Conservative and Unionist Party MP for Berwickshire, Roxburgh and Selkirk since (elected).
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| Conservative | MP | Berwickshire, Roxburgh and Selkirk | – present | elected | — | Party history |
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I beg to move, That this House has considered e-petition 751472 relating to prostate cancer screening. It is a pleasure to serve under your chairmanship, Dr Murrison. I begin by thanking David James, director of patient projects and influencing at Prostate Cancer Research, for creating the petition, and the 101,932 people who supported it, including 195 in my constituency in the Scottish Borders.
I am grateful to my hon. Friend for making that point. It is a testament to the importance of the issue not just to her constituents—given the number who signed the petition—but to all our constituents who signed it that so many see the need for the Government to address this matter. All the charities do important work in the area.
I will make some progress, if I may, to develop a few arguments. I will take a couple of interventions, but I am conscious of the number of colleagues who are keen to speak. The petition argues: “Targeted screening for all high-risk men should be the starting point for building a screening programme that can ultimately protect all men.” It also questions the decision to offer screening exclusively to men with BRCA1 or BRCA2 genetic variants. Since the petition was launched, the UK National Screening Committee recommendation has narrowed, and the Government have now accepted screening for a a smaller group than the petition sought. The questions for us today are: who should be included? Why have other high-risk groups been excluded? And what evidence would justify widening the programme? Prostate cancer is the most commonly diagnosed cancer in men in the United Kingdom. More than 68,000 men are diagnosed annually, with over 12,000 dying from the disease each year. Patient survival hinges heavily on when it is diagnosed: if it is at stages 1 or 2, nearly 100% of men survive for five years or more, whereas if it is at stage 4, only about half live for five years or more.<span id="2WH" class="column-number" data-column-number="2WH"></span> Sir Chris Hoy, Scotland’s most decorated Olympian, knows this better than anyone. He was diagnosed in 2023, in his 40s, after a scan for shoulder pain. He had no prostate cancer symptoms at all, yet by then the cancer had spread to his bones and was terminal. His father and grandfather both had prostate cancer. Under the programme that the Government have now accepted, a family history like his would not, on its own, qualify a man for screening. Last year, the broadcaster Dermot Murnaghan was diagnosed with stage 4 prostate cancer and, sadly, died in July this year. He said that he “fell through the gaps”, having assumed that the regular health checks he received would include a PSA—prostate-specific antigen—test. They did not. His message to other men was simple: “Get the test. Insist on the test.” Risk is not evenly distributed—age, family history, genetics and ethnicity all matter. One in eight men will develop prostate cancer during their lifetime, with the proportion rising to around one in four for black men. That is why the petition argues for screening to begin with men already known to be at greater risk.
The right hon. Gentleman makes an important point. I will come on to the importance of ensuring that we get a UK-wide approach, because there are subtle differences among the devolved nations. The UK Government decision to accept the UK NSC’s final recommendation in England—to provide a PSA test every two years to men aged 45 to 61 with pathogenic BRCA2 variant and a relevant family history of breast, ovarian, pancreatic or prostate cancer—is a significant step forward, and roll-out is expected from 2027. BRCA1 carriers, however, are excluded, and BRCA2 carriers must also meet the family history criterion. The Department of Health and Social Care estimates estimates that only around 1,500 men in England will be eligible, and acknowledges that most prostate cancer cases will therefore fall outside the programme. The final recommendation also falls well short of what Members from across the House have called for. In November 2025, a cross-party letter signed by more than 120 MPs, hand delivered to the Health Secretary by my right hon. Friend the Member for Richmond and Northallerton (Rishi Sunak), called on the Government to act for the men at greatest risk: black men; men with a family history of prostate, breast or ovarian cancer; and BRCA1 and BRCA2 carriers. Its message was clear: perfection must not be the enemy of progress. The concern raised by those MPs reinforces the central question that the petition addresses: is the current screening programme too narrow?
The hon. Member makes an important point about awareness and the challenge in rural areas. I will come to that later in my speech. I am pleased that my right hon. Friend the Member for Richmond and Northallerton is present, having done so much to advance this issue. As Prime Minister, his Government backed the £42 million Transform trial, providing £16 million of Government funding to examine different approaches to prostate cancer screening. For the benefit of Members who are not aware, Transform is the largest prostate cancer screening trial in two decades. Designed and led by Prostate Cancer UK, with Government funding through the National Institute for Health and Care Research, it is comparing combinations of PSA blood tests, fast MRI scans and genetic saliva tests to find the safest and most effective way to detect prostate cancer before it becomes incurable. Crucially, it is designed to include far more black men than previous trials. With further Government funding announced this year, it is now worth around £60 million, and its first-stage results are expected before the end of 2027. My right hon. Friend has since become an ambassador for Prostate Cancer Research and has called for a targeted national screening programme for the groups most at risk. Prostate Cancer Research says that the final UK NSC recommendation “falls short of what is needed”, arguing that too many high-risk men remain outside the programme.
The hon. Member is right. There is so much work and research going on in this area, and it is imperative that the Government acknowledge that work and react once more informed evidence becomes available. The petitioners argue that the UK NSC has “fixated on potential harms” and underweighted the benefits of earlier detection, but there are good reasons why screening programmes face a higher evidential threshold. A raised PSA level does not by itself diagnose prostate cancer, but can cause anxiety and lead to further investigation. Screening can also result in overdiagnosis and unnecessary treatment, which can cause lasting harms. Prostate Cancer Research challenged the draft modelling, arguing that it relied too heavily on older evidence and did not adequately <span id="4WH" class="column-number" data-column-number="4WH"></span>reflect modern MRI-led diagnostic pathways. The UK NSC says it considered those criticisms and updated its modelling before reaching its final recommendation.
My hon. Friend makes a crucial point about the importance of testing centres being available in rural areas, and about how community-based testing centres link into the NHS and the research that is being carried out. There remains significant disagreement about the scale of harm. The UK National Screening Committee estimates that for every 1,000 men offered screening, up to 20 could be overdiagnosed, while around two lives are extended. Analysis by Prostate Cancer Research of more contemporary, MRI-led studies estimates that, roughly, for every two lives saved, three men are overdiagnosed. The updated Cochrane review published in May found that for every 1,000 men screened, PSA-based screening is likely to reduce prostate cancer mortality by around two deaths, while questions about overdiagnosis and treatment-related harms remain. When I met researchers from the Transform team, they highlighted an important nuance: MRI has reduced unnecessary biopsies, but it has not yet been shown that those diagnostic advances sufficiently reduce overtreatment. Questions also remain about how organised screening would interact with the PSA testing that is already taking place, and about screening black men, with the UK NSC saying it has insufficient evidence to determine “whether screening would cause more good than harm.”
My right hon. Friend makes an important point. My ask is that the Government continue their engagement, but also keep assessing the evidence and information coming forward, so that patients are given the best possible opportunity for survival. The uncertainty around screening matters the most for black men, as one in four will develop prostate cancer and they are around twice as likely to die from it, but rather than being offered screening, they are being invited to take part in a trial. Transform has received up to a further £18 million to directly test several relevant questions, and to ensure that if stage 1 of the project is successful, all eligible black men aged between 45 and 74 will be invited to stage 2. Researchers told me that useful stage 1 evidence should be available before the long-term trial is complete, and will be fed back to the UK NSC.<span id="5WH" class="column-number" data-column-number="5WH"></span> As the MP for the Scottish Borders, I want to highlight Scotland’s experience. The Scottish Prostate Cancer Initiative, supported by Sir Chris Hoy, Sir Tom Hunter, Professor Sir Chris Evans and Kenny Logan, aims to offer free PSA tests to 25,000 men aged 40 to 80 during 2026. Sir Chris described the initiative as “a major step forward for prostate cancer testing.” In May, 313 men were tested in Hawick and 515 men were tested in Galashiels, meaning that across two days 828 men in my constituency were tested. The initiative is not an NHS screening programme, but its community-based model may offer useful lessons about access, uptake and reaching men who might otherwise be missed. That matters, because inequalities remain stark. Analysis from the NHS, National Services Scotland and Macmillan Cancer Support found that men in the most deprived areas had a 98% higher risk of death from prostate cancer than those in the least deprived areas. I hope the Minister can address several points. First, will she commit to independent expert scrutiny of the UK NSC modelling, and to publish the findings and the Committee’s response in full? Secondly, as stage 1 of Transform produces significant new evidence, particularly on the screening of black men, will the Government ask the UK NSC to review its recommendation? Thirdly, how will the NHS proactively identify eligible BRCA2 carriers, particularly men whose genetic risk is not already known? Fourthly, what lessons on improving access to testing can be drawn from community-based initiatives in Scotland? Fifthly, what discussions has the Minister had with the Scottish Government and the other devolved Governments to ensure that a man’s access to screening does not depend on which side of the border he lives on? Finally, what will the Government do to make sure that the many men who fall outside the programme know they can ask their GP for a PSA test and receive clear, balanced information when they do?
That is a key point, because not everybody who is diagnosed with prostate cancer will necessarily need further treatment. Some people will not die of prostate cancer but will die with prostate cancer. The challenge for the Government is getting the balance right between when it is appropriate to test and treat and when it is not. I am conscious that many Members want to speak, so let me conclude. Screening is not simple. Finding more cancer is not automatically the same as saving more lives, but legitimate concerns about overdiagnosis should not prevent us from asking whether advances in diagnosis <span id="6WH" class="column-number" data-column-number="6WH"></span>have changed where the balance now lies. More than 100,000 people have asked Parliament to consider targeted screening for men at higher risk. Since they signed the petition, targeted prostate cancer screening has entered policy for the first time. That is an important first step. The question now is how and when the boundary should move as the evidence develops. The evidence I heard when preparing for this debate points both ways. Earlier detection could save lives, but questions remain over whether modern screening can reduce past harms. The Transform trial should help to provide the answers. When it reports, the Government must be ready to act quickly; that is what the petitioners asked for and what I hope the Minister will commit to. I look forward to hearing from her and from colleagues.
I thank David James, the petition creator, and Prostate Cancer Research for leading the campaign so effectively. That so many colleagues decided to contribute to this debate is a sign of its success. I thank all colleagues, who spoke passionately, albeit briefly, about the importance of the issue. Some shared very moving experiences, either personal or on behalf of their constituents. I thank the Minister for her response. It is important to have reassurance from the Government that they will be led by the evidence. The Minister said that she will consider further evidence that emerges from the research, but it is important that the Government do more than consider the evidence; they must be led by it.