The final item of business is a members’ business debate on motion S6M-07546, in the name of Ruth Maguire, on cervical cancer prevention week 2023. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises that 23 to 29 January 2023 is Cervical Cancer Prevention Week, which encourages women to reduce their risk of the disease by promoting the steps that they can take to look after their health; understands that cervical cancer is the fourth most common cancer among women globally, with nine new diagnoses and two women losing their lives every day in the UK; is concerned by the reported statistic from Jo’s Cervical Cancer Trust that one in three women and people with a cervix do not take up their screening invite; highlights tools such as the HPV vaccination and cervical screening, which can help screen and prevent, and, it considers, one day end, cervical cancer; notes the support for the global strategy for cervical cancer elimination, which suggests that each country should meet the 90-70-90 targets by 2030; acknowledges that these targets are for 90% of girls to be fully vaccinated with the HPV vaccine by the age of 15, for 70% of women to be screened using a high-performance test by the age of 35, and again by the age of 45, and for 90% of women with pre-cancer to be treated, and 90% of women with invasive cancer to be managed; understands that cervical cancer is preventable and curable, as long as it is detected early and managed effectively, and notes the calls for all women and people with a cervix to attend invitations to screening appointments and vaccinations.
18:06
It is a privilege to open the debate on cervical cancer prevention week, but I confess that I do not feel entirely comfortable. I did not get into politics to talk about myself. Although being open about my diagnosis in 2021 may have inadvertently raised some awareness, I have to say that my motivation for doing that was so that I could properly take time out of the public eye to give my treatment the best chance. I have said this before, but I put on record again my thanks to my team, Lynn and Karen, for their support, and to constituents in Cunninghame South for their understanding and the well-wishes that they sent.
Now, after a year back at work, it feels like an okay time for me to share some of my story. I am grateful to the Sunday Post for helping me to do that, and to Tracey Bryce for the kindness and respect that she showed me in her reporting.
I fully understand that my experience of diagnosis of, and then life-saving treatment for, cervical cancer will not be the same as other women’s experiences. I am acutely aware of just how lucky I was to have all the resources, support and love that I needed to get well. However, I think that I can confidently say one thing on behalf of women who have experienced cervical cancer; it is also the reason why, this year, I am speaking up and supporting Jo’s Cervical Cancer Trust in its biggest campaign. It is that we would not want anyone else to go through what we did. The effects of treatment, although that treatment is life saving, can be life changing and long lasting. If we can prevent, end and eradicate cervical cancer, we must.
Jo’s Cervical Cancer Trust is calling for
“government commitments to elimination, with strategies to make sure that no-one is missed out or left behind.”
In screening and immunisation, we have powerful tools to do just that.
In my local health board area of Ayrshire and Arran, cervical screening coverage is 71.7 per cent. The latest figure for coverage for Scotland is 69.3 per cent, with women in our most deprived areas being least likely to take part in screening. There will be a number of reasons why women do not attend when invited, and it is important that we understand that, so that we can take action to address it. There might be practical considerations. Getting time off work can be difficult for some people—in particular, those who are in low-paid or precarious employment. Likewise, travel, and the cost or time to get there, can be an issue.
More generally, women might feel apprehensive or uncomfortable about the test itself. For one in three women, as survivors of sexual violence, it can be particularly difficult. I would like them to know that they are not alone. The Eve Appeal has a fantastic publication, “Cervical Screening—A guide for survivors of rape, sexual assault and sexual abuse”, with tips for the appointment itself and for communicating needs to healthcare professionals. Crucially, the organisation has also published “Cervical Screening—A guide for Healthcare Professionals”, and I commend it to all those who are interested in providing essential trauma-aware support to women.
A Ferret article that was published on 22 January found that
“440,000 eligible”
for cervical screening
“in 2020-21 ... had not had ... a smear test, in the last three to five years.”
It went on to say that
“Those most likely to miss their screening were aged 25-29”,
along with, as I mentioned, those in deprived areas.
There are wider issues to do with inequality in dealing with health. My own experience of accessing tests and treatment made me acutely aware of just how challenging it would have been if I did not have someone to run me there, or if I did not have a job in which I could, to a certain extent, manage my own diary and schedule things in. I am very keen to hear from the Minister for Public Health, Women’s Health and Sport about the work that the Government is doing to understand and address the inequalities in uptake. That would be helpful not only for cervical cancer screening, and indeed all cancer screening and treatment, but for all areas of health.
I thank those colleagues who supported my motion, and I look forward to hearing contributions from colleagues this evening. I also thank everyone who attended the event that Carol Mochan and I sponsored with Jo’s Cervical Cancer Trust. It was good to see so many local press releases going out and awareness being raised locally around the country.
I urge the Scottish Government to continue on the path to elimination. I know that there is good news to tell here, in Scotland, and we need to press forward and keep going on with that. We also need to redouble our efforts on inequality, as that will save lives.
To women and, indeed, to everyone, I say: immunise your young people. To individual women, I say: attend your screenings when invited and, crucially, do not ignore symptoms or bleeding that are different for you; it could save your life. [Applause.]
Thank you very much, and congratulations, Ms Maguire.
We move to the open debate. Given that, unusually, we have two members’ business debates this evening, I would be grateful if members could stick to their speaking allocation so that we do not conclude too late.
18:13
I thank Ruth Maguire for securing the parliamentary time for such an important debate. Tragically, cancer is a major cause of death in Scotland. All of us have likely been touched in some way by its impact, and I know that all of us long for the day when it is eliminated for good.
It is a sobering thought that two women in the United Kingdom died today from cervical cancer, and this evening another nine women and their families are coming to terms with a diagnosis of cervical cancer. Some are mums, and some face the devastating prospect of losing their fertility as part of their treatment. However, there is hope, and that is through the cervical screening programme and the HPV vaccination programme.
On the latter, I was struck by the figures that were reported by Jo’s Cervical Cancer Trust: cases of cervical cancer have fallen by 97 per cent among women in their 20s as a result of the vaccine. I understand that in Scotland, uptake rates for the first dose of HPV have consistently exceeded 90 per cent, as Ruth Maguire said, and that is to be welcomed. However, as she pointed out, uptake levels for cervical screening are not as high, and that is where improvement is most needed.
Public Health Scotland data is available only for the period up to 31 March 2021, but it shows that the uptake rate for cervical screening was 69.3 per cent among eligible women. Worryingly, as Ruth Maguire said, uptake has declined in recent years and is especially low among women aged between 25 and 29.
Ruth Maguire also flagged up the multiple barriers to accessing a screening appointment. Anxiety and embarrassment can mean that women delay or decide not to do it. As she pointed out, experience of sexual trauma can also prevent women from being screened, and there are accessibility issues for women with a disability. Pain and fear of the result can also act as obstacles. We must do everything that we can to address those barriers, and it is important that we see leadership at the highest levels.
Jo’s Cervical Cancer Trust and other charities were vocal in their calls for the urgent appointment of a women’s health champion in Scotland. Bizarrely, that role was promised by the Scottish National Party as a “Medium-Term” action as part of its “Women’s Health Plan”, which is intended to cover only the period from 2021 to 2024.
I am pleased to see the position has now been filled by Professor Anna Glasier. However, like many of us, I was deeply frustrated by the time that was lost over the prolonged appointment process. I know that Professor Glasier is keen to focus her work on the menopause, endometriosis and polycystic ovary syndrome. I hope that she will also work with health boards and charities to improve cervical screening uptake and to explore new ways to facilitate that process.
In the meantime, I urge all eligible women to please, please book a cervical screening appointment when the letter arrives—it could save your life.
18:16
I congratulate my colleague Ruth Maguire on securing the debate and on her very powerful opening speech; I know that she is sitting right behind me.
We know that the human papilloma virus vaccine helps to protect people from HPV-related cancers, including cervical cancer. The first study of its kind, which was funded by Cancer Research UK, has shown that rates of cervical cancer in women in their 20s who were offered the bivalent Cervarix HPV vaccine at ages 12 to 13 in England were 87 per cent lower than the rates in those who did not receive the vaccine.
That is why it is essential to vaccinate all those who are eligible by improving uptake so that they receive their vaccine. The HPV immunisation statistics for Scotland for the 2021-22 school year show that HPV vaccination coverage increased in comparison with the previous year. However, the numbers are not equivalent to pre-pandemic levels in all areas, and there is still significant regional and local variation.
Coverage of the first dose of HPV vaccine for secondary 1 pupils increased in 2021-22, with overall coverage rates of 73.5 per cent, in comparison with 52.1 per cent in 2020-21. By the end of S2, 86.4 per cent of females had received the first dose. While those statistics are welcome, however, I ask the minister to ensure that the Scottish Government is doing all that it can to enable HPV vaccine take-up.
I want to touch on screening also. We know that screening is key to both preventing cancers developing more widely and detecting cancers at an early stage, when treatment is more likely to be successful. Cervical screening aims to identify whether a person is at higher risk of developing cervical cell changes or cervical cancer, which enables them to access treatment quickly.
Self-sampling as part of screening for HPV is an area that I have been pursuing. I know that the Scottish Government is pursuing that also. In the previous session of Parliament, I was made aware that 6,000 women in Dumfries and Galloway had defaulted on their invitation to attend their screening smear test. That meant that 6,000 women were being missed. I met Dr William Forson and Dr Heather Currie, who, along with their team, were attempting to improve screening numbers by introducing a self-sampling approach, which they wanted to test for effectiveness in addressing the women who were failing to accept and attend the invite to screening.
I am pleased to hear that that approach has now been picked up by the Government. There are benefits to self-sampling. Home tests, away from clinics and general practices, offer people a choice of place. There is no interruption to work or travelling to an appointment necessary, and there are no other barriers to the take-up of cervical screening.
As we have heard already, some women find the intimate examination that is involved in having a smear test very difficult, painful, distressing and embarrassing. Self-sampling for HPV is one way to help increase screening uptake, especially for women in remote, island and rural areas such as my South Scotland region. I was one of the defaulters who were contacted by NHS Dumfries and Galloway, and I had the opportunity to take part in the self-test trial, so I would be grateful if the minister could provide an update on the status of home sampling and on whether there are any findings about its success.
During lockdown, I attended a Jo’s Cervical Cancer Trust online meeting with women who were part of the Wigtownshire Women and Cancer charity. It was an excellent presentation. The Jo’s Trust representatives were fantastic, and they supported a continuation of engaging with women and supporting them in taking up their screening. I encourage women to do the same.
Again, I thank Ruth Maguire for securing the debate, and I look forward to hearing the minister’s response.
18:20
I begin by thanking Ruth Maguire for securing this important debate, and I thank her for sharing her experience. I take this opportunity to commend the work of Jo’s Cervical Cancer Trust.
I apologise to members, as I have to leave early to chair a cross-party group meeting. I am grateful to you, Presiding Officer, for permission to do so.
I believe that members across the chamber are united in the belief that cervical cancer can and should be beaten once and for all, but statistics show that, unfortunately, we are going backwards when it comes to ending this disease. The roll-out of self-sampling is too slow, and those with abnormal smear tests face waits of a year for colposcopy appointments, while inequalities for women in the poorest communities continue to rise.
The World Health Organization calls for 70 per cent of women globally to be screened regularly for cervical cancer but, according to Public Health Scotland, women from the most deprived areas of the country are less likely to take part, with uptake reaching only 63 per cent there. As we have heard, 45 per cent of women between the ages of 25 and 29 have not attended a screening at all, which suggests that younger women are less likely to come forward for their smear test.
There are several reasons why that might be happening. It can be down to an experience of trauma, concern about pain, inaccessible general practices or even a lack of information and time. That is why Jo’s Cervical Cancer Trust has asked the Scottish Government to roll out new tests such as HPV self-sampling. The trust surveyed more than 800 professionals working in and alongside cancer prevention, and 70 per cent of them said that they thought that HPV self-sampling provided the biggest opportunity to eliminate cervical cancer in the UK. Although it is important to ensure that clinician-led screening is still encouraged and supported, allowing for self-sampling will certainly begin to address the low numbers of people coming forward.
Cervical cancer will not be tackled by addressing screening uptake alone. The process for addressing abnormalities and examining the cervix in the aftermath of a smear test is extremely important, and statistics show that women are being failed here when it matters most. Waits for follow-up colposcopies in NHS Greater Glasgow and Clyde continue to soar. During cervical cancer awareness week, I raised the case of my constituent who had a smear test in February 2022 that showed abnormal cells. She had to wait a year for the follow-up colposcopy. I received a letter from the Cabinet Secretary for Health and Social Care wishing her well for an appointment at the end of January this year—which was cancelled. We really need to do better for women. My constituent told me:
“It’s been really tough on my mental health. I was left questioning if the delay would have a detrimental outcome for me.”
Freedom of information requests have revealed that the longest wait for a colposcopy across NHS Greater Glasgow and Clyde is currently 48 weeks. In comparison, in neighbouring Lanarkshire, no one has had to wait more than 10 weeks for a colposcopy over the past six months. In NHS Lothian, the second-biggest health board in Scotland, the average wait was just short of nine weeks. There is a postcode lottery in women’s experience across Scotland.
The figures for NHS Greater Glasgow and Clyde are shocking, and they are far worse than those in the rest of the country. Health inequalities are worsening in this area, and that should be addressed as a matter of urgency.
Cervical cancer is a treatable disease, and I welcome the improvement in HPV vaccination, but we need to do more. The Scottish Government must tackle screening inequalities and screening uptake, it must fund further research and it must address wait times for colposcopies, particularly in NHS Greater Glasgow and Clyde. Only then can we hope to beat cervical cancer once and for all.
18:24
I thank Ruth Maguire for securing and leading the debate. Anyone who knows her will know that she does not like to talk about her own situation in her work, and I am in no doubt about what it has taken for her to talk in this public forum about the disease that she has had to deal with, but I thank her for doing so.
As with everything that Ruth Maguire does, it is about helping other women. That is just what she does, and I would like to assist her in that, in a small way, by outlining what women should be looking for. When it comes to cervical cancer, knowledge is power, so I am glad to have the opportunity to help to spread awareness and encourage others to take the necessary steps towards reducing their risk of that preventable disease.
Cervical cancer is preventable, and it can be treatable if it is found early enough. However, the symptoms can mask themselves as something that can be brushed off as the kind of curveball that our reproductive systems throw us women from time to time, not least when we are in our 40s and 50s. Not everyone will show symptoms, but it is still crucial to be aware of them, so I will highlight them. I feel that when we have these types of debates, if even one person who watches it live or who watches the recording on Facebook afterwards actually takes up the smear test invitation, it is worth it.
I will outline some symptoms that could be a sign of cervical cancer. One is vaginal bleeding that is unusual for you—it could be during or after sex, between your periods or after the menopause, or it could involve just having heavier periods than usual. Other symptoms include any changes to discharge from your vagina, pain during sex and pain in your lower back, between your hip bones or in your lower abdomen.
Those symptoms can be caused by other conditions such as fibroids or endometriosis, so, if you experience such symptoms, you might pass them off as being part and parcel of something like that. However, it is important to get checked by your general practitioner if your symptoms change or get worse.
I emphasise that some of those symptoms can be present in women who are about to go through, or who are going through, the menopause. Women who are around the age of 40 or older might experience pain or unusual bleeding and simply assume that it is the menopause. That is the thing about us women: we put up with quite a lot with our bodies. We get used to a certain amount of pain and discomfort, and we often just struggle on and pass it off. I say to women: do not do that, because you need to find out what is really going on.
Sometimes, however, there are no symptoms, and that is why screening is important, particularly in detecting any abnormalities as early as possible. Although we, in Scotland, have taken steps in the right direction to prevent cervical cancer, I share other members’ concerns about the uptake of screening invitations. As others have mentioned, about one in three women will not take up their invitation for screening. However, the facts do not lie: every week in Scotland, about six women will learn that they have cervical cancer. It is the most common cancer in women aged between 25 and 35, and screening might prevent you from having to deal with the disease.
I will end with some good news. First, my friend Ruth Maguire is back in action after her treatment, and thank goodness for that. Secondly, in the future, the disease that she had could easily become one of the rarest, with all our daughters having had the HPV vaccination. However, although cervical cancer might one day be eradicated, it will not go away on its own. We have to ensure that we get our daughters vaccinated and that we take up those screening invitations.
My thanks go to Ruth Maguire for bringing the debate to the chamber and for bringing Jo’s Cervical Cancer Trust to the Parliament a couple of weeks ago.
18:29
I thank Ruth Maguire for securing this important debate.
We are fortunate to live in a time when we have access to early detection and prevention strategies for cervical cancer, which is a largely preventable disease. The HPV vaccine had been approved in 80 countries by 2007 and, as of October 2019, 100 countries worldwide were vaccinating against HPV as part of their regular vaccine schedule.
Uptake of the vaccine in Scotland is about 84 per cent, which is an incredible achievement, and Scottish data has shown that diagnosis of cervical cell changes decreased by 89 per cent among people who had been vaccinated against HPV. However, we still need to do more.
The cervical screening programme is a powerful tool to detect cell changes prior to them becoming cancerous, and that is where we need to see improvement. It is worrying to hear that one in three women do not take up the screening invite. In order to improve those numbers, we must identify and address the barriers that people face. Fear of the procedure itself, embarrassment and lack of knowledge about the implications of smear results undoubtedly play a role in individuals avoiding or delaying their smear invitations. That is compounded by the current pressures that are facing the national health service, which are causing a lack of appointments and, often, long waits.
Unfortunately, the more disadvantaged groups in our society are, again, the worst affected. We know that people with learning or physical disabilities and individuals from disadvantaged backgrounds are less likely to attend smear appointments. Excellent work is already being done to tackle those problems. Strategies such as self-sampling programmes to enable at-home testing show promising results, and they allow those for whom traditional methods of screening might be unsuitable the option to get checked.
The NHS and relevant charities already do a fantastic job. Their awareness campaigns, staff screening clinics and online resources continue to increase awareness and push us towards the World Health Organization’s global strategy for cervical cancer elimination.
We have the tools and knowledge to eradicate the disease, but the reality is that two women in the UK continue to lose their lives from cervical cancer every day. Cancer affects us all, whether personally or through someone close to us. Cervical cancer is one of the few cancers that we are currently able to detect and treat at such an early stage. That is why we need to push for the change that will make the disease a less common reality for women not only in Ayrshire or Scotland but around the world.
I encourage all women to take up their cervical screening invites. Your health is important, and this simple procedure, done at the right time, could make all the difference. I urge everyone to continue to speak about this important topic and, when they are invited, to take up the offer of vaccination and screening. Those are quick steps that could literally save your life.
I call Monica Lennon.
18:32
I am sorry, Presiding Officer—my throat has been struggling all day, so I will keep this brief. I join colleagues in paying tribute to Ruth Maguire, and I thank her not only for lodging the motion and making the debate possible, but for speaking about something that is deeply personal to her. Those of us who know Ruth know that she is a modest person who is feeling uncomfortable about doing that, but we thank her for putting herself, and her pain and experience, out there. I know that her family, friends and loved ones, who will be listening and watching, will be feeling very proud of her, and we are all glad that she is back in the Parliament.
I was struck by something that Ruth said in her interview with The Sunday Post. She said,
“I didn’t have time to have cancer”,
which stopped me in my tracks on the Sunday morning when I read it. That is a theme in today’s debate, and it was a theme at the recent event that took place in Parliament. I was not able to attend that event because of a funeral, but I chair the cross-party group on women’s health, at which we heard from another woman about her experience and her reality. The issue of not having the time came up again there, because, as women, we so often put ourselves at the back of the queue. We are juggling work and childcare and caring responsibilities, and so much more, so we all have to get real about the issue of time. Life is short, and it is precious, and we have to look after ourselves, so I am glad that Ruth made that point in her interview.
Another woman whom I want to speak about in my brief remarks is Emma Keyes, who is a constituent of mine. Emma is a young mum—she is now 31, and she has three children. She is a very busy and energetic young woman, and those of us who have met her are inspired by her. I know that the minister has previously given her time to meet with Emma, so I remind her that Emma has not gone away. She is a survivor, and she is very much fighting to make sure, as other members have said, that we get there by not simply talking about an elimination strategy but really picking up the pace on cervical cancer.
Emma wants to remind the Parliament and the Government of her story. She says:
“After being diagnosed with cervical cancer and understanding that this is a preventable cancer, it sickens me that other women have to go through this. If we get the right testing implemented, that increases uptake and fewer women will have to hear those dreaded words, ‘You have cervical cancer’. Fewer women will have to face harsh treatments resulting in fertility loss”,
which was Emma’s experience.
She goes on to say:
“HPV home testing kits give us a better chance to treat a pre-cancerous stage as opposed to this horrible cancer diagnosis for a younger age group. If we can increase the uptake with HPV home testing, as has been shown in the trials, then why would not we roll this out sooner? This will literally save women’s lives and take away the many barriers that come along with smear testing.”
That is what Emma has to say. Like other members, therefore, I am really keen to hear from the minister about where we have got to following the trials in Dumfries and Galloway, how we can speed up the process and how we can ensure that, whether in Parliament, in Government or in our own lives, we make the time to treat this issue seriously and use all the tools at our disposal to eliminate cervical cancer.
18:36
I thank my colleague Ruth Maguire for bringing this important debate to the chamber. I also commend her for recently hosting a drop-in event at the Parliament for Jo’s Cervical Cancer Trust and highlighting the end cervical cancer campaign.
Jo’s Cervical Cancer Trust was set up by James Maxwell in memory of his wife, Jo, who died from cervical cancer at the age of 40 in 1999. Following Jo’s diagnosis in 1995, Jo and James had difficulty in finding good information about every aspect of cervical cancer. It was their hope that one day, everyone would have easy access to the best and most up-to-date information.
Most importantly for Jo, it was her wish that women who were affected by cervical cancer would have the opportunity to communicate with others who were facing similar challenges. It is encouraging that, more than 20 years later, Jo’s legacy still lives on, but there is still work to be done.
Funding from the Scottish Government’s screening inequality fund in 2022 is enabling the charity to offer training, information and support to health boards in Scotland in order to address inequalities in cervical screening uptake. As we have heard, sadly, women from the most deprived areas are less likely to take part in screening, with uptake of only 63 per cent in comparison with 74 per cent in the least deprived areas. As we know, younger women, particularly those aged between 25 and 29, are also less likely to attend screening. No woman should be left behind when it comes to cervical screening.
To mention someone from many years ago, of whom we are all aware, there has been a Jade Goody effect on cervical cancer screening. The reality television star lost her life to cervical cancer in 2009. Her battle was very public, with her diagnosis coming two days after she was set to appear in the Indian version of “Big Brother” in August 2008. Before her TV appearance, she had had tests for symptoms including pain in her legs and heavy bleeding. In September that year, her cancer was deemed life threatening, and she had a radical hysterectomy and started chemotherapy and radiotherapy. A documentary called “Jade’s Cancer Battle” was aired on television at that time.
She died on 22 March 2009. She was only 27, and the mother of two young boys. However, her legacy would prove to be something powerful, as we see if we take a step back. When it was first announced that her cancer was terminal, medical authorities across the whole UK announced a surge in requests from women, particularly young women, for cervical screening.
Jade Goody had the ability to reach those women that some campaigns and awareness drives just could not reach, and her fight brought home the importance of the cervical smear. Her legacy saved lives. Sadly, as time has gone on, that effect has worn off, which is why it is so important that we continue to highlight the importance of screening. It is important that women, young and old, know about the signs and symptoms of cervical cancer and the importance of taking up cervical screening when it is offered. We need to have the conversation continue. Telling personal stories can be difficult, and I applaud the bravery of everybody who is keeping the conversation alive. If it saves one life, it will have been worth it.
For some, the conversation will be a reminder but, for younger women, it might be a new conversation. Therefore, I say to every woman who might be listening to this debate that, when the smear test letter comes through your door, please ensure that you make your appointment. Yes, it can be embarrassing and it can be slightly uncomfortable, but it is over in 10 minutes and it could save your life. One in three women do not attend their smear test, and we must change that. It needs to change if we are going to save lives. Let me tell you the symptoms again: unusual bleeding, and pain in your back, your hips or your legs. Just look out for symptoms that are out of the ordinary.
As previous speakers have mentioned, each year in Scotland, 323 women are diagnosed with cervical cancer and 95 women lose their lives. However, 93 per cent of cervical cancers are preventable through screening—they just have to be caught in time. Therefore, I say again that, when the letter appears, please do not ignore it and please take time to book your screening, because it could save your life.
The final speaker in the open debate will be Carol Mochan, who joins us online.
18:40
I, too, thank Ruth Maguire for bringing this important debate to the chamber. I am sorry that I am not in the chamber but at home.
I will make a short contribution, because I know that we have a lot of business to get through today. My first point is that it was an absolute honour to co-host, with Ruth Maguire, the drop-in event for MSPs with Jo’s Cervical Cancer Trust as part of cervical cancer prevention week. It was crucial that members had the opportunity to learn about the statistics in their regions relating to cervical cancer and HPV vaccine availability and uptake, as well as the general work of Jo’s trust and the work that it does in raising awareness across Scotland.
The report that Jo’s trust published last month entitled “We can end cervical cancer: The opportunities and challenges to eliminating cervical cancer in the UK” raises some concerning points. Notably, it highlights that the incidence in Scotland per 100,000 is higher than that in any other part of the United Kingdom and more than three times higher than the WHO target. Therefore, it is important that we take the issue very seriously.
The report also indicates that, as we have heard from many speakers, people in the most deprived areas are, by quite some distance, less likely to attend screening appointments. That is even more concerning given that Jo’s trust tells us that 50 per cent of instances of cervical cancer in the UK are in women who have never been screened. Yet again, we see that health inequalities in Scotland are deep and divisive. I have often raised in the chamber the point that health inequalities are taking lives.
That is why I have repeatedly asked the minister about self-sampling, and why I am pleased that many members have raised that issue tonight. Cancer charities feel that self-sampling is one of the most important issues among the top five priorities for screening programmes across the UK, and that it could help at that level.
In closing, I want to ask the minister about the pilot project in Ayrshire and Arran for people with physical disabilities. We have spoken about the health inequality that exists for women with physical disability. I hope to visit the service there with Jo’s trust, and I hope that the minister will see that as an important step in making sure that we get that right for those women.
In the interests of time, I will close there. I thank everybody for their contributions. I again thank Ruth Maguire, and I thank the minister for responding.
I invite Maree Todd to respond to the debate.
18:44
I thank my good friend and colleague Ruth Maguire for raising this issue in the chamber today and for sharing her personal experience. I also thank colleagues for their important speeches.
Raising awareness of cervical cancer prevention is absolutely crucial if we are truly to achieve prevention of this disease. We have a unique and exciting opportunity to entirely eradicate a cancer that affects so many, and I am determined that we do all that we can to achieve that.
There are a few different aspects that work together to help us to prevent cervical cancer. As outlined in the motion, the World Health Organization has identified three key targets that will move us towards eliminating this disease. I am working very closely with my officials on progressing work in relation to the WHO targets for screening, the HPV vaccine and treatment.
Cervical screening is key to ensuring that those who are developing the cancer are treated as early as possible, whether that is at an early stage of cancer or even at the point of identifying pre-cancerous cells. As I often reiterate, this is the one screening test that catches cancer before it is even cancer. The World Health Organization target is for 70 per cent of women to be screened using a high-performance test by the age of 35 and again by the age of 45. In Scotland overall, screening uptake is consistently above 70 per cent in women in the 35 to 44 and 45 to 49 age groups. However, as many members have mentioned, screening uptake is below 70 per cent in younger age groups and among women in the two lowest quintiles of the Scottish index of multiple deprivation. That is not good enough.
It is not enough for us to meet the World Health Organization targets at general population level. We must work to ensure that we meet the targets for the whole population. One of my top priorities for the screening programme is to continue to increase overall uptake but also to reduce inequalities. As we all know, the factors that drive inequality are complex and defy easy solutions, but I am passionately committed to closing the gap and so, too, is the screening community in Scotland.
We have awarded £456,000 to Jo’s Cervical Cancer Trust to support its vital campaign work on cervical cancer. That includes work to raise awareness of screening benefits and to tackle and understand key issues around access and uptake. This month, we have worked with Public Health Scotland to support other partners to promote cervical cancer prevention week.
For all the cancer screening programmes, we have committed £2 million over the past two years to take a more sustainable and systematic approach to reducing inequalities. That has empowered health boards to take action at a local level to meet the needs of specific populations. Nationally, it has supported improvements in communication with screening participants and the collection and analysis of data so that interventions can be better tailored for maximum impact. These inequalities are driven by complex factors, and work is on-going to develop a long-term strategy to address those.
All members in the chamber will be aware that there has not yet been a recommendation on cervical self-sampling from the UK National Screening Committee. However, in Scotland, we continue to lay the groundwork for introducing cervical self-sampling, which has the potential to remove some of the barriers that can deter people from attending for screening. That is a complex undertaking, and we are awaiting—not very patiently, I agree—consensus on the most appropriate test and how to use it. I see a lot of potential benefits to it. One very powerful example of that benefit is that victims of sexual violence could carry out self-sampling in the safe environment of their own homes. We are doing all that we can to ensure that we will be able to respond quickly to the NSC advice once it is published.
Of course, cervical self-screening is not the entire solution. We already have home screening kits for bowel cancer and we do not get 100 per cent participation, so although self-screening is a very important step forward, it is not the entire solution. The inequalities project produced some key findings on cervical screening. Methods that are successful in increasing uptake include using locations that feel safe, familiar and convenient, and targeting defaulters, which is what self-sampling pilot schemes look to do, is an important part of that work. Flexibility in delivery is also important. If we continue with cervical screening at GP practices, what about providing out-of-hours clinics?
I want to pick up those themes around inequality and the need for flexibility. We hear a lot from women who have real trouble having the conversation with their employer or manager to get time off work. What discussions is the minister having with employers and trade unions about how we can remind people of fair work principles, to ensure that, in particular, women who are in precarious and low-paid work do not face additional barriers, which is the reality for many people in our communities?
I thank the member for raising that issue. Work is being done to raise awareness among employers and trade unions. In addition, NHS Forth Valley did an interesting project, as part of which it sent cervical screening reminder letters to 8,000 women and gave them the option of booking a day or an evening appointment. Prompted by those letters, a total of 282 women attended, 80 per cent of whom were from areas of higher deprivation. That increase in flexibility is absolutely vital. As a result of that, a few practices are now offering regular screening clinics as a matter of course.
The cervical screening toolkit aims to address falling attendance rates and a lack of understanding of cervical cancer. The toolkit highlights the importance of the vaccine and is leading with new digital assets in raising awareness of HPV and the benefits of cervical screening testing.
The WHO has set a target for 90 per cent of girls to be fully vaccinated with the HPV vaccine by the age of 15. In line with the Joint Committee on Vaccination and Immunisation advice, an HPV vaccination programme was introduced for girls in Scotland on 1 September 2008. On 1 January 2023, a new single-dose schedule was introduced for those who are eligible up to their 25th birthday. I am absolutely certain that reducing the complexity of the dose schedule will increase the uptake. We envisage that that programme change will increase the number of people who complete their vaccination schedule, as it will remove the requirement for people to be recalled to have a second dose and to manage follow-up appointments. Coverage of the one-dose HPV vaccine is currently at 91.5 per cent for girls in S4. From 1 January 2023, the single dose will be considered to be a completed course of HPV vaccination.
Prevention is the main aim, but it is really important that we ensure that our diagnostics and treatment pathways are maintained for those who need them. We know that the earlier cancer is diagnosed, the easier it is to treat and even cure, which is why we continue to invest in our detect cancer early programme.
Jackie Baillie raised the issue of access to colposcopy appointments. Urgent cases continue to be prioritised and dealt with within four to five weeks, but I absolutely agree that the current situation is not good enough. NHS Greater Glasgow and Clyde recognises the anxiety that the long wait is causing and is taking on locums to tackle the backlog.
As we have heard, the Scottish Government, along with all members here, is absolutely committed to encouraging those who are eligible for cervical screening to engage with the screening programme. I want to be clear: if anyone has any symptoms or suspicion of cancer, they should get checked. To support cervical cancer prevention week, we ran social content on the Scottish Government’s wee c channels throughout the week.
I thank all the partners that help us in achieving our cervical cancer goals. We will continue to work together to further improve people’s awareness of cervical cancer and to increase participation in cervical screening.
That concludes the debate. There will be a brief pause before we move on to the next item of business.
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NHS Tayside Mental Health Services