WEDNESDAY 21 JUNE 2000

PROFESSOR JOHN MONSON AND PROFESOR J N PRIMROSE

  593. As our final witnesses I call Professor John Monson and Professor Primrose from the Surgical Research Society.

  (Professor Monson) Good afternoon. I should like to thank you first of all for the opportunity to speak to you today. You will have received a submission from the Society which for your information represents the largest grouping of surgical academics in these islands and has, since 1954, been presenting and deliberating on research, much of which is related to cancer research. In common with virtually every organisation which has appeared here today, we agree that cancer funding in this country is sadly lacking and needs a major rethink. We also believe in supporting the concept that long-term novel strategies based on advanced molecular and cellular oncology do indeed offer the best prospects for long-term resolution to some of the malignancies. However, to date they have made virtually no impact whatsoever on the outcome of malignancies. At present the majority of research in the clinical field concentrates on medical oncology and radiation oncology, mostly medical oncology, utilising the issues of molecular strategies, which, whilst they have indeed significantly helped our understanding in the pathogenesis of the disease, again have made a relatively modest impact on outcome. The notable exceptions will, of course, be the leukaemias, testicular cancers and lymphomas. For the big hitting cancers in this country, lung, breast, colorectal cancer, they have made virtually no difference. For lung cancer you heard earlier today that 5 per cent of people survive five years. Those 5 per cent survive only because of surgical treatment. They are the lucky ones diagnosed early enough to be surgically treated. For colorectal cancer, the second biggest killer in this country, 17,000 people a year die in England and Wales alone. Chemotherapy has made a 10 per cent increase in survival despite all the resource. Most of the cancers which are cured in this country are cured by surgery alone, yet we see very, very little research into surgery. For example, the major developments which have occurred in improving cancer outcome and care have come from surgical initiatives. The examples I would give you are: the move from radical mastectomy to lumpectomy in breast cancer which is a surgical initiative, unfunded by any body; the development of new surgical techniques for the treatment of rectal cancer, which have reduced local occurrence rates down from 30 to 40 per cent to 5 per cent, totally unfunded surgical initiative; the development of screening techniques using nurse-led endoscopy, surgically-led initiative, originally unfunded and only recently funded by the MRC. The development of liver resection for metastases following colorectal cancer, changing a five-year survival from zero to 25 per cent; surgical initiative, unfunded. Our reason for appearing here before you today is not to plead for a specific interest group, not to suggest that funding should be moved one way or the other, but to try to help you understand that there is no conceivable advance in the treatment of cancer in the short to medium term which could even approach the potential benefit of improving cancer surgery. The outcomes will improve with better cancer surgery. Any reasonably competent economist will tell you that you will get more "bang for your buck" by investing in surgical techniques and technology. We hear too much about this from the media at the moment. What we need to understand is that is where the benefit will be. We believe that mechanisms need to be found to improve, probably by proactive commissioning, methods of funding high quality surgical research. Thank you very much.

  Chairman: Thank you very much. We have another minute.

  594. Is there an issue too of a lack of specialist cancer surgeons? Is not much of the cancer surgery being carried out by general surgeons? Is there scope for training and improvement here?
  (Professor Monson) Huge scope in that area; quite right. Some of the areas such as rectal cancer surgery have a number of high quality centres which do high quality work but statistically they do the minority of the work. These centres are simply not capable of taking all the cases. There is a major need for that. There is an enormous shortfall of surgical expertise out there. Equally there is an enormous shortfall of research done into the issues which determine what is good surgery and bad surgery. Some people say that the surgeons do not apply for the grants. One of the reasons they do not apply is that there has been this philosophical issue which has really lost the plot because it has directed people down molecular biology.

  595. I am very interested in the way you have highlighted this deficit. Is it only true in Britain or is it true internationally that there is not enough emphasis?
  (Professor Monson) It is true internationally, although that is not our concern. There are issues internationally that are similar in reflection. You should not be in any doubt that the UK is way behind in many aspects of site specialisation, for example, and most certainly, compared to the US, where there is dedicated research surgical funding through the NCI, and the breast and bowel project, for example, is surgeon led, run on a surgical ground and has made a major contribution.

  Chairman: Thank you very much indeed. I should like to say first of all thank you to everyone who came to give evidence to us. The evidence has been recorded, it has been noted and will be taken into consideration by us when we produce our report. I should also like to congratulate everyone on being so disciplined in giving their evidence in five minutes. We have run just eight minutes late in two hours, which I think is better than British Airways. We have done pretty well on that. It is an experiment. It is the first time we have done anything of this type, not just this Committee but the whole House. The proceedings this afternoon have been observed by senior Members of the House of Commons to see whether the experiment should be repeated with other committees. I have no doubt, from my own judgement and I think the judgement of those around me, that the success this afternoon means that the public will be given opportunities in future to come along and give evidence in five-minute bursts as you have done. May I say that I have appeared before a select committee twice in my 18 years here when I have been appearing before the Information Committee of the House of Commons trying to obtain funds for scientific organisations in the House. I find it far easier to chair a select committee than I do to appear before a select committee, so I have sympathy with all of those who sat in the witness's chair. Finally, may I say that we have had 20 maiden speeches this afternoon in the House of Commons and you have all done so very well. You will be able to say to your friends now that you have made your maiden speech in the House of Commons! Who knows when you might make your next one? Thank you very much indeed for coming this afternoon. We have enjoyed having you. We hope you have not found it too nerve-wracking to be here. The Committee is now adjourned. Order.