English: Thank you, Deputy Presiding Officer. I'm very pleased to open this debate on the Petitions Committee report on a petition received calling for a national screening programme for ovarian cancer. This petition was organised by Margaret Hutcheson, and was supported by 104 people. Ms Hutcheson, a retired palliative care nurse, was inspired to start the petition after several of her friends had been diagnosed with ovarian cancer. Her primary concern was to improve timely diagnosis and treatment of this terrible disease. Her main ambitions for the petition were for a national screening programme for ovarian cancer, and increased awareness of ovarian cancer and its symptoms amongst health professionals and the general public. As a committee, we held oral evidence sessions with the petitioner, the Minister for Social Services and Public Health, and we also wrote to cancer charities to seek their views. We as a committee are grateful to the Welsh Government, Cancer Research UK, Ovarian Cancer Action, and Target Ovarian Cancer, who all provided their views on the subject of the petition. Ovarian cancer is responsible for around 240 deaths each year in Wales - or, in terms we understand, six per constituency - and is one of the major causes of mortality in women in the UK. One in 50 women will have ovarian cancer at some point in their lives and, tragically, less than half of women diagnosed with ovarian cancer are alive five years after diagnosis. Evidence we received also indicated that survival rates in the UK are lower than the European average. Margaret Hutcheson, the petitioner, was accompanied by her friend Jenny Chapman to answer the committee's questions, and I would like to place on record the committee's sincere thanks to both of them for coming along and giving us their views. All the views we heard support the importance of early identification of the symptoms of ovarian cancer. Doesn't that sound common for all cancers? Early diagnosis improves the chances of successfully defeating the disease, and I think that that is something that we perhaps need to say more and more often. We heard that there's a close correlation between early diagnosis and the outlook for women receiving that diagnosis. Whilst this is not unique to ovarian cancer, the committee did hear that ovarian cancer can be particularly difficult to diagnose. This is because the common symptoms are easily mistaken for either other conditions, or there are no symptoms at all. For these reasons, by the time most women with ovarian cancer develop symptoms and their cancer is detected, it has spread outside the ovaries and is far more difficult to treat successfully. Figures we received from Cancer Research UK showed that the five-year ovarian cancer survival rate in England and Wales is 46 per cent, or, put the other way, 54 per cent die within five years. However, amongst women diagnosed at the earliest stage, this increases to 90 per cent. So, over a third more women who are diagnosed at the early stage survive than would if they waited until the later stage. We believe this represents a convincing case for taking further action to increase the number of women with ovarian cancer receiving an early diagnosis. This petition primarily called for the introduction of a screening programme to detect early-stage ovarian cancer. The petitioner argued strongly this could help save the lives of women who develop cancer. The petitioner made the case that this should involve women receiving an annual blood test aimed at detecting early-stage ovarian cancer. In her evidence to committee, Margaret Hutcheson suggested the programme should specifically target all women aged over 50. Ovarian cancer screening is not currently available on the NHS in Wales, nor in any other part of the UK. The committee heard that studies to find a general population screening test for ovarian cancer are currently ongoing. The largest of these is the UK collaborative trial of ovarian cancer screening, which has been running since 2001. Findings were published in December 2015. They indicated there could be benefits from conducting screening using blood tests, but these were inconclusive overall. As a result, the study has been extended for another three years. In her evidence, the Minister for Social Services and Public Health outlined the process through which Welsh Government takes its advice from a UK national screening committee, which advises all UK Governments. We learned that the screening committee has recently reviewed its recommendation about ovarian cancer screening and their existing recommendation remains for no population screening at this stage.' We also heard concerns about the accuracy of the most common blood test for ovarian cancer, the CA125 test. Women with ovarian cancer tend to have high levels of the CA125 protein in their blood - more than women who do not have ovarian cancer. But CA125 can also be raised for a number of non-cancerous reasons. This means there is a significant risk of false positives. We heard it is possible that only 1 per cent of women referred to secondary care following a CA125 blood test would actually have ovarian cancer, and I think that one of the things we did feel was that we don't want people to be frightened of something when the chances of them having it are that low. Therefore, the research currently indicates that the test is not currently accurate enough to be used as part of a screening programme. Having given careful consideration to the range of evidence the committee received, on balance, we accept that the current evidence does not support the introduction of a population screening programme. However, given the study is still under way and will report further findings in the coming years, we recommend that Welsh Government should keep the situation under close review and give detailed consideration to any evidence in relation to a new national screening programme. Given that early diagnosis is so important in cases of ovarian cancer, an effective screening programme could play a vital role in improving survival rates, and I am pleased that the Minister accepted this recommendation. As stated earlier, though we are not able to support a national screening programme, we felt as a committee that other measures taken to improve early identification of ovarian cancer - . I will now turn to those. The need to increase public awareness of ovarian cancer was the central theme of the evidence we received. The petitioner expressed concern that public awareness of the condition is extremely low and described ovarian cancer as a 'silent killer'. We heard that a leaflet on ovarian cancer, including common symptoms of the disease, is available through GP surgeries, and the Velindre NHS Trust ran a month-long awareness campaign in March 2016. As part of this, information packs for GPs were produced by the charity Target Ovarian Cancer. We welcome these actions and the efforts taken to increase public awareness of ovarian cancer and the common symptoms. Nevertheless, we feel that more could and should be done to ensure greater numbers of women are aware of the disease. Building awareness is the key, because, once they become aware of it and become aware of the symptoms, then there's a greater chance of them going to see their GP and getting a referral. We have recommended the Welsh Government should do more to improve public awareness of ovarian cancer, including the common symptoms and when people should seek medical advice. We would like to see this build upon previous work and run over a prolonged period. I recognise there is merit in raising the public profile of a large number of conditions and diseases. However, the evidence we received convinced us there should be a focus on ovarian cancer specifically because of the vital importance of detecting the disease at the earliest possible stage. This was strongly supported by the petitioner and by the charities we contacted. For example, Ovarian Cancer Action told us that: Funding would be better spent at this time on a national symptoms public awareness campaign.' I must say I am very disappointed the Minister has declined this recommendation. I hope that in the ministerial reply she will be able to explain how a commitment to raising awareness of the symptoms of cancer generally within the cancer delivery plan will have the desired effect of raising awareness of ovarian cancer. Our final recommendation concerns professional awareness of ovarian cancer. It is imperative that all women can receive timely tests and diagnosis when ovarian cancer is a possibility. Women who present with ovarian cancer symptoms must be able to access the appropriate diagnostic tests quickly so that optimal treatment is available to them. The evidence received was clear about the importance of awareness of ovarian cancer amongst health professionals. In particular, it is crucial that GPs - who, for most people, is the first person they see when they have symptoms that make them unwell - are consistently able to recognise the symptoms of ovarian cancer and appropriately refer people for diagnostic tests. What we don't want is GPs not knowing about it, sending them back and telling them to come back in three months' time if they haven't got any better, because that will mean the time they have to wait to be dealt with will increase and their chances of survival will decrease. We were pleased to hear that recent work has been carried out in relation to GP awareness in Wales, and the Minister spoke of her intention to continue to improve the understanding of symptoms and early diagnosis of ovarian cancer by clinicians. The committee noted that this is already a priority area in GP contracts and that GPs were required to review every case of ovarian cancer detected in 2015 in order to help learn lessons in relation to diagnosis and referral. We recommended that the Government continues this work and supports primary care cancer leads to use the learning from this review to inform plans in each health board aimed at improving early diagnosis. I'm very glad that the Deputy Minister accepted that recommendation. In conclusion, Llywydd, I'd like to reiterate that the committee fully supports the motivation behind the petition. Whilst the evidence does not currently support the call for national screening of all women, we believe there's strong evidence of the importance of seeking to develop greater awareness of ovarian cancer amongst the public and health professionals. I hope our report and the debate this afternoon will help contribute in some small way towards this. Finally, I would like to place on record the committee's thanks to Margaret Hutcheson for using the petitions process to bring this matter to the Assembly's attention, and for her hard work and enthusiasm throughout the process. I would also like to thank the members of the committee and the staff who helped in our consideration of the petition and the production of our report. If only one woman gets diagnosed early enough to save her life, it will be worth while.
Welsh: Diolch, Ddirprwy Lywydd. Rwy'n falch iawn o agor y ddadl hon ar adroddiad y Pwyllgor Deisebau ar ddeiseb a ddaeth i law yn galw am raglen sgrinio genedlaethol ar gyfer canser yr ofari. Cafodd y ddeiseb yma ei threfnu gan Margaret Hutcheson, ac fe'i cefnogwyd gan 104 o bobl. Cafodd Ms Hutcheson, nyrs gofal lliniarol wedi ymddeol, ei hysbrydoli i gychwyn y ddeiseb ar ôl i sawl un o'i ffrindiau gael diagnosis o ganser yr ofari. Ei phrif bryder oedd gwella diagnosis a thriniaeth amserol ar gyfer y clefyd dychrynllyd hwn. Ei phrif uchelgeisiau ar gyfer y ddeiseb oedd gweld rhaglen sgrinio genedlaethol ar gyfer canser yr ofari, a mwy o ymwybyddiaeth o ganser yr ofari a'i symptomau ymysg gweithwyr iechyd proffesiynol a'r cyhoedd yn gyffredinol. Fel pwyllgor, cynhaliwyd sesiynau tystiolaeth lafar gyda'r deisebwr, y Gweinidog Gwasanaethau Cymdeithasol ac Iechyd y Cyhoedd, ac ysgrifennwyd hefyd at elusennau canser i ofyn am eu barn. Fel pwyllgor, rydym yn ddiolchgar i Lywodraeth Cymru, Cancer Research UK, Ovarian Cancer Action, a Target Ovarian Cancer, sydd wedi rhoi eu barn ar destun y ddeiseb. Mae canser yr ofari yn arwain at oddeutu 240 o farwolaethau bob blwyddyn yng Nghymru - neu, mewn termau yr ydym yn eu deall, chwech ym mhob etholaeth - ac mae'n un o brif achosion marwolaeth ymhlith menywod yn y DU. Bydd un o bob 50 o fenywod yn cael canser yr ofari ar ryw adeg yn ystod eu bywydau ac yn drasig, bydd llai na hanner y menywod sy'n cael diagnosis o ganser yr ofari yn dal yn fyw bum mlynedd ar ôl cael y diagnosis. Roedd y dystiolaeth a gawsom hefyd yn dangos bod cyfraddau goroesi yn y DU yn is na'r cyfartaledd ar gyfer Ewrop. Cafodd Margaret Hutcheson, y deisebydd, gwmni ei ffrind Jenny Chapman i ateb cwestiynau'r pwyllgor, a hoffwn gofnodi diolch diffuant y pwyllgor i'r ddwy ohonynt am ddod draw i roi eu safbwyntiau. Mae'r holl safbwyntiau a glywsom yn cefnogi pwysigrwydd nodi symptomau canser yr ofari yn gynnar. Onid yw hynny'n swnio'n gyffredin ar gyfer pob canser? Mae diagnosis cynnar yn gwella'r gobaith o drechu'r clefyd yn llwyddiannus, a chredaf fod hynny'n rhywbeth y mae angen i ni ei ddweud yn amlach. Clywsom fod cydberthynas agos rhwng diagnosis cynnar a'r rhagolygon i fenywod sy'n cael y diagnosis. Er nad yw hyn yn unigryw i ganser yr ofari, clywodd y pwyllgor y gall canser yr ofari fod yn arbennig o anodd gwneud diagnosis yn ei gylch. Y rheswm am hyn yw y gellir yn hawdd gamgymryd y symptomau cyffredin am gyflyrau eraill, neu nid oes unrhyw symptomau o gwbl. Am y rhesymau hyn, erbyn yr adeg y bydd y rhan fwyaf o fenywod â chanser yr ofari yn datblygu symptomau a'u canser yn cael ei ganfod, mae wedi lledaenu y tu allan i'r ofarïau ac yn llawer anos ei drin yn llwyddiannus. Mae ffigyrau a gawsom gan Cancer Research UK yn dangos bod y gyfradd goroesi pum mlynedd ar gyfer canser yr ofari yng Nghymru a Lloegr yn 46 y cant, neu o'i roi mewn ffordd arall, mae 54 y cant yn marw o fewn pum mlynedd. Fodd bynnag, ymysg menywod sy'n cael diagnosis ar y cam cynharaf, mae'n codi i 90 y cant. Felly, mae dros draean yn fwy o fenywod sy'n cael diagnosis yn y cyfnod cynnar yn goroesi nag a fyddai pe baent yn aros nes y cam diweddarach. Credwn fod hyn yn gwneud achos argyhoeddiadol dros roi camau pellach ar waith i gynyddu nifer y menywod â chanser yr ofari sy'n cael diagnosis cynnar. Roedd y ddeiseb hon yn galw'n bennaf am gyflwyno rhaglen sgrinio i ganfod canser yr ofari ar gam cynnar. Dadleuodd y deisebydd yn gryf y gallai hyn helpu i achub bywydau merched sy'n datblygu canser. Gwnaeth y deisebwr yr achos y dylai hyn gynnwys prawf gwaed blynyddol i fenywod gyda'r nod o ganfod canser yr ofari ar gam cynnar. Yn ei thystiolaeth i'r pwyllgor, awgrymodd Margaret Hutcheson y dylai'r rhaglen dargedu pob menyw dros 50 yn benodol. Nid yw sgrinio canser yr ofari ar gael ar y GIG yng Nghymru ar hyn o bryd, nac yn unrhyw ran arall o'r DU. Clywodd y pwyllgor fod astudiaethau i ddod o hyd i brawf sgrinio poblogaeth cyffredinol ar gyfer canser yr ofari yn mynd rhagddynt ar hyn o bryd. Y mwyaf o'r rhain yw treial cydweithredol sgrinio canser yr ofari y DU sydd wedi bod ar waith ers 2001. Cyhoeddwyd y canfyddiadau ym mis Rhagfyr 2015. Roeddent yn dangos y gallai fod manteision o sgrinio drwy ddefnyddio profion gwaed, ond roedd y rhain yn amhendant ar y cyfan. O ganlyniad, mae'r astudiaeth wedi cael ei hymestyn am dair blynedd arall. Yn ei thystiolaeth, amlinellodd y Gweinidog Gwasanaethau Cymdeithasol ac Iechyd y Cyhoedd y broses lle y mae Llywodraeth Cymru yn cymryd cyngor gan bwyllgor sgrinio cenedlaethol y DU, sy'n cynghori pob Llywodraeth yn y DU. Gwelsom fod y pwyllgor sgrinio wedi adolygu ei argymhelliad yn ddiweddar ynglŷn â sgrinio ar gyfer canser yr ofari a'u hargymhelliad presennol o hyd yw na ddylid sgrinio'r boblogaeth ar hyn o bryd. Clywsom bryderon hefyd ynglŷn â chywirdeb y prawf gwaed mwyaf cyffredin ar gyfer canser yr ofari, y prawf CA125. Mae menywod â chanser yr ofari yn tueddu i fod â lefelau uchel o'r protein CA125 yn eu gwaed - mwy na menywod heb ganser yr ofari. Ond gall y lefelau CA125 fod yn uwch am nifer o resymau nad ydynt yn ymwneud â chanser. Mae hyn yn golygu bod risg sylweddol o ganlyniadau positif anghywir. Clywsom ei bod yn bosibl mai 1 y cant yn unig o fenywod a atgyfeirir at ofal eilaidd yn dilyn prawf gwaed CA125 a fyddai â chanser yr ofari mewn gwirionedd, ac rwy'n meddwl mai un o'r pethau a deimlem oedd nad ydym am i bobl ofni rhywbeth pan fo'r posibilrwydd eu bod yn dioddef ohono mor isel â hynny. Felly, mae'r gwaith ymchwil ar hyn o bryd yn dangos nad yw'r prawf yn ddigon cywir i gael ei ddefnyddio fel rhan o raglen sgrinio. Ar ôl ystyried yn ofalus yr ystod o dystiolaeth a gyflwynwyd i'r pwyllgor, ar y cyfan, rydym yn derbyn nad yw'r dystiolaeth bresennol yn cefnogi cyflwyno rhaglen sgrinio poblogaeth. Fodd bynnag, o ystyried bod yr astudiaeth yn dal i fod ar y gweill ac y bydd yn adrodd ar ganfyddiadau pellach yn y blynyddoedd i ddod, rydym yn argymell y dylai Llywodraeth Cymru gadw llygad agos ar y sefyllfa a rhoi ystyriaeth fanwl i unrhyw dystiolaeth mewn perthynas â rhaglen sgrinio genedlaethol newydd. O ystyried bod diagnosis cynnar mor bwysig mewn achosion o ganser yr ofari, gallai rhaglen sgrinio effeithiol chwarae rôl hanfodol yn gwella cyfraddau goroesi, ac rwy'n falch fod y Gweinidog wedi derbyn yr argymhelliad hwn. Fel y nodwyd yn gynharach, er nad ydym yn gallu cefnogi rhaglen sgrinio genedlaethol, rydym yn teimlo fel pwyllgor fod mesurau eraill a gymerir i wella camau i nodi canser yr ofari yn gynnar - . Trof yn awr at y rheini. Yr angen i gynyddu ymwybyddiaeth y cyhoedd o ganser yr ofari oedd thema ganolog y dystiolaeth a gawsom. Mynegodd y deisebwr bryder fod ymwybyddiaeth y cyhoedd o'r cyflwr yn isel iawn a disgrifiodd ganser yr ofari fel 'llofrudd tawel'. Clywsom fod taflen ar ganser yr ofari, gan gynnwys symptomau cyffredin y clefyd, ar gael drwy feddygfeydd meddygon teulu, a chynhaliodd Ymddiriedolaeth GIG Felindre ymgyrch ymwybyddiaeth drwy gydol mis Mawrth 2016. Fel rhan o hyn, cynhyrchwyd pecynnau gwybodaeth ar gyfer meddygon teulu gan elusen Target Ovarian Cancer. Rydym yn croesawu'r camau hyn a'r ymdrechion a wnaed i gynyddu ymwybyddiaeth y cyhoedd o ganser yr ofari a'r symptomau cyffredin. Serch hynny, teimlwn y gellid ac y dylid gwneud mwy i sicrhau bod mwy o fenywod yn ymwybodol o'r clefyd. Mae adeiladu ymwybyddiaeth yn allweddol, oherwydd, pan fyddant yn dod yn ymwybodol ohono ac yn dod yn ymwybodol o symptomau, yna mae mwy o obaith y byddant yn mynd i weld eu meddyg teulu a chael eu hatgyfeirio. Rydym wedi argymell y dylai Llywodraeth Cymru wneud mwy i wella ymwybyddiaeth y cyhoedd o ganser yr ofari, gan gynnwys y symptomau cyffredin a phryd y dylai pobl ofyn am gyngor meddygol. Byddem yn hoffi gweld hyn yn adeiladu ar waith blaenorol ac yn rhedeg dros gyfnod estynedig. Rwy'n cydnabod bod gwerth mewn codi proffil cyhoeddus nifer fawr o gyflyrau a chlefydau. Fodd bynnag, cawsom ein hargyhoeddi gan y dystiolaeth a gawsom y dylai fod ffocws ar ganser yr ofari yn benodol oherwydd pwysigrwydd hanfodol canfod y clefyd ar y cam cynharaf posibl. Câi hyn ei gefnogi'n gryf gan y deisebydd a chan yr elusennau y cysylltwyd â hwy. Er enghraifft, dywedodd Ovarian Cancer Action wrthym: Byddai'n well gwario arian ar hyn o bryd ar ymgyrch gyhoeddus genedlaethol i godi ymwybyddiaeth o'r symptomau. Rhaid i mi ddweud fy mod yn siomedig iawn fod y Gweinidog wedi gwrthod yr argymhelliad hwn. Rwy'n gobeithio yn ateb y Gweinidog y bydd yn gallu egluro sut y bydd ymrwymiad i godi ymwybyddiaeth o symptomau canser yn gyffredinol yn y cynllun cyflawni ar gyfer canser yn cael yr effaith a ddymunir o godi ymwybyddiaeth o ganser yr ofari. Mae ein hargymhelliad olaf yn ymwneud ag ymwybyddiaeth gweithwyr proffesiynol o ganser yr ofari. Mae'n hanfodol i bob menyw allu cael profion a diagnosis amserol pan fydd canser yr ofari yn bosibilrwydd. Rhaid i fenywod sy'n mynd at y meddyg gyda symptomau canser yr ofari allu cael mynediad at y profion diagnostig priodol yn gyflym fel bod y driniaeth orau sy'n bosibl ar gael iddynt. Roedd y dystiolaeth a ddaeth i law yn glir ynglŷn â phwysigrwydd ymwybyddiaeth o ganser yr ofari ymysg gweithwyr iechyd proffesiynol. Yn benodol, mae'n hanfodol fod meddygon teulu - y person cyntaf y bydd y rhan fwyaf o bobl yn ei weld pan fyddant yn cael symptomau sy'n eu gwneud yn sâl - yn gyson yn gallu adnabod symptomau canser yr ofari a chyfeirio pobl i gael profion diagnostig yn briodol. Yr hyn nad ydym ei eisiau yw meddygon teulu nad ydynt yn gwybod am y peth, yn eu hanfon yn ôl a dweud wrthynt ddod yn ôl ymhen tri mis os nad ydynt wedi gwella, oherwydd bydd hynny'n golygu bod yr amser y mae'n rhaid iddynt aros i gael eu trin yn cynyddu a bydd eu gobaith o oroesi'n lleihau. Roeddem yn falch o glywed bod gwaith diweddar wedi cael ei wneud mewn perthynas ag ymwybyddiaeth meddygon teulu yng Nghymru, a siaradodd y Gweinidog am ei bwriad i barhau i wella dealltwriaeth o symptomau a diagnosis cynnar o ganser yr ofari gan glinigwyr. Nododd y pwyllgor fod hyn eisoes yn faes â blaenoriaeth yng nghontractau meddygon teulu a'i bod yn ofynnol i feddygon teulu adolygu pob achos o ganser yr ofari a ganfuwyd yn 2015 er mwyn helpu i ddysgu gwersi o ran diagnosis ac atgyfeirio. Rydym yn argymell bod y Llywodraeth yn parhau â'r gwaith hwn ac yn cynorthwyo arweinwyr canser gofal sylfaenol i ddefnyddio'r hyn a ddysgwyd o'r adolygiad hwn i lywio cynlluniau ym mhob bwrdd iechyd gyda'r nod o wella diagnosis cynnar. Rwy'n falch iawn fod y Dirprwy Weinidog wedi derbyn yr argymhelliad hwnnw. I gloi, Llywydd, hoffwn ailadrodd bod y pwyllgor yn cefnogi'r ysgogiad sy'n sail i'r ddeiseb. Er nad yw'r dystiolaeth yn cefnogi'r alwad am sgrinio cenedlaethol i bob menyw ar hyn o bryd, credwn fod yna dystiolaeth gref o bwysigrwydd ceisio datblygu mwy o ymwybyddiaeth o ganser yr ofari ymysg y cyhoedd a gweithwyr iechyd proffesiynol. Rwy'n gobeithio y bydd ein hadroddiad a'r drafodaeth y prynhawn yma yn helpu i gyfrannu mewn rhyw ffordd fach tuag at hyn. Yn olaf, hoffwn gofnodi diolch y pwyllgor i Margaret Hutcheson am ddefnyddio'r broses ddeisebu i ddod â'r mater i sylw'r Cynulliad, ac am ei gwaith caled a'i brwdfrydedd drwy gydol y broses. Hoffwn ddiolch hefyd i aelodau'r pwyllgor ac i'r staff a fu'n helpu wrth i ni ystyried y ddeiseb a chynhyrchu ein hadroddiad. Os caiff un fenyw ddiagnosis digon cynnar i achub ei bywyd, bydd wedi bod yn werth chweil.