Chamber
Plenary, 14 Sep 2000
14 Sep 2000 · S1 · Plenary
Item of business
Prostate Cancer
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 cross-party debate.
Since the establishment of the Scottish Parliament, a number of members have taken an interest in prostate cancer—I have also taken an interest in the issue and examined it in some detail. I assure members that my interest will continue.
I hope that the debate will help to increase understanding of prostate cancer, given that the disease is diagnosed in more than 1,800 men a year in Scotland, as other members said.
I stress that the Executive is committed to tackling cancer in all its forms and in the most effective ways possible. We are investing a great deal of time, energy and resources in this area and we will continue to do so. Screening is included in that work, as is, in particular, the putting in place of effective screening programmes that will detect cancers reliably and early. Early detection means that treatment can start earlier, which, in turn, is likely to lead to more successful outcomes. In short, the Executive is pledged to ensure better prevention, earlier diagnosis and faster and better treatment for cancer in all its forms.
As far as the introduction of routine prostate cancer screening is concerned, it is important that I set out some of the issues that I must take into account, including, in particular, some of the limitations of population screening, as well as the benefits. It is also important that members are clear about the basis on which the Executive reaches decisions in this area.
As was noted earlier, a screening test is not a diagnostic test. Screening is aimed at apparently healthy people, so that the small number who may develop cancer can be detected; they might then be diagnosed and receive effective treatment sooner rather than later.
The Executive is given expert and independent advice on screening programmes by the National Screening Committee, a UK expert committee with Scottish representatives. Work continues all the time to investigate screening issues. In considering new possibilities for screening programmes, the National Screening Committee works to criteria that include two key requirements: first, that there should be a screening test that is accurate, simple, quick and easy to interpret; and secondly, that there should be a recognised and clinically effective standard treatment for the condition. At present, the National Screening Committee's advice is that the test and treatment for prostate cancer do not meet either of those key requirements.
I recognise the widespread concern about prostate cancer. Like other members, I have seen its effects at close quarters, so I understand why people are searching for the most effective way of making progress. I therefore understand the attraction of a routine screening programme of the kind that has helped so much in the fight against cervical cancer and breast cancer.
However, I stress that, in the case of prostate cancer, the issues are different. The available tests have not been found to be reliable enough. They cannot always distinguish between prostate cancer and other conditions, such as infection, or between different types of prostate cancer. As members have mentioned, current treatments for prostate cancer have serious side effects, including impotence and incontinence. On the basis of advice and consideration by the experts on the National Screening Committee, it has been concluded that we cannot rely on a national screening programme to deliver the benefits that we have seen for some other cancers.
Prostate cancer is a complex disease, which behaves in different ways in different men. Prostate cancers grow at different rates; some grow very quickly, while others grow very slowly and may never cause problems in a man's lifetime. Currently available tests cannot differentiate between the more aggressive and the slower-growing prostate cancers. The appearance of both in the test results is the same, which makes the evaluation of prostate cancer screening difficult.
In most other cancers, a positive diagnosis would result in a decision to treat immediately. In prostate cancer, however, the treatments themselves may cause significant unwanted side effects. Those are some of the reasons why the situation with regard to prostate cancer screening is different to that for screening for other cancers.
Since the establishment of the Scottish Parliament, a number of members have taken an interest in prostate cancer—I have also taken an interest in the issue and examined it in some detail. I assure members that my interest will continue.
I hope that the debate will help to increase understanding of prostate cancer, given that the disease is diagnosed in more than 1,800 men a year in Scotland, as other members said.
I stress that the Executive is committed to tackling cancer in all its forms and in the most effective ways possible. We are investing a great deal of time, energy and resources in this area and we will continue to do so. Screening is included in that work, as is, in particular, the putting in place of effective screening programmes that will detect cancers reliably and early. Early detection means that treatment can start earlier, which, in turn, is likely to lead to more successful outcomes. In short, the Executive is pledged to ensure better prevention, earlier diagnosis and faster and better treatment for cancer in all its forms.
As far as the introduction of routine prostate cancer screening is concerned, it is important that I set out some of the issues that I must take into account, including, in particular, some of the limitations of population screening, as well as the benefits. It is also important that members are clear about the basis on which the Executive reaches decisions in this area.
As was noted earlier, a screening test is not a diagnostic test. Screening is aimed at apparently healthy people, so that the small number who may develop cancer can be detected; they might then be diagnosed and receive effective treatment sooner rather than later.
The Executive is given expert and independent advice on screening programmes by the National Screening Committee, a UK expert committee with Scottish representatives. Work continues all the time to investigate screening issues. In considering new possibilities for screening programmes, the National Screening Committee works to criteria that include two key requirements: first, that there should be a screening test that is accurate, simple, quick and easy to interpret; and secondly, that there should be a recognised and clinically effective standard treatment for the condition. At present, the National Screening Committee's advice is that the test and treatment for prostate cancer do not meet either of those key requirements.
I recognise the widespread concern about prostate cancer. Like other members, I have seen its effects at close quarters, so I understand why people are searching for the most effective way of making progress. I therefore understand the attraction of a routine screening programme of the kind that has helped so much in the fight against cervical cancer and breast cancer.
However, I stress that, in the case of prostate cancer, the issues are different. The available tests have not been found to be reliable enough. They cannot always distinguish between prostate cancer and other conditions, such as infection, or between different types of prostate cancer. As members have mentioned, current treatments for prostate cancer have serious side effects, including impotence and incontinence. On the basis of advice and consideration by the experts on the National Screening Committee, it has been concluded that we cannot rely on a national screening programme to deliver the benefits that we have seen for some other cancers.
Prostate cancer is a complex disease, which behaves in different ways in different men. Prostate cancers grow at different rates; some grow very quickly, while others grow very slowly and may never cause problems in a man's lifetime. Currently available tests cannot differentiate between the more aggressive and the slower-growing prostate cancers. The appearance of both in the test results is the same, which makes the evaluation of prostate cancer screening difficult.
In most other cancers, a positive diagnosis would result in a decision to treat immediately. In prostate cancer, however, the treatments themselves may cause significant unwanted side effects. Those are some of the reasons why the situation with regard to prostate cancer screening is different to that for screening for other cancers.
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 ...