Honourable Members of Parliament I would like to thank you for this opportunity to discuss with you some of the problems associated with head and neck cancer in this country.

INTRODUCTION

  My name is Cathy Pope, I am 46 years old. In 1995 I was mugged by a group of youths at a petrol station. My nose was smashed and required a cartilage graft from my ear to rebuild it. It was only during my recovery that I mentioned to the surgical team about a flap of skin in the floor of my mouth. This turned out to be cancer. In 1998 I had to have the floor of my mouth, jaw and neck glands removed in a 12 hour operation. The surgeons rebuilt my mouth using a living graft from my leg. I then had a course of radiotherapy. Thankfully I'm cured but I've been told that if the cancer had been left for a few weeks more it would have been inoperable.

  In 1998, 3,400 new cases were diagnosed, I was one of those cases as such I am lucky, 1,600 patients died, this is unacceptable.

  This leads me to my first point:

1.  Patient education and early diagnosis

  Head and neck cancers are an area of growing concern with the incidence increasing year on year. It is now the 15th commonest cancer in this country and is as common as cervical cancer. Yet, incredibly there is no screening programme and little education. The sharpest increase seems to be in younger patients especially females. Like my cancer the symptoms can be quite subtle and unfortunately over 40 per cent of patients present at the initial appointment are already at stage four of the disease. If we screen patients for cervical cancer why don't we do the same for head and neck cancer? The mouth is so easy to access and examine with none of the taboos of cervical cancer. We need to raise awareness amongst patients, doctors and allied health professionals who can all help by promoting regular oral examinations.

  Oral cancer is smoking and alcohol related. There is a need for a national education strategy in particular targeting patients who are both heavy smokers and drinkers. When I go to my GP there are several pamphlets on other cancers, for example, cervical, breast, prostate, but nothing on head and neck cancer. I have found in my wide discussions with patients and support groups that there is an overwhelming ignorance as to the dangers of smoking and drinking in oral cancer. In addition, strange as it may seem, even nuns can present with this most cruel of cancers.

2.  Rehabilitation in the cancer journey

  Rehabilitation and reintegration into society is important to all cancer sufferers. My type of cancer is particularly cruel but thanks to the wonders of modern microvascular free tissue transfer techniques, I have been rebuilt. My scarring is minimal and unless you knew of my medical history you would have no perception of what's gone on. Fortunately I am luckier than most, as I was diagnosed and treated in one of the best centres in the UK and I have retained my ability to speak. Also the surgeons have placed titanuim implants into my new jaw so that I can eat, though this still remains a daily challenge. Rehabilitation involves a large multidisciplinary team, which includes for example oncologists, speech therapists, physiotherapists, counsellors, dieticians and so on. Such intensive resources makes it essential that patients are treated in a limited number of centres of excellence. From personal experience, if you have cancer, you are prepared to travel anywhere to get the best treatment and after care. Without this form of rehabilitation I would have been a social outcast and it is not difficult to imagine why that in the not so distant past suicides amongst head and neck cancer patients were not uncommon. Even in the well established Maxillofacial cancer centres rehabilitation is delayed because of lack of funding. I appreciate that it's expensive but I feel very strongly that without this expertise being available to every patient, the cancer journey can be one never ending nightmare.

3.  Funding for research

  The third and final point I'd like to bring to your attention is the lack of funding for head and neck cancer research. Compared to America, where cancer research is government funded, a relatively small amount of government money is spent on cancer research in the UK, which is mainly funded by charitable donations. Also it appears that there is a North/South divide when funding research. This is particularly strange when one considers that the incidence of oral cancer in the North is around twice that of the South. More money should be allocated to head and neck cancer research and this should be targeted to cancer black spots. To gain further understanding of this most disfiguring of cancers we need not only a limited number of regional cancer centres but also a national supra-regional centre of excellence in England, Wales, Scotland and Northern Ireland.

  In summary, I hope to speak for all oral cancer sufferers we need education on the risks of alcohol and tobacco, we need a screening programme to help promote early detection and patient awareness, and we need a national centre of excellence established as a priority. I understand that the Committee is visiting Christies in Manchester. I urge you to travel a few extra miles down the M62 and visit the University Hospital Aintree so that you may witness at first hand the innovative structure of this unit that must act as a benchmark for cancer services nationally.

June 2000