Dáil Éireann - Volume 475 - 18 February, 1997

Other Questions. - Cancer Treatment.

[33] 21. Mr. Andrews asked the Minister for Health his views on the recently reported comments of the medical director of St. Luke's Hospital, Dublin that more than 2,000 people newly diagnosed with cancer each year may not be receiving the necessary treatment; and the progress, if any, made on the implementation of the National Cancer Strategy. [4352/97]

28. Mr. D. Wallace asked the Minister for Health the comparative level of cancer survival rates here with other EU countries on a site by site basis in view of his plan to provide extra resources for cancer treatment; his precise targets in terms of improving these rates; and the sites which he considers offer greatest realistic hope in this regard. [3918/97]

47. Kathleen Lynch asked the Minister for Health if he will state the number of women aged from 40 to 50 years and over 50 years who availed of breast screening services in each of the years from 1991 to 1996; the progress, if any, made to date regarding the national breast screening service; the steps, if any, which are being taken in 1997 to ensure that the holiday delays experienced by women seeking screening in 1996 are not repeated; and if he will make a statement on the matter. [4332/97]

Mr. Noonan (Limerick East): I propose to take Questions Nos. 21, 28 and 47 together.

The statement by the medical director of St. Luke's Hospital regarding the treatment provided to people diagnosed with cancer must be taken in its correct context. My Department has confirmed with the medical director that he referred to differing practices in the treatment of cancer in Ireland and that he had not alleged patients were not receiving treatment. I understand he suggested that one type of treatment for cancer — radiotherapy — was not being used as commonly in Ireland as in other countries when compared with alternative treatments for cancer such as surgery and chemotherapy. As reported in one of the newspaper articles on the subject, the medical director stressed that there was no evidence of systematic denial of radiotherapy to patients.

The National Cancer Strategy, which I published on 5 November last, emphasises the importance of providing the most appropriate type of treatment to each new case presenting. The strategy notes this can be helped by a concentrated approach to identifying and implementing best practice so that all patients receive the most appropriate form of treatment. To this end the strategy promotes such steps as the development of protocols for diagnosis and treatment; agreement between clinicians as to which types of cancer can best be treated where; and agreement regarding the minimum and maximum case loads for clinicians. My Department published a set of expert guidelines on the safe administration of chemotherapy in conjunction [34] with the publication of the National Cancer Strategy and I anticipate these guidelines will be the first of a number of such initiatives in the area of cancer treatment.

There is considerable international debate among experts about what constitutes a valid measure of survival in cancer. Comparison of cancer survival rates is subject to many qualifications which make it difficult to draw meaningful conclusions when comparing between sites or between countries.

The National Cancer Strategy reaffirms the target set by the health strategy Shaping a Healthier Future in relation to mortality from cancer. This target is to reduce the death rate from cancer in the under 65 age group by 15 per cent in the ten year period between 1994 and 2004. I do not consider it useful to set more detailed targets for survival rates in view of the difficulties of comparison and of interpretation to which I referred.

The National Cancer Registry Board is developing its database on the incidence and prevalence of cancer in Ireland. This will provide a useful picture of the major problem areas and it will help target resources towards the most successful areas of prevention and treatment.

On breast screening, mammography services are currently used mainly as a diagnostic tool for symptomatic or worried women on referral from their general practitioner. Following the experience of a pilot programme of organised screening run by the Mater Foundation, I announced details of the first phase of a national programme of breast screening some time ago. Expert clinical advice is that the target age group should be women aged between 50 and 64 years. The pilot programme which ran from 1990 to 1994 had a target population of 35,000 women or 16 per cent of all women in this age group. The first phase of the national programme, which will cover the Eastern, North Eastern and Midland Health Board areas, will have a target population of 120,000 women or 50 per cent of all women in this age group.

I will shortly announce an action plan indicating how I propose to implement the initiatives in the National Cancer Strategy. This will include measures on the development of the national breast screening programme.

Dr. Moffatt: Will radiotherapy be available in peripheral provincial centres under the national plan for cancer?

Mr. Noonan (Limerick East): As I announced in the cancer strategy, services will be provided at central hospitals in each health board area, but in respect of some expensive treatments for which people are referred from acute hospitals, three centres will be available; one in Dublin, one in Cork and one in Galway. It is in those areas that the possibility of radiotherapy and chemotherapy arises.

Written Answers follow Adjournment Debate.