? Does he agree how important it is for men from any ethnic group to be aware of the need to seek care and assessment if they suspect that they have symptoms? There needs to be a culture change among all men--younger men in particular, not simply those over 50--to make them aware of the need to see their doctor if they have any doubts.

Lord Hunt of Kings Heath: My Lords, I do not disagree with the noble Baroness's point. She will be

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aware that there are problems with the PSA test and that, while treatment can be effective, it has some very undesirable side effects. Because of that, the Department of Health is developing an education programme about prostate cancer, which will be published in a few months' time. That will focus on ensuring that when men see their general practitioner they are able to reach an informed decision about the risks and benefits of taking a test.

Lord Morris of Manchester: My Lords, I know my noble friend will recall my correspondence with him and my parliamentary questions over the past four years about the deeply important issue raised so well by my noble friend Lady Howells. But is he aware that the initial research findings of Gordon Muir, the distinguished urologist, suggest a 50 per cent higher incidence of prostate cancer among black men in the King's College Hospital's catchment area? Is there not a pressing need now to make further such research an urgent priority and to alert those who are shown by research in this country and abroad to be at exceptional risk of having inoperable cancer?

Lord Hunt of Kings Heath: My Lords, I thank my noble friend for his comments. I have already made clear that we shall look closely at such research. The point that he makes is borne out by statistics gathered in the United States. I have already said that the NSC will review the evidence that is available in this country, and that that will have an impact on our future policies towards prostate cancer.

Lord Ezra: My Lords, pursuing the matter raised by the noble Baroness, Lady Gardner of Parkes, does the Minister accept that there is growing concern about the situation in relation to prostate cancer and that that concern arises in particular from the fact that what was assumed to be a satisfactory test--the PSA test--is no longer regarded as being satisfactory and that no alternative has been proposed? At the same time, we are told that, if the condition is not diagnosed in time, life can be threatened. Surely the situation demands much greater action than is presently being taken.

Lord Hunt of Kings Heath: My Lords, that is why the Government have increased the resources--to 4.2 million by 2003-04--to be spent on research into prostate cancer and on testing and treatment, which were discussed by the noble Lord. On the PSA test, the problem is that some men with prostate cancer will not have a raised PSA level whereas some men with a raised PSA level will not have prostate cancer. The other problem, which relates to treatment, is that it is estimated that the operation may cause operative deaths of between 0.4 and 0.6 per cent, some incontinence in up to 20 per cent of cases, and impotence in between 20 and 85 per cent of people who are treated, depending on the patient's age. That is why such caution is displayed in this country towards testing and treatment. That is also why we need to ensure that our research effort is as effective as possible.

Lord Elton: My Lords, as a survivor thus far of radiotherapy for prostate cancer, and I hope a

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reasonably good advertisement for it, I ask whether the noble Lord is aware of the presentation by Georg Bartsch to the American Urological Association Year 2000 annual meeting, which showed that the introduction of PSA screening in the Austrian state of Tyrol, where there are 62,000 men between the ages of 45 and 75, was followed in 1998 by a 42 per cent lower mortality rate from prostate cancer than in the rest of Austria where there is no such screening. Existing techniques were used, which suggests that they are worth pursuing.

Lord Hunt of Kings Heath: My Lords, I am prepared to look at the research to which the noble Lord has referred, but we need to treat such figures and comparisons between this country and other countries with a degree of caution. My impression is that diagnosis of prostate cancer is higher in other countries than in this country because the PSA test is used more frequently in those other countries. However, that would tend to suggest that the survival rate, if equalled out, is not as different as is often claimed because in this country we do not see so many people diagnosed with prostate cancer.

Lord Cavendish of Furness: My Lords, as another survivor of this unpleasant disease through being diagnosed early due to having had a PSA test, I ask the Minister not to accept that the level of false positives is grossly exaggerated. Does he accept that many treatments for women with the same level of false positives are supported by the Government? Does he also accept that most doctors, and nearly all sufferers, believe that that policy is driven more by the Treasury and less by considerations of health?

Lord Hunt of Kings Heath: My Lords, I congratulate the noble Lord on his experience. The Government received advice, not from the Treasury, but from the National Screening Committee. We continue to follow the advice of that committee, which is that using current techniques for testing and treatment there is no evidence that a screening programme would save lives. As I said, the Government are not complacent. We have stepped up by many hundreds in percentage terms the amount of money spent on research in this important area.

Parliamentary Ombudsman on Access to Official Information: Report

2.45 p.m.

Lord Goodhart asked Her Majesty's Government:

    What is their reaction to the report of the Parliamentary Ombudsman on Access to Official Information for April to December 2000.

The Parliamentary Under-Secretary of State, Home Office (Lord Bassam of Brighton): My Lords, the Government welcome the ombudsman's report. The Government agree with his conclusions that there can

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be no excuse for some departments to fail to deal effectively with requests under the code of practice. Recently the Permanent Secretary at the Home Office has written to his colleagues to remind them that they are required to comply fully with the provisions of the code.

Although not complacent about the failings identified by the ombudsman, we should recognise the Government's achievements in promoting openness. In 1995, there were 44 complaints to the ombudsman about non-disclosure under the code. I am happy to report that in 1999 that number reduced to 36. In 1995, 8.4 per cent of requests under the code were refused and in 1999 that had reduced to 6.3 per cent. The Government have, through the Freedom of Information Act 2000, provided, for the first time, a wide-ranging statutory right to information. When implemented, the Act will replace the code and, in particular, will provide a free and direct means for the public to enforce and to access their rights.

Lord Goodhart: My Lords, naturally I welcome what the Minister has said, but does he agree that that is a wholly unacceptable standard for the moment? Will the Government ensure that the kind of attitudes shown up in the ombudsman's report are wholly eliminated before we move from the code of conduct to the Freedom of Information Act?


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