Ex-minister: budget cuts meant my cancer was not spotted

As health secretary, I tried to introduce nationwide screening. On this and more, progress is required

THE former Conservative health secretary Andrew Lansley today reveals that he has bowel cancer and blames Treasury budget cuts for “wrongly” curtailing a national screening programme that he introduced.

Lord Lansley says his disease could have been caught sooner had his pilot scheme been rolled out nationwide.

Writing in The Daily Telegraph, Lord Lansley, 61, says he is receiving chemotherapy, and has “every reason” to hope to be among the more than half of patients who survive the disease over a long-term.

However, he reveals that his Stage 3 tumours were only discovered due to his wife “nagging” him to see a GP because of back pain.

As the health secretary for two years under David Cameron, Lord Lansley launched a screening programme called “bowelscope” for men aged 55 and over in 2010, which was due to be running nationally by the end of 2016.

However, it is currently only available to roughly 50 per cent of the population, due in part to a shortage of endoscopists and support staff as a result of cuts to the Health Education England budget.

Lord Lansley writes: “When I was health secretary, among the early plans for cancer investment which David Cameron and I announced in October 2010 was a commitment to introduce a one-off flexible sigmoidoscopy, or “bowelscope” test, at age 55 with a pilot leading to a national rollout across England.

“If this had happened, I would have been called to this new screening programme. Bowelscope could save 3,000 lives a year but training and recruiting enough endoscopists and support staff will take years.

“Health Education England is getting more resources for training more NHS staff, reversing the Treasuryimposed cut to the budget in 2014 (when it was treated, wrongly, as a budget not within the NHS ‘ring-fence’).”

Stage 3 tumours have normally grown into the bowel wall and may also have spread to nearby lymph nodes.

Almost 65 per cent of men whose bowel cancer is diagnosed at this stage can expect to live beyond five years, according to Cancer Research UK. “Bowel cancer, if diagnosed early, is curable,” Lord Lansley writes. “That has to be our aim.”

He says that, prior to his diagnosis, he had not noticed any symptoms of the cancer other than a change of bowel habit, which he put down to taking statins for the first time. “Mistake. Not a good idea to assume anything. If in doubt, ask your GP,” he says.

He describes himself as “lucky” to have seen a GP who referred him to a specialist and a “first-rate” NHS surgical team which carried out his sevenhour operation, but he adds that cancer survival “must not be about luck”.

Currently only 10 per cent of bowel cancer cases are diagnosed through screening, with roughly one-fifth of diagnoses not made until the patient is in an emergency department, by which time the cancer has often spread around the body and cannot be cured.

The Government has committed to introducing a new test for bowel cancer, called FIT (faecal immunochemical test), which pilot schemes have indicated will increase uptake for screening and detect more cancers.

Last Monday, I sat in a chair in a medical day unit while a chemotherapy went into my vein. A drug called Oxaliplatin which, with daily tablets of capecitabine to follow, are my ongoing treatment for bowel cancer. As I sat there, I was thinking that I was lucky. Lucky, because I went to see my GP (after much nagging from my wife) about nine months ago with spreading back pain, without any thought that it could be a cancer.

Lucky, because my GP was perceptive enough to refer me to the hospital. Lucky that the investigation showed Stage 3 tumours with no spread to my liver. Lucky that I had first-rate NHS treatment and care, including a great surgical team, whose seven-hour operation on my bowel must have been exhausting (all I had to do was go to sleep and wake up again). Lucky that, even if I suffer side effects and the prospect of a “new normal” after treatment, there is every reason to hope to be among the more than half of cancer patients who can look forward to long-term survival.

But the main reason I had these thoughts was because, at the same time, I felt deeply for George Alagiah, whose personal account I had read the previous day. We’re much the same age. He was diagnosed with Stage 4, with spread to his liver. It must not be about luck, I reflected. Bowel cancer, if diagnosed early, is curable. That has to be our aim.

This month is Bowel Cancer Awareness Month and so I am supporting the newly merged charity Bowel Cancer Uk/beating Bowel Cancer in their drive to push for progress in raising awareness of bowel cancer symptoms; in delivering optimal bowel cancer screening; and in identifying those with genetic forms of bowel cancer such as Lynch syndrome so that the disease can be prevented or detected early.

I can reflect on each from personal experience. To begin with, I didn’t think I had any symptoms of bowel cancer: no blood in my stool; no unexplained weight loss; no extreme tiredness; no lump in my tummy or pain there. But, I did have a change of bowel habit, which I put down to taking statins for the first time. Mistake. It’s not a good idea to assume anything. If in doubt, ask your GP. There is a reason why more than half of bowel cancer diagnoses are made following a GP referral.

Yet too many people don’t recognise these symptoms or don’t act on them; or don’t benefit from bowel cancer screening. In fact, only 59 per cent of people who are invited for screening take part. One-fifth of diagnoses are not made until the patient is in the emergency department, by which time it is often an advanced cancer, with metastases in other organs. This is particularly concerning because, if diagnosed at Stage 1, most people survive, yet by Stage 4 long-term survival drops to under 10 per cent.

Optimal bowel cancer screening is key to preventing and curing so many more cancers, yet only 10 per cent of diagnoses follow a screening test. When I was health secretary, among the early plans for cancer investment that David Cameron and I announced in October 2010 was a commitment to introduce a one-off flexible Sigmoidoscopy, or “bowelscope” test, at age 55, with a pilot leading to a national roll-out across England by the end of 2016.

If this had happened, I would have been called to this new screening programme. But the “bowelscope” is only available to about 50 per cent of the population. A lack of endoscopists and difficulties with IT have frustrated delivery. Bowelscope could save 3,000 lives a year, but training and recruiting endoscopists and support staff will take years. Health Education England is getting more resources for training more NHS staff, reversing the Treasury-imposed cut to the HEE budget in 2014 (when it was treated, wrongly, as a budget not within the NHS “ring-fence”). There is a screening programme using the faecal occult blood test (FOBT), at age 60, but it is blunt and misses too many cancers.

Positively, the Government has committed to introducing a simpler and more effective screening test called “Fit”. Pilots have shown that this will increase screening uptake and has great potential to detect more cancers. It will also require fewer endoscopies than full implementation of bowelscope would need. Switching the screening programme over to using Fit should now be an immediate focus, with a roll out this year and the development of a plan for optimising its use in future as further workforce capacity becomes available.

This should include improving the sensitivity of the test and reducing the age of screening to 50, in line with international best practice. This will require up-front investment in the pathology and endoscopy workforce but – as more people will be detected early or cancers prevented – it will lead to savings from more expensive later-stage treatments.

Progress is also required in identifying genetic causes of disease. The NHS is a world-leader in this. The 100,000 Genome Project should complete this year. The “baker’s dozen” of Genomics Medicine Centres are creating the care pathways to develop precision medicine. As Bowel Cancer Uk/beating Bowel Cancer highlighted again last week, some

4 per cent of bowel cancer patients have Lynch syndrome, an inherited gene characteristic that causes a lack of the proteins that would repair gene mismatch, leading to a significantly increased risk of developing bowel cancer.

I was fortunate that I was in a hospital that does conduct such genetic testing and I did partially lack one such protein. It may not be Lynch syndrome, but I have the reassurance of it being tested. Yet only one in five hospitals in England are presently undertaking this testing, despite the potential it could give for preventative treatment of the early onset of bowel cancer in family members – only about one in 20 of those with Lynch syndrome know it.

Bowel cancer is the second most common cause of cancer deaths in this country. It should be so much less. These priorities for progress can make a real difference. By prevention and early diagnosis, we can save lives and money. So, next Monday, when I again have a chemo infusion, I want to know that for others like me in future, with better knowledge about symptoms, with earlier improved screening in place, and with a new focus on personalised preventative medicine, it really isn’t about luck.