Hansard

I join other members in thanking Rhona Brankin for securing this important debate, in the 21st year of the NHS breast screening service. I remember Professor Forrest presenting the findings of research when screening was introduced. It is good that early doubts about it have been put to rest and that screening is now used by so many.

As other members have said, there are groups who do not take up the opportunity of screening. There needs to be retargeting, refocusing and outreach by the health service, so that screening reaches more deprived groups—to which Mary Scanlon and Margaret Smith referred—and black and minority ethnic groups, among which uptake is low at present. There is also some indication that uptake is dropping, which is slightly worrying. There needs to be a degree of renewal.

Members have mentioned research, which is important. Recently the British Medical Journal suggested that some early interventions after screening may not be appropriate. In the late 1980s and early 1990s, I was part of a research group, led by Dr Ian McIntosh, that carried out research into the psychological impact of screening. One concern was the time it took to get test results back. Margo MacDonald and Rhona Brankin have raised that issue—almost 20 years on, the concern is still the same. Anything that we can do to speed up the process would be welcome. That should surely be possible with the technology that we now have.

Misdiagnosis is a problem. One difficulty is that not all general practitioners emphasise the fact that an appointment is urgent, which would allow patients to benefit from rapid referral to the assessment that should take place. That can lead to delays. Recently a constituent wrote to my colleague Anne McGuire and me about her experience of misdiagnosis. During self-examination at the age of 40, she found a lump. The GP told her that it was a milk gland and nothing to worry about. Five months later, the lump was still there. She asked for a second opinion and was referred to Stirling royal infirmary, where she insisted on being given a mammogram. The single-view mammogram that she received was reported as negative, but she was offered a six-month review, at which the consultant undertook fine needle aspiration. She was informed that she had more than one malignant tumour and had a mastectomy, chemotherapy and radiotherapy.

The time from the original presentation to completion was one year. My constituent followed up the matter and took legal action. It was found that there had been negligence in her case—something that we would not wish.

Scottish intercollegiate guidelines network guideline 29 is clear: a woman with a lump should be assessed and, in almost every case, offered the triple assessment of clinical examination, imaging from mammography—preferably more than one view—and ultrasound or ultrasound and histology, where the lumps are taken by fine needle aspiration or core biopsy. If that does not happen, the result can be legal action. Between 2002 and 2008, legal action was taken in 30 cases. It is important to follow through in this regard; survival rates have improved, but we are still behind.

Further to my parliamentary questions of 11 December last year, I ask the minister for a response on the national advisory group's plans for digital mammography and the sentinel node biopsy programme. Like other members, I look for answers to the issues of retargeting outreach to BME groups, lymphoedema, reconstructive surgery and secondary cancer. All indicate that we still have some way to go, albeit that the situation is undoubtedly improving.