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Wednesday, 29 March 2006
Page: 62

Mr SWAN (1:20 PM) —It is unquestionably in the nation’s interests that more be done to detect, diagnose, treat and cure the ravages of cancer. There is not a family in this country, there is not a street in any suburb, regional town or rural area where someone does not have a relative who is affected by cancer. When someone in a family has cancer, the whole family is affected. It is not a question of whether it is a cancer like prostate cancer, affecting men, or breast cancer, affecting women; we are all in this together. It must be a very important national priority to do something about more accurately detecting cancer, particularly in the early stages, and then, if it proceeds, to cure that disease much more effectively.

Wonderful movements are occurring in research around the world. We are having greater success in detecting cancer early and in curing it. That gives us all a lot of hope, which is why, I am sure, members come to this House today entirely supportive of a more improved, coordinated attack upon the ravages of cancer in our society.

The Cancer Australia Bill 2006 establishes Cancer Australia in order to improve coordination within the cancer sector and to ensure that ‘the entire spectrum of cancer care services throughout Australia are evidence based and consumer focused’. I welcome the appointment of Dr Bill Glasson to this very important position. He is a man whom I regard highly and have seen to be a very effective operator and doctor over many years. It is very important that Cancer Australia is an effective organisation with strong leadership, because I think it is true to say that that leadership has not necessarily been as strong, as effective or as evidence based as it ought to have been in recent years.

This is a very important body. It is very important that it implements practices of evidence based research and it is very important that it stays consumer focused. As I said before, sadly this has not necessarily happened across the board in the past. So today I want to make some constructive comments about how it can more effectively base its decisions on research and how it can more effectively pursue that goal of early detection, because early detection is always the best protection.

The importance of this comes home to me all the time as I travel around Australia and work with the Prostate Cancer Foundation to raise awareness and to assist them to raise funds for early detection and for medical research into more successful cures, which are so desperately required. The fact is this: whether you are dealing with prostate cancer, breast cancer or cervical cancer, too many Australians do not get early detection of their cancer. For too many Australians, it is a lottery. This is particularly the case with prostate cancer. Many men I meet have not been detected early and as a consequence are suffering terribly from that, as indeed are their families. Of course, this is the case in many other areas—cervical cancer is a particularly difficult cancer to detect early. But great strides can be made if the funds can be marshalled behind the research effort that aids in early detection as well as more effective cures.

That is why I have been very proud to have been involved with the ‘Be a Man’—see your doctor—campaign, which is funded not by the public of Australia, not by the Cancer Council, but by the Australian Pensioners Insurance Agency, who stepped into the breach which was left open by the failure of the Cancer Council of Australia to come to the party and support early awareness-raising activities of the Prostate Cancer Foundation. This campaign should have been the beneficiary of more public support, but it did not receive it from people like Professor Alan Coates, the current CEO of the Cancer Council. Despite that, it did go to air and I am sure it is raising awareness in the community and is saving lives.

These are not matters which are new; these matters came before the House back in June 2003, when this House came together to talk about raising awareness for prostate cancer. Many members spoke and it was a very good debate. Around that time Professor Coates had said that he personally would not get tested for prostate cancer and publicly advised men not to be tested for prostate cancer. It was essentially an attitude that said, ‘Don’t bother to find out.’ He went on to mount an argument that testing was not reliable. Nothing could be further from the truth. But the problem was that when Professor Coates made those statements he torpedoed the prostate cancer awareness-raising campaign. It did not go to air. It took another two years before the Prostate Cancer Foundation could get that campaign to air. The consequence of that not going to air then, of the delay involved in it not going to air then, would have been quite savage for many Australian men who were not the beneficiaries of those awareness-raising activities. It is vital that we get early detection, but we cannot have early detection if men are not presented with the information they need.

That Be a Man campaign went ahead based on scientific research that Professor Coates has chosen to ignore year after year. He did it in an environment where only one in 10 men is tested for prostate cancer—the physical examination and the PSA test. Compare that to breast cancer, where seven in 10 women are tested for breast cancer. Only one in 10 men is tested for prostate cancer, despite the similar numbers—around one in 10 or one in 11 are affected by those cancers. That is why it was deeply disturbing to hear Professor Coates recently on the SBS Insight program repeat those ill-informed comments that he made some years ago which initially torpedoed the Be a Man campaign. That has been going to air advising men to see their doctor and get tested.

When you have the head of the principal cancer organisation in Australia saying that he personally would not be tested for prostate cancer, what sort of a message does that send to men who may be too afraid or too ignorant to go to their doctor and get tested? What it actually provides is encouragement for people to choose ignorance over information. So I was appalled when these remarks were made by Professor Coates only some weeks ago on the Insight program, making for a more difficult problem in the community when what we need to be doing is encouraging men to get tested.

More importantly, we need campaigns for early detection and awareness based on evidence—based on scientific research. Professor Coates’s comments fly in the face of scientific evidence that men should be tested at certain ages. They flew in the face of perhaps a definitive report on this question that appeared in the Medical Journal of Australia, Volume 183, No. 6, 19 September 2005. This is a report on a defining piece of research titled ‘Revisiting the role of radical surgery in early stage prostate cancer’. The subtitle poses the question: ‘Is it time to walk the line between overtreating indolent disease and undertreating aggressive disease?’ These were the research findings that Professor Tony Costello reported in the Medical Journal of Australia:

In men treated with surgical intervention, the incidence of metastatic disease and risk of death from prostate cancer was significantly reduced compared with those who are managed by watchful waiting.

…            …            …

This health benefit was highest in men younger than 65 years of age, with 19% of watchful-waiting patients compared with 8% of patients treated with surgery dying from prostate cancer at 10 years.

That is a definitive piece of research which backs up the argument that has been put by urologists—people like Professor Tony Costello—that you must have early detection based on awareness-raising campaigns. The foundation for it basically says that men over 50 ought to be tested through the physical examination and the PSA test, and, if they have a first-degree relative, they ought to be tested at 40 and over. But the message that is coming from the Cancer Council of Australia and its CEO, Professor Allan Coates, is that that is not the case. They deny the validity of that evidence.

This blinkered view is one that ought to be rejected and it ought to be rejected in a body such as the new Cancer Australia, because we need to have early detection based on evidence based research such as that which has appeared recently in the Medical Journal of Australia. The sort of leadership we have had from Professor Coates is leadership of the worst kind. In one fell and particularly ill-considered swoop, Professor Coates has significantly set back the marvellous education and testing campaigns being run by the Prostate Cancer Foundation and I think also by a range of breast cancer organisations.

Unfortunately, this debate has now erupted with respect to breast cancer, where seven in 10 women are tested. Following the press recently I have seen similar critiques on the early screening for breast cancer, arguing that it should not occur, that the evidence for screening is not there, that the longitudinal studies are not in, that too much distress is caused for those who are not found to have a life-threatening disease and so on. All of this comment is not based on research and is very ill informed. The view being put forward by Professor Coates and a small number of rogue practitioners flies in the face of the commonsense observation that early detection is the best protection.

As I said before, the latest research published in the Medical Journal of Australia in September proves that testing and treating men with prostate cancer saves lives—that eight years after detection and treatment men have a 50 per cent chance of living longer compared to those who have no treatment at all. This important piece of research proves that only 20 per cent of men with prostate cancer will not suffer life-threatening consequences. Of course, tragically, that means that 80 per cent of those men will suffer life-threatening consequences. If they take the advice of Professor Coates 80 per cent of those men will suffer life-threatening consequences. As many men in the community today know, this is a ratio that they ought not consider as being acceptable. What Professor Coates is really saying is that, to protect the peace of mind of only 20 per cent of men, 80 per cent of men should make a conscious decision to ignore a life-threatening disease. I fear what the tragic consequences of that would be if this sort of advice were to spread to those who are looking at the early detection of breast cancer, when the testing rate is in now seven in 10 compared to only one in 10 for prostate cancer.

By publicly stating his conscious intention not to be tested, Professor Coates has decided to substitute considered public policy for an ill-considered personal view. His advice against testing will, for some men, lead to an early and painful death. Professor Coates is effectively telling men to stick their heads in the sand. He is telling us to be guided by the false calm of apathy and ignore the compelling scientific evidence that shows men will live longer with early detection and treatment of their disease. We as a community, through this new body, should choose knowledge and information as the weapons required to defeat fear and apprehension and ultimately to defeat the curse of cancer.