Chamber
Plenary, 14 Sep 2000
14 Sep 2000 · S1 · Plenary
Item of business
Prostate Cancer
I thank Maureen Macmillan for raising this subject, and congratulate her on securing the debate, especially during this special week.
Like many cancers, prostate cancer suffers from the silent treatment. According to Professor McVie of the Cancer Research Campaign:
"If more people talked about the disease we could raise awareness and save lives."
I first became interested in the subject following the death of one of my friends, at the tragically early age of 60, from complications caused by prostate cancer. In December, I asked the Executive a question regarding research into prostate cancer and was given the figure of 3,644 deaths from the disease in Scotland between 1994 and 1998. The Herald of 12 May gave the figure of 2,000 deaths a year.
A by-product of my question was raised concern about the commitment to the screening of men in Scotland. As is often the case, one thing led to another and facts began to emerge. The Scottish five-year survival rate of 48 per cent compares with 86 per cent in the USA. Dr Richard Simpson told me that that is because the USA usually resorts to radical surgery. Cases of prostate cancer have risen by 49 per cent since 1986, compared with a rise of 27 per cent in the same period for breast cancer. Apparently, 100,000 men have died in the UK from prostate cancer since 1990.
The current policy, described as watchful waiting, has been followed so far because of the risks of the side effects of treatment, such as impotence and incontinence, and uncertainty about the PSA test. Unfortunately, there is no evidence that PSA screening reduces mortality, but studies show that PSA testing strongly predicts cancer deaths. It is acceptable and feasible to screen for PSA, and urgent studies to evaluate its potential have been called for. As Maureen Macmillan and Brian Adam said, there is evidence that early detection leads to good survival rates. In Austria, a trial that screened 65,000 men led to a 42 per cent decrease in the number of deaths. Where screening was not offered, death rates remained unchanged.
However, there is hope. Yesterday, I was given information by Dr Alexander and Dr Habib of the University of Edinburgh, which points out that it is less certain that current screening methods have the same benefits as breast screening. The test that is used does not differentiate between men who have prostate cancer that requires treatment and those who do not. Often, prostate cancer does not cause any clinical problems. It is also extremely common. Studies show that eight out of 10 80-year-old men have the disease, but many of those men will never know that they have it and will die of unrelated causes.
On the other hand, if the cancer is detected and treated, treatment itself can lead to serious complications. What is needed is a screening test that will distinguish those men who have prostate cancer that is likely to advance to a life-threatening disease, so that they can be given the necessary treatment.
It is to be hoped that the research that is being carried out at the University of Edinburgh will lead to a test that can predict which men will succumb to this life-threatening disease.
An e-mail that I received yesterday said:
"Spending on women's health is eight times greater than spending on men's health. According to the Government's 5-point plan, there should be equal access to the highest standards of care and equal access for new treatment. We think it is not unreasonable to ask that men be given the same equal consideration as women."
It concludes:
"I was 48 when I was diagnosed with advanced prostate cancer. I don't want my son or anyone's son to miss the opportunity for successful treatment if prostate cancer should strike at them."
That plea should strike a chord in the Scottish Parliament.
Like many cancers, prostate cancer suffers from the silent treatment. According to Professor McVie of the Cancer Research Campaign:
"If more people talked about the disease we could raise awareness and save lives."
I first became interested in the subject following the death of one of my friends, at the tragically early age of 60, from complications caused by prostate cancer. In December, I asked the Executive a question regarding research into prostate cancer and was given the figure of 3,644 deaths from the disease in Scotland between 1994 and 1998. The Herald of 12 May gave the figure of 2,000 deaths a year.
A by-product of my question was raised concern about the commitment to the screening of men in Scotland. As is often the case, one thing led to another and facts began to emerge. The Scottish five-year survival rate of 48 per cent compares with 86 per cent in the USA. Dr Richard Simpson told me that that is because the USA usually resorts to radical surgery. Cases of prostate cancer have risen by 49 per cent since 1986, compared with a rise of 27 per cent in the same period for breast cancer. Apparently, 100,000 men have died in the UK from prostate cancer since 1990.
The current policy, described as watchful waiting, has been followed so far because of the risks of the side effects of treatment, such as impotence and incontinence, and uncertainty about the PSA test. Unfortunately, there is no evidence that PSA screening reduces mortality, but studies show that PSA testing strongly predicts cancer deaths. It is acceptable and feasible to screen for PSA, and urgent studies to evaluate its potential have been called for. As Maureen Macmillan and Brian Adam said, there is evidence that early detection leads to good survival rates. In Austria, a trial that screened 65,000 men led to a 42 per cent decrease in the number of deaths. Where screening was not offered, death rates remained unchanged.
However, there is hope. Yesterday, I was given information by Dr Alexander and Dr Habib of the University of Edinburgh, which points out that it is less certain that current screening methods have the same benefits as breast screening. The test that is used does not differentiate between men who have prostate cancer that requires treatment and those who do not. Often, prostate cancer does not cause any clinical problems. It is also extremely common. Studies show that eight out of 10 80-year-old men have the disease, but many of those men will never know that they have it and will die of unrelated causes.
On the other hand, if the cancer is detected and treated, treatment itself can lead to serious complications. What is needed is a screening test that will distinguish those men who have prostate cancer that is likely to advance to a life-threatening disease, so that they can be given the necessary treatment.
It is to be hoped that the research that is being carried out at the University of Edinburgh will lead to a test that can predict which men will succumb to this life-threatening disease.
An e-mail that I received yesterday said:
"Spending on women's health is eight times greater than spending on men's health. According to the Government's 5-point plan, there should be equal access to the highest standards of care and equal access for new treatment. We think it is not unreasonable to ask that men be given the same equal consideration as women."
It concludes:
"I was 48 when I was diagnosed with advanced prostate cancer. I don't want my son or anyone's son to miss the opportunity for successful treatment if prostate cancer should strike at them."
That plea should strike a chord in the Scottish Parliament.
In the same item of business
The Deputy Presiding Officer (Mr George Reid):
SNP
I wish members an early good afternoon. The first item of business is a members' business debate on motion S1M-1122, in the name of Maureen Macmillan, on scr...
Motion debated,
That the Parliament supports the routine screening of middle aged men for early indications of prostate cancer, a disease which causes the second highest num...
Maureen Macmillan (Highlands and Islands) (Lab):
Lab
One of our most important jobs as elected representatives is to highlight important issues that struggle to get attention. I am therefore very pleased to hav...
The Deputy Presiding Officer:
SNP
Four members have asked to speak from the floor. That will be possible if they keep their remarks to three and a half minutes.
Brian Adam (North-East Scotland) (SNP):
SNP
In a previous existence, I worked as a clinical biochemist in the national health service so I am aware of the difficulties that are associated with some of ...
Nick Johnston (Mid Scotland and Fife) (Con):
Con
I thank Maureen Macmillan for raising this subject, and congratulate her on securing the debate, especially during this special week.Like many cancers, prost...
Nora Radcliffe (Gordon) (LD):
LD
I, too, commend Maureen Macmillan on securing this members' business debate. We have won the battle to raise awareness of breast cancer; we have the same bat...
Colin Campbell (West of Scotland) (SNP):
SNP
I thank Maureen Macmillan for lodging the motion.We recognise that people sometimes fall through the social work and community care nets. In my experience, t...
Mrs Margaret Ewing (Moray) (SNP):
SNP
I add my congratulations to Maureen Macmillan on securing the debate. She is an assiduous pursuer of members' business and has touched on many issues that im...
The Deputy Presiding Officer:
SNP
I call Susan Deacon to respond to the debate on behalf of the Executive. Minister, you have quite a lot of time—about 14 minutes. You may speak until the Fir...
The Minister for Health and Community Care (Susan Deacon):
Lab
I am grateful to Maureen Macmillan for raising prostate cancer as a matter for members' business. I am also grateful for the speeches of other members in the...
Mrs Margaret Ewing:
SNP
I do not claim to be a technical expert on the subject, but the information that I have received states that, although a PSA screening result of level 4 is a...
Susan Deacon:
Lab
The issue of PSA is important and I shall go on to say more about that in a moment. However, while Mrs Ewing was speaking, some of her colleagues were shakin...
Brian Adam:
SNP
Will the minister take an intervention?
Dr Richard Simpson (Ochil) (Lab):
Lab
Will the minister take an intervention?
The Deputy Presiding Officer:
SNP
We will take Brian Adam first.
Brian Adam:
SNP
I appreciate the difficulties that are associated with the PSA test. Will the minister indicate how the Executive hopes to improve diagnostic capability for ...
The Deputy Presiding Officer:
SNP
Dr Simpson, did you want to intervene on the same point?
Dr Simpson:
Lab
Yes.
The Deputy Presiding Officer:
SNP
We will take both points in that case.
Dr Simpson:
Lab
I apologise to members for arriving late. I had another meeting. I congratulate the minister on her exposition of a very difficult subject.Will the minister ...
Susan Deacon:
Lab
I am grateful to both members for their comments. I fear, however, that we have been lulled into a false sense of security about the time. Having been given ...