3. Will the Cabinet Secretary make a statement on cancer screening services in Wales? OAQ(5)0134(HWS)

We have well-established screening programmes for breast, cervical and bowel cancer, with more than 400,000 men and women routinely screened each year. Breast cancer screening became a fully digitalised service in 2012 and we have recently announced planned improvements to the tests used for bowel and cervical cancer screening.

Thank you, Minister, for that response. I’d just like to specifically refer to cervical screening, if I may. I think we all agree on the benefits of early diagnosis of cancer wherever possible, but this also raises the question of the appropriate age at which certain screening should start. I don’t know whether I’m alone in being approached by constituents calling for cervical screening for women to revert to screening at age 20, but certainly I’ve been contacted along those lines.

I’m aware, of course, that the decision to raise the age from 20 to 25 in 2013 was based on guidance from the UK national screening committee, which not only questioned the benefits of early screening but also highlighted some of the potential harm in routine screening on women below the age of 25. In that context, the roll-out of the HPV vaccine to schoolgirls from the age of 12 to 13 has been very welcome, as has the primary testing for HPV as part of the screening process.

However, my main concern in relation to cervical cancer screening relates to the slight fall in the percentage of women who are presenting for screening. In particular, it’s noticeably lower in deprived areas. Would the Minister agree with me that, alongside the changes that we are seeing in cervical cancer screening, there is a need to ensure that there’s a key role for Welsh Government and all healthcare providers not only to play their part in raising awareness amongst patients of the screening provisions, but also in operating what NICE termed the low threshold of suspicion when considering referrals for testing? That is the threshold at which, based on symptoms, a GP or care provider takes the decision to refer a patient for further tests.

Thank you very much for that question. I absolutely agree with you, obviously, that early detection of cancer is crucial, because it allows for a combination of more effective and less intensive treatments for the individual and, obviously, the better outcomes that that will lead to.

In addition to the screening programmes, it is important that the 2015 NICE guidance for the recognition and referral of suspected cancer is embedded in clinical practice to ensure that the health service identifies more cancers at an early stage. I agree with you there. We’ve developed a programme of support for primary care, in partnership with Macmillan, called the framework for cancer and that’s being led through the Wales cancer network. There are also provisions in the GP contract as well to support practice-based learning and further work through the cancer network to support better access to testing.

You referred to the issue of the 2012 UK national screening committee’s recommendation on ceasing cervical screening for those women aged 20 to 24. You’ll be aware that the screening committee is an expert voice, basing its decisions and advice to all UK Government Ministers on the evidence, and the evidence does show that cervical cancer screening for women under 25 offers little protection as abnormalities are very common within this age group and are usually self-limiting. Furthermore, the detection of abnormalities through screening in women under 25 does lead to considerable over-treatment and that can lead to later problems with pregnancy and so on.

Going on to the point you raised about the slight fall in uptake, which is a concern to all of us—but particularly of concern is the inequality in uptake. We know that people in more affluent communities are much more likely to take up all of our screening programmes, actually, than those living in poorer communities. For our programmes to reach their potential, we have to ensure that we reach out to all communities.

So, how do we do that? I think a combination of awareness raising, which you referred to, and more simple and practical testing and easier testing is important as well, which is why our move to HPV testing for cervical cancer and FIT testing for bowel cancer will be so important in that regard as well. We do have a screening engagement team in Public Health Wales, which is working with public health teams, health boards and primary care to raise uptake amongst particularly hard-to-reach groups. I can certainly write to the Member with some examples of what’s taking place as well.

Minister, women at high risk of ovarian cancer are advised to have their ovaries and fallopian tubes removed as there is, currently, no screening programme for the disease in Wales. Research published in the ‘Journal of Clinical Oncology’ shows that a blood test—a simple blood test—every four months could help to detect ovarian cancer earlier, when tumours should be easier to treat and remove. What plans does the Minister have to make regular blood testing available to women at high risk of ovarian cancer in Wales? Thank you.

I thank you for that question. This is an issue that we discussed at some length recently in the Petitions Committee. The Petitions Committee has produced a report based on the evidence that it took from the Government, but also from members of the public and from the leading cancer charities. The leading cancer charities actually were not in favour of introducing the screening. This is one of those cases where you do have to balance up the risks and the benefits, and the risks outweigh the benefits in this case at the moment on the evidence that we have. But, we have said that we will keep a close eye on emerging evidence from the UK and across the globe on this particular issue.