Seanad Éireann - Volume 183 - 22 March, 2006
Cancer Services: Motion.
Dr. Henry Dr. Henry
Dr. Henry: I move:
That, in view of the fact that cancer is the second most common cause of death in Irish women and that death rates from cancer are higher in women in Ireland than in women in other European countries, Seanad Éireann regrets the lack of progress in:
— expanding the very successful cervical screening programme in the Limerick area all over the country;
— the slow progress of rolling out BreastCheck throughout the country;
— the failure to set up a pilot programme for colorectal cancer screening;
— the paucity of clinics for those families who may have a genetic predisposition to certain cancers; and
— the lack of equity of access to specialist treatment throughout the country.
It is important to remember that these initiatives are not technical or academic exercises. We want the establishment of good, proven medical practice to which people in this country, one of the richest in Europe, are entitled. Cancer is the second most common cause of death in Ireland among both men and women and represents a significant burden on the health services. The incidence of and death rate from cancer have been steadily increasing in Ireland during the past decade. This is due in part to the increased age of the population. This year the recently published Women and Cancer in Ireland 1994-2001, compiled by the Women’s Health Council and the National Cancer Registry, stated we could expect 7,400 Irish women to be diagnosed with cancer.
Early diagnosis of cancer is most important in effecting a cure. This fact is nowhere more relevant or obvious than in cancer of the cervix and the uterus. Last year a young woman friend of mine who lived in Dublin died of cancer of the cervix in her 40s. She was diagnosed a year earlier  when the cancer had already invaded other tissues but it was too late for curative treatment. I believe that if my friend had lived in Limerick she would be alive today. This is because in Limerick a general cervical cancer screening programme has been in place for six years.
In 1992 the then Minister for Health appointed a cervical screening committee to review cervical screening in Ireland. In 1996 it recommended that a national cervical screening programme on an age-sex register be established to screen women between the ages of 25 and 60 at five-yearly intervals within the primary health care setting. It took until October 2000 to get phase 1 in the Limerick area up and running. In 2003 a statistical review carried out by the Irish cervical screening programme found that coverage of the target population was 70%, well within striking distance of the international screening target of 80%.
If invitations for screening were sent to Irish women they would accept and visit their general practitioner. Further examination of the programme in 2004 showed that it worked well. In view of this will the Minister of State explain why, well into 2006, we are still talking about rolling it out nationally? In her speech on the launch of the report on women and cancer on 7 February 2006 the Tánaiste and Minister for Health and Children stated:
I consider that the programme would be best rolled out in the primary care setting, subject to affordable and acceptable arrangements being agreed. A review of the contractual arrangements for the provision by general practitioners of publically funded primary care services is being conducted at present under the auspices of the Labour Relations Commission and I have asked that the general practitioner elements of a national cervical screening programme be tabled at these discussions. Any remuneration arrangements agreed must be capable of delivering a high uptake among women. Payments must be primarily based on reaching acceptable targets.
The Minister of State should note that this mainly addresses the issue of how much it would cost, not how many Irish women’s lives would be saved.
The survival rate for women diagnosed with cervical cancer throughout Europe is approximately 95% but Ireland is near the bottom of the league table, just above Scotland and only just better than Slovakia, Estonia and Poland, which have only recently become members of the European Union. Even then our survival rate exceeds that of Slovakia by only 4% and that of Poland by 12%, two very poor countries. The five-year survival rate has risen from 61% in the mid 1990s to 69% by 2001 but in other countries the rise has been far higher. The Women and Cancer report states “differences between countries in provision uptake and effectiveness of cervical screening are  almost certainly responsible for some of the variation in survival”. There is no provision for cervical screening for most Irish women, though we know from the pilot scheme that the uptake was high, at 70%.
Approximately 70 Irish women die each year from a condition for which a curative result would have been possible. The average age at death is 56 years. One could postulate that 40 or more women lose their lives each year in this country due to lack of screening. Families lose mothers in their 40s and 50s. This is not shroud-raising but represents the facts and without a sense of urgency this will continue.
At present we rely on opportunistic screening, where women attending a maternity hospital may be offered screening or may ask their GP. With the decline of fertility of women in this country and the lower age of reproduction, many women do not attend maternity hospitals in their late 20s or early 30s, nor will they attend as frequently as in the past because families are smaller. As for the option of visiting a GP, I was contacted recently by a nurse with whom I worked and who would by no means consider herself impoverished. She said that the payment of €65 for cervical screening by a GP or practice nurse would be a lot of money. She had checked the prices in her district and other GPs were charging €50 but that is still a lot of money for some people.
The Minister of State will be well aware that medical cards, whether general or doctor-only, are not covered, although I could not get a quick answer from the Medical Council about this issue. We know that women from the poorest socio-economic levels are those who are most likely to develop cervical cancer, which is outrageous. We are still discussing the matter despite the discussion originating in 1992.
Survival rates are good given early detection but in Ireland they are below the EU average. Between 1,700 and 1,800 women are diagnosed with breast cancer each year and 650 die from the condition. Since 1990, improvements in survival rates are evident but they are not in line with the better survival rates of other EU countries or the United States of America. We are at the back with the eastern European countries. To cite the Women and Cancer report, when screening for breast cancer, using mammography is effective in reducing mortality rates from breast cancer in the population. It detects breast tumours early and early detection allows for early treatment, which improves chances of survival.
A good screening programme has been in place in different parts of the country since 1999 but how do women in parts of the country where no breast screening is available feel when they hear advertisements urging them to keep their mammography appointments to ensure they have a good chance of early detection, diagnosis and treatment and a better chance of survival?
Ms White Ms White
 Ms White: Hear, hear.
Dr. Henry Dr. Henry
Dr. Henry: It must be dreadful for them and some telephoned me to say how distressing it was. Mammography is not available to people with medical cards, another area in which people from poorer backgrounds are discriminated against. The Tánaiste has plans to role out the programmes but there is no sense of urgency. How many of the 650 women who died prematurely in each previous year due to breast cancer might be alive if BreastCheck were in place — 100, 200? I do not know but people lose decades of their lives because of late diagnoses.
The European code against cancer recommends screening for people over 50 years for colorectal cancer, the second most common cancer in both women and men in Ireland. Early diagnosis improves survival rates. For years, gastroenterologists have been asking for the establishment of a pilot scheme for faecal occult blood testing, tests in which people send in containers of faecal specimens over three consecutive days to determine if there is blood in them. If there is, something can be done via colonoscopy to determine whether the person has a tumour. Almost 2,000 Irish people are diagnosed each year with colorectal cancer, the same incidence as that of the United States of America, but the survival rates there are 26% better.
Lifestyle and environmental factors are important in the development of cancer but up to 10% of cases have a genetic predisposition, particularly so in two of the cancers I have mentioned. Women who have BRCA1 or BRCA2 genes or close relatives who have been diagnosed with breast cancer have higher chances of developing the disease, particularly at young ages. These people can only be seen and tested in a small number of family clinics in order to determine whether they have the gene mutation but there is an 18-month waiting list. What must those people who wonder whether they are at risk feel while this is happening? The same is the case in respect of colorectal cancers, in which two genetic conditions — hereditary nonpolyposis colorectal cancer and familial adenomatous polyposis cancer — are due to mutations of a particular gene. This country is at the forefront of genetic research in these areas but our people are not getting the benefits.
The Tánaiste knows that I have always supported her initiatives and those of her predecessors in setting up specialised units for the treatment of cancer. Our poor survival rates can be influenced by times of diagnosis but are also affected by the small unspecialised units around the country. I have implored politicians in this House not to ask for the continuation of these clinics and to think of the outcome for the people in their areas, not votes. Small units without proper team approaches are not getting the same results as larger centres. It is all very well if the  medical profession must be taken on and politicians and the public must be educated. Our public and private patients deserve access to the best possible specialist treatment, which they are not getting. Instead, they are getting late diagnoses.
Mr. O’Toole Mr. O’Toole
Mr. O’Toole: I am privileged to second the motion tabled by my colleague, Senator Henry, as it is a crucial issue. I welcome the Minister of State to the House but cannot understand why it was necessary to table an amendment to the motion. I commented to Senator Henry that this motion would be easy on the Government, as it would not need to be amended. However, here we are.
We have spent considerable time in this Chamber discussing gun crimes and deaths, driving behaviour and road deaths, but if we take the example of any cancer which affects women, such as breast cancer, more people die from this each year than from gun crimes and road traffic accidents combined. Why is there no outcry? Why is this happening when we have the answer? We can talk about controlling guns and changing driver behaviour and catching people who behave badly on our roads to bring them to court, which might or might not work, but we know for an absolute fact that we could possibly save lives in the area of cancer treatment services. We have the knowledge and everything that is needed. All that must be done is to roll out the facilities to every county in the country, but this is not being done. It is extraordinary.
The facts contained in the latest report, Women and Cancer in Ireland 1994-2001, and outlined by my colleague, Senator Henry, are startling. It might have been better had the people who wrote the report written just half of it, as one can reach a state of overload due to statistics. They begin to lose their impact. However, some facts hit me straight in the eye, as it were, including that the death rate from cancer of Irish women is among the highest in Europe. Why is this the case? We are the country with the greatest economic story in the last ten or 15 years, that has made the most progress and been set up as a role model, but we still cannot care for our people in a simple and straightforward way. It is inexcusable.
I do not know why there has not been a revolution due to this matter or how Governments can survive without dealing with it. I do not know how ordinary people everywhere can deal with it. Today, people from the west coast were outside the gates of Leinster House because of the salmon fishing issue. I went out to meet them and support what they are doing. Three weeks ago, boats from the west steamed into Dublin on a demonstration relating to the fishing industry. Along that coast there is hardly any access to the type of screening facilities demanded in this motion but people do not seem to be grasping  this issue. Why is that the case? Why are more people not kicking down the doors of Leinster House because of what is happening in their areas? What has gone wrong? Why is it that the economic impact of farming or fishing in rural Ireland, which are serious issues in their own right, can motivate more people to get out onto the streets against the establishment than the issue we are discussing now, an issue of life or death? I do not understand it, although I have tried.
The only effort I can make to deal with it is if I read a comment in the fine preface of the report written by a woman who is or was one of the Minister of State’s constituents, Professor Cecily Kelleher. She states that cancer was once associated with unremitting fear but that things have changed. I believe this is incorrect as fear of the word “cancer” still exists. Those who are not close to it are afraid and refuse to engage with it or discuss it. They are happy in ignorance.
Every time I read about cancer I feel uplifted as the stories are all success stories, apart from the greater incidence of cancer. The Government amendment to this motion refers to the reduction in the cancer mortality rate among the under 65 age group. While I do not completely accept this I assume the statement has been tested. We have easily moved from referring to dying of cancer to living with cancer. Anyone who knows someone with cancer knows that this change is real. People can have good quality of life seven or eight years after being diagnosed. A person who was diagnosed with leukemia 20 years ago was given a few years to live but is still living a full, happy life today.
The introduction of mammogram screening is a measure we can afford. Why is this not a priority? It would have full support and immediate results. Politicians are blamed for not accomplishing things because important measures take a long time to make a difference. However, this measure would make an immediate difference. Inviting each woman in Ireland for breast, cervical and other cancer screening would immediately save lives, make an impact on the quality of life in the community and benefit families. There are no negative consequences to this. The worst cancers might be diagnosed too late to cure the person but the measure would extend the life of everybody diagnosed in that period.
What is the difference between cancer, road deaths and gun crime? If we do not make this service available people will die in greater numbers than if there were guns scattered around the countryside. Politicians may like to talk about matters where there is no clear solution but in this case the solution is absolutely clear. This is a cash investment with immediate returns, welcomed by everyone and supported by the community. I urge the Minister of State to apply pressure to make this happen. If it does not hap pen, we will face a revolution and we will never be thanked.
People become angry with frustration when they realise an early diagnosis could have allowed a loved one to live longer. The Minister of State must have met such people, as I have. What is more important in pro-life Ireland than to protect and save life? A panoply of institutions, such as the Garda Síochána, courts and prisons exist to combat gun crime and road traffic deaths yet the issue of cancer has a more negative impact on society. We should take steps to improve the situation.
Breast and cervical cancer screening must be made available to women in every county in Ireland. An information programme is of equal importance so people know the diagnosis of cancer is not a death sentence. If the disease is diagnosed early it is not a death sentence in the majority of cases. The campaign should show the success rate that can be achieved if people are checked.
On a number of occasions Senator Glynn has mentioned the fear men have of being tested for prostate cancer. People do not want to be tested because of the fear of what they may find. If one is diagnosed with cancer one knows what one might not otherwise have known for four or five years and one can be kept alive.
A breast and cervical screening programme must be fully implemented. We also need appropriate tests for those who are worried their genes may make them more susceptible to cancer. These tests are being done but it is too late in many cases. I also suggest we launch an education programme on diet, lifestyle, alcohol and smoking. This has been done to great effect with regard to smoking and the programme should show how these other aspects can also affect lives and how they can be controlled to save lives.
People will rise up and take on the political world and we will all be swept under when they learn what we know. If we were told 644 people would die of avian influenza in the next year nothing would stop us from dealing with it. Tests and screenings would be put in place but we have become anaesthetised to death in the case of cancer. In fact, it may be described as killing rather than dying because we could prevent it. Will someone take a class action against an Irish Government because a family member died unnecessarily?
Mr. Glynn Mr. Glynn
Mr. Glynn: I move amendment No. 1:
To delete all words after “That” and substitute the following:
Seanad Éireann commends the Government for the unprecedented investment in the development of diagnostic, treatment and care services for people with cancer, particularly in the area of women’s health. Seanad Éireann acknowledges:
 — the reduction in the cancer mortality rate among the under 65 age group;
— the progress to date on achieving the target of 2007 for commencement of the roll-out of BreastCheck nationally;
— the recent decision of the Tánaiste and Minister for Health and Children to ask the HSE to prepare the roll-out of the Irish cervical screening programme;
— the progress that has been achieved to date on the Government’s national plan for radiation oncology services announced by the Tánaiste and Minister for Health and Children last July; and
— the commitment of the Government and of the Tánaiste and Minister for Health and Children to ensure equitable access to high quality cancer care to patients throughout the country.
I welcome the Minister of State to the House. This matter primarily affects women but we all have mothers, wives, sisters and aunts so it concerns men as much as women. I would be concerned if a member of my family were afflicted in such a way. Much has been achieved although I acknowledge that much more must be done.
Senator O’Toole referred to information on lifestyle towards the end of his contribution. The Irish Cancer Society gave an important in-house seminar on men’s health in the audio-visual room. I attended, as did Senator Henry and others, and I found it useful. We are debating cancers that affect mainly women. We must acknowledge many causes of cancer. While it is not an exact science there is a fair amount of information in the public domain, however this information does not always reach those who should avail of it. The recent obesity report implies that our eating habits are of primary importance in preventing cancer. Although diet is not the main causal factor it should be taken on board.
I identify with what Senators Henry and O’Toole said about the word “cancer”, which conjures great fear and puts people into denial and delusion. When it is said that a person has cancer it appears that it is the end of the world, which it is not. I agree with Senator Henry that it is particularly important that mammography services be available on the GMS. This test must be available to people dependent on medical cards. As has been pointed out, it has a pivotal role to play in early detection and, in consequence, early treatment. Cancer care in Ireland has been transformed over the past decade. Significant progress has been made. It is vital we move on to make the full range of cancer services available and accessible to patients throughout Ireland in accordance with best international practice.
 I will mention some of the achievements over recent years. Since 1997 additional investment of approximately €720 million in cancer care has meant the appointment of an extra 109 consultants and over 250 nurse specialists. When the Midland Health Board debated cancer services I argued for devolving certain cancer procedures to various locations. In this I was wrong because it has been proven, both in practice and in theory, that the greater the number of procedures that take place in a centre, the more efficient and viable it is as an effective treatment centre — I agree with Senator Henry on this. The key goal of the national cancer strategy, to achieve a 15% decrease in mortality from cancer in the under-65 age group, was achieved three years ahead of target. A major programme is now required to rapidly develop clinical radiation oncology treatment services to modern standards. In light of this in July 2005 the Government announced a plan for a national network of radiation oncology services to be put in place by 2011 and commencing in 2008. It is important that this be brought forward. It is marvellous to have an objective and, as I said, it has been proven that we have exceeded a target by three years. The network will consist of four large centres in Dublin, Cork and Galway and two integrated satellite centres in Waterford and Limerick Regional Hospitals. This will mean an investment in additional capacity to the equivalent of 23 additional linear accelerators. The public investment involved will be approximately €480 million, most of it funded through the public-private partnership over the period to 2011. In 2004 approval was granted for €15 million in full-year funding to open a new radiotherapy department in Galway and to expand capacity in Cork. The new radiation oncology department at University College Hospital, Galway, commenced treatment in March 2005. In Cork University Hospital the third linear accelerator commenced treatment in March 2005 and the fourth linear accelerator commenced treatment on 10 October 2005.
BreastCheck is one of the central themes of this evening’s debate. There is a 2007 target date for its nationwide expansion and it is expected that this will be met. I hope we can meet it before than. The national breast screening programme commenced in 2000 and currently covers the eastern, north-eastern, midland and parts of the south-eastern areas of the country. In those areas free screening is being offered to women in the target age group of 50 to 64 years. Since the programme commenced in 2000, cumulative Revenue funding of approximately €60 million and capital funding of €12 million has been allocated to the programme. The investment has enabled the appointment of additional surgeons with an interest in breast disease, histopathologists and radiologists to enhance the delivery of breast cancer services nationally. To end 2004 the number of women screened by BreastCheck was approxi mately 185,000. The cancer detection rate is approximately 7.4 per 1,000 screened and to date more than 30,000 cancers have been detected.
This Government is committed to the roll-out of the cervical cancer screening programme in line with international best practice. No matter what anybody says, whatever we have done, we must do more. Lives are important. Senator O’Toole made an important point on avian flu. The means of dealing with this are within our grasp. The hackneyed political slogan that we have much done and much more to do holds true. We have come a long way but we have further to go. The Minister of State, Deputy Tim O’Malley, is caring, as is the Tánaiste and Minister for Health and Children, Deputy Harney. If this programme can be accelerated to deal with the concerns of the movers of this motion and the many people who suffer from cancer, then let us do it.
Ms Terry Ms Terry
Ms Terry: I welcome the Minister to the House. I am happy to support this motion and I thank Senators Henry and O’Toole for their excellent presentations. I am disappointed with the Government’s amendment and I ask Senator Glynn to consider withdrawing it. We all agree with the motion, particularly women but also men. We want to see the services provided as detailed in the motion. I ask that both sides of the House unite on this motion.
I wish I could speak with the passion of Senator O’Toole, who brought the message home. Although this is not solely a women’s issue, it is great to see a man expressing that kind of passion when speaking about cancers from which women suffer in greater numbers such as breast and cervical cancers. Despite the increasing wealth in this country the financial contribution to women’s health smacks of lip service. There is a lack of understanding that investment in areas such as prevention and health promotion would have long-term positive benefits. As the life expectancy of Irish women extends into their mid-80s, women deserve a good quality of life to enable them to fulfil the important contribution they have to make to society. It is unacceptable that the lack of investment in services results in the death of many men and women. If the funds used to treat those who develop cancer were targeted at prevention, they would be much better spent and lives would be saved in the long run.
The figures published in mid-2005 by the Irish Cancer Society are not as shocking as those detailed by Senator Henry. I hope the Minister of State will be able to provide exact figures for the incidence of breast and cervical cancer and the number of associated deaths. The Irish Cancer Society figures suggest that there are 288 new cases of breast cancer in women under 45 every year and an increasing incidence of breast cancer in younger women. The small additional amount of funding required to expedite the rollout of the screening programme throughout the country should be a priority for any Government.
 One of the areas of women’s health that is glaringly neglected is that of cancer screening. In particular, there are unacceptable delays in the roll-out of the cervical screening programme and delays in completing the BreastCheck programme. One can be lucky to live in the Dublin area or in other areas where the BreastCheck programme is operational, or unlucky to live in an area where the cervical screening programme, which is only available in one part of the country, is not in place. The rate of cervical cancer in Ireland is one of the highest in western Europe — shame on us. At present, approximately 77 women die each year from what is essentially preventable cancer. As this cancer mostly affects young women, it is a cause of death of many young mothers.
In the EU, the number of deaths caused by cervical cancer exceeds the number of deaths from AIDS or hepatitis B. However, in some EU countries the incidence of cervical cancer has been declining in recent decades, primarily due to the introduction and adoption of national screening programmes. The facts speak for themselves. For example, deaths from cervical cancer plummeted in the UK since it introduced a national screening programme in 1989. In Finland, cervical cancer screening was introduced in 1963, with regular updates to the programme since that time. This resulted in a very low incidence and mortality rate for the disease. In Ireland, where we do not have a national screening programme, the rate of cervical cancer and mortality is considerably higher and results in over 70 deaths at an average age of 45.
At present, in all parts of Ireland except the mid-west, the only way women can avail of screening is by attending their GP for a smear test. This is described as “opportunistic screening” and best practice suggests that this system does not work. Disadvantaged women will suffer the most and will be least likely to be able to afford the test. Therefore, we are compounding the poverty of such women, or worse if they develop the disease. Unlike many cancers, cervical cancer is highly treatable and preventable through modern screening methods. A national screening programme can save up to 60 lives a year and prevent up to 90% of cases. Smear tests miss 10% to 30% of abnormalities and, therefore, regular screening is necessary.
In addition to screening, new technologies may soon become available, among which is the HPV vaccine. At this time, the most modern technology, such as liquid-based cytology, the most up-to-date laboratory technology for analysing smear tests, is only available to those women who can afford to pay for it. This could be an important tool in the fight against cervical cancer when used in conjunction with screening programmes. HPV is a known cause of cervical cancer, yet women are still not tested in routine Pap smear tests.
If pre-cancerous types of HPV are treated early, it is possible to prevent cervical cancer completely. Potential prevention of cervical can cer is great news, but it is not a replacement for screening. A doctor from the National Cancer Institute in the US stated:
We need to use the principles “prevent, detect, modulate and eliminate”. We have the opportunity to put more effort into the front end of the disease instead of the end. We will not beat cancer with yesterday’s solutions.
What he had to say is very relevant to Ireland. We are even further behind than the US in terms of tackling a problem which it is possible for us to tackle. It is a disgrace that so many women are not able to access screening programmes that should be available to all women. I urge the Minister of State to ensure that the funding is provided as a priority so these programmes can be rolled out as quickly as possible.
In the long term the primary aim is to save lives. Early detection will save lives and by achieving this, we will save the health services significant resources in terms of the treatment of women. Early detection is cost effective, not to mention the fact that men and women will survive cancer, which is the aim. In this day and age, it can and must be done. However, the Government has dragged its feet. As Senator O’Toole stated, women in particular have stayed far too quiet when dealing with this issue. In the time remaining to the Government, we want immediate action. I hope the Minister of State will impress on the Minister that this action must be taken.
Ms White Ms White
Ms White: I welcome the Minister of State, Deputy Tim O’Malley, to the House. Senator Henry’s motion states “in view of the fact that cancer is the second most common cause of death in Irish women and that death rates from cancer are higher in women in Ireland than in women in other European countries”. When one considers this issue coldly and clinically, it is clear that if one can pay for a private health service, one will not be in the group of people who die from cancer.
This point has not been made so far in the debate. We are talking about people who do not have the money to access private health care. In the time of the Celtic tiger, that is a primitive situation. We are excluding those who cannot pay for health care whereas others could avail of cancer screening, a cervical test or a mammogram today and receive the results tomorrow. We need to get our act together. One person died in Turkey from avian flu but there are 65 deaths per year in Ireland from cervical cancer alone. In 2001, 645 women died from breast cancer. We need an inclusive national screening programme, regardless of whether women are rich or poor, rather than the exclusive medical system we have in place.
There are three medical people among us, the Minister of State, Deputy Tim O’Malley, and Senators Glynn and Henry. They are dealing with these issues and know about them. Vision is needed to cut through the waffle and the reports  and to inform the HSE to set about implementing a national cervical cancer screening programme. A decision must be made to implement it and to treat all woman equally rather than on the basis of their means. This is not a women’s issue but a family issue. It is also a man’s issue because, as Senator Glynn pointed out, women have sons.
The former Minister for Health and Children, Deputy Martin, had the vision and guts to push through the banning of smoking in public places. He did not have much support for that ban initially but he continued to push for it. As a former smoker I suppose I cannot talk about the issue. I gave up cigarettes 20 years ago and did not find it easy to do so. Now we are experiencing the pleasure of not having to breathe in cigarette smoke in public places. The Minister, Deputy Martin, had the vision to deal with the objections and cut to the chase to ban smoking in public places. The Minister, Deputy Harney, needs to have similar vision in deciding to implement a national cervical cancer screening programme which will cost €18 million to roll out.
Dr. Grainne Flannelly, a consultant in Holles Street, who deals with cervical cancer screening, invited me to visit her clinic last year. She told me that women arrive into her clinic in a pre-cancerous stage and are petrified because they believe that once they get cancer, the chances are they will die. A woman who has a number of children and is on a low income would prefer to pay for her children, rather than herself, to be seen by the doctor. She will forfeit her own health to look after her family’s health. That is the position in many cases.
I will support the motion on this side of the House; Senator Henry knows the position I am in.
Dr. Henry Dr. Henry
Dr. Henry: An awkward position.
Ms White Ms White
Ms White: I tabled a motion on the need for a cervical cancer screening programme at the Fianna Fáil Parliamentary Party six months ago and I will raise the matter again in the next two weeks.
I am embarrassed to contemplate that if one has money, one can have a mammogram tomorrow or the day after, but those who cannot afford to pay for it for themselves will use the income they have to buy shoes and other necessities for their children.
Another important point is the prevalence of ageism in health screening. Like Senator Henry, I am mortified when I see the advertisement on television encouraging women who are under the age of 65 and live in a certain part to be screened for breast cancer. I point out the cheek of the bureaucrat in the Department of Health and Children who decided that women over the age of 65 should not be included in the breast screening programming in the areas of the country were it is available, and I will not go into the debate on why that is not available throughout the country. As regards the ageism aspect, there are words in my head that I do not want to use because they  are too basic, but it is ultra-conservative social thinking and ignorance that ageism is introduced in health matters. Why should a woman over the age of 65 not have as much right to be screened for breast cancer as a woman under the age of 65?
Mr. Ryan Mr. Ryan
Mr. Ryan: Hear, hear.
Ms White Ms White
Ms White: Cancer Research in the United Kingdom has published figures that indicate that 75% of breast cancer occurs in women over the age of 65, yet a bureaucrat in the Department of Health and Children decided to cut off the age limit for screening at 65. I do not care if the research at the time indicated that was appropriate. If those in the Department did their homework properly they might have got the proper figures.
We are here to make changes in society and at the end of our time here we will be judged as to whether we made a significant contribution. The Minister of State should press home to the Tánaiste and the leader of his party the need for these screening programmes. I am an admirer of the Tánaiste; I do not want to go over the top but I believe the woman is a genius. However, she needs vision to roll out the national screening programmes that are the subject of the motion tabled by Senator Henry and her colleagues, whom I applaud for doing so.
Mr. Ryan Mr. Ryan
Mr. Ryan: When one has been affected by the incidence of cancer in one’s immediate family, one can appreciate, as I do, the extraordinary quality of service that can be available. I happen to live in a city where, as Senator Henry said, if one has the means, a high quality level of cancer care is available. When one is a politician, the incidence of cancer within one’s family circle focuses one on what is wrong in the system, what is missing, what is uneven, what might have happened if one’s family lived somewhere else or if one’s family was on an income level that meant they either had to depend on public health and, by implication, could not afford to pay for private health insurance. A significant number of people are between the extraordinarily ungenerous level of income at which a full medical card is made available and an income level at which private health insurance can be paid for without enormous sacrifices being made.
I always find it a little distasteful to make something as personally sensitive to everybody who has encountered it — and those who have not — into a political issue. However, I am also concerned that while, on the one hand, this is a high profile illness, on the other, it is not an issue which on a day-to-day basis can grab headlines in the way that people on trolleys in accident and emergency units can. It is not tangible, quantifiable and immediate in the way that the scenario of people lying on trolleys in accident and emergency departments is.
Men will now talk about female-specific cancers like breast cancer or cervical cancer where they would not have discussed them 25 years ago.  However, many men still believe that the issue should be left to women. Therefore, it frequently does not assume the central role in political discourse that it should.
We cannot dispute the fact that death rates from cancer are higher than they could or should be. We have had ten years of unprecedented prosperity and while some progress has been made, it is still implied that it is acceptable to have a rate of progress which leaves significant numbers of women at risk of dying young from cancers that are both treatable and preventable because either the treatment or the initial investigations are not available at the right time and in a location which these women can access.
I will now turn to the subjects of breast cancer and cervical cancer, which are mentioned in the motion. We know that breast cancer is eminently treatable when it is diagnosed at a sufficiently early stage. Treatment is difficult and traumatic for many women but the disease is still treatable. However, it needs to be diagnosed early. I understand that early diagnosis is extremely difficult in the case of certain cancers. Pancreatic cancer is frequently cited as an example of such a cancer. However, it is scandalous to have available to us the means, technology and skill to provide early diagnosis of cancer but fail to do so.
It is worth pointing out that the decision in principle to introduce a national breast cancer screening programme was made during the tenure of the rainbow Government. This decision was taken ten years ago at a time when the country was possibly in the first year of its spectacular and welcome economic growth which saw it catch up with the rest of western Europe. We are now told that the screening programme will be rolled out 11 years later in 2007. Those of us living in Cork will wait to see it rolled out and fully established. I have heard some of the very dedicated staff connected with the programme explain the logistical problems but I am also aware that resource issues delayed decisions at various stages. Possibly resource issues do not delay decisions now but there is no doubt that it took a long time and a ferocious political campaign to secure the decision in principle to move from a pilot programme in a number of regions to a national programme. People are still waiting for the national programme.
The Government must move on and also examine its commitment to cancer treatment. I accept the argument that it is not possible to provide high quality treatment for breast cancer if it is scattered over a vast number of regions. However, it is astonishing how little those who plan our medical services think of the consequences of centralising treatment for those who must travel for treatment. They appear to think that people can travel from 50, 60 or 100 miles away to the centre in Dublin. We are talking about women who are frightened, have families and might feel sick. Nobody has thought about how to permit these women to travel to Dublin  in a humane, efficient and effective way, a feature of the entire programme which I find astonishing.
The amendment is very short on specifics. It is full of phrases like the “decision of the Tánaiste and Minister for Health and Children to ask the HSE to prepare the roll-out of the Irish cervical screening programme”. No timescales or quantification have been given. According to the amendment, the House should commend the progress that has been achieved on the Government’s national plan for radiation oncology services. Again, no quantification or specifics have been given. One would hope that the situation is better than it was but we need to know when it will be complete.
The amendment refers to the reduction in the cancer mortality rate among people under 65. What does this mean? Does it mean that people over 65 do not count? We want to see a global reduction in cancer mortality rates. This amendment appears to imply that people over 65 do not count as much as those under 65, which is extraordinary. I am sure the Minister of State’s script does not address this issue but I invite him to address it and tell me why the Members on the Government’s side of the House saw fit to insert a reference to a particular age group in the amendment and imply that those outside this group do not count even though the highest rate of cancer incidence is among people over 65. The motion plays with statistics and suggests an indifference to the lives of some people.
Mr. Minihan Mr. Minihan
Mr. Minihan: I thank the Minister of State and his officials for coming to the House. I realise that the Minister of State and his Department, along with health service personnel, are working incredibly hard to meet the challenges we face. That both he and his officials are here to discuss this important issue is most welcome.
The motion referred to five broad topics, namely, the death rates from cancer, particularly among women; cervical cancer screening; the BreastCheck programme; colorectal cancers; and regional access to cancer services. Examining each of these topics in turn reveals the Government’s determination to seek out the best expert advice on the provision of cancer care in Ireland and its determination to invest heavily on the basis of this advice. This is the appropriate way for us as a society to deal with this terrible set of diseases as best we can.
With regard to the first of the five issues raised by Senators Henry and O’Toole, as I stated on the last occasion when we debated this topic in the House, cancer is not a singular disease but a range of diseases. These diseases are the second most common cause of death in Ireland for both women and men. We know that the number of new cancer cases and the number of deaths from cancer have, unfortunately, steadily increased in both sexes over the past decade. In 1994, some 5,900 cases of malignant cancer were diagnosed in women. The figure is expected to reach approximately 7,400 this year. Approximately  3,500 women die from cancer each year in this country, which is testimony to the truly terrible toll this disease takes on Irish women, their families, friends and carers.
Although it is of little comfort, the reason for the rise in the incidence of cancer is the increasing life expectancy of and concomitant growth in the number of those aged 65 and over. I will refer to the remarks made by Senator Ryan. The amendment does not play with statistics. When one examines the statistics, one must consider the increase in the age profile and longevity of the population. The awful truth is that the risk of cancer increases with age. Research indicates that approximately one woman in seven will develop cancer by the age of 65, with the figure rising to one woman in four by the age of 75. Once adjustment has been made by population ageing, the annual death rate shows a slight decrease of approximately 0.8% each year.
The national cancer strategy correctly provides the expert basis for policy and investment in this area. Since 1997, €720 million has been invested in treatment and care services for people with cancer, which has made a real difference. More than 100 additional consultant posts for cancer care throughout the country have been created and, more important, the goal of a 15% decrease in the mortality rate from cancer in the under-65 age group was achieved in 2001, three years ahead of target. However, we must do more. The Health Research Board states that funding of approximately €1.8 million has been made available for research into breast cancer and €0.35 million has been made available for research into prostate cancer. Awards of more than €3.5 million have been made available through the board to support this initiative in nine hospitals throughout Ireland.
The second issue relates to screening programmes. The House will be aware that comprehensive, well organised and high quality screening programmes, incorporating appropriate specialist follow-up treatments, are an effective way of reducing breast, cervical and colorectal cancer mortality rates. This is why the Government is committing more and more resources to such programmes. The Independent group motion makes specific mention of the pilot cervical screening programme, which commenced in October 2000. This is available to eligible women in Limerick, Clare and north Tipperary. Cervical screening is offered free of charge to approximately 74,000 women in these counties.
The Tánaiste is fully committed to the national roll-out of a cervical screening programme in line with best international practice. The Department has requested the HSE to prepare a detailed implementation plan for a national programme. Significant preparatory work is well under way in this regard. This involves the introduction of a new and improved cervical test, improved quality assurance training and the preparation of a national population register. An additional €9 million has been made available to the HSE for  cancer services development in 2006, including for the roll-out of the programme.
Regarding BreastCheck, this excellent national breast screening programme has been made available to women in the 50 to 64 year age group in the eastern, north-eastern, south-eastern and midlands regions. This target age group represents approximately 160,000 women in these regions. If we needed evidence of the importance of BreastCheck, one should consider the 1,600 cancers detected since the programme commenced. BreastCheck operates with a team approach and in partnership with other health care providers. Their value reaches not just those who have problems identified and who receive treatment, but those they reassure. The vast majority of women are found to be perfectly healthy.
On the roll-out of the programme to the remaining regions, there are 130,000 women in the target population for screening in the southern and western regions. BreastCheck is confident that the target date of next year for the commencement of the roll-out will be met. I am equally aware of the campaign in the southern area in Cork, to which Senator Ryan referred. The experts are confident that this roll-out date of 2007 will be achieved. On colorectal cancer, the National Cancer Forum provided a strategy for cancer control in Ireland in 2006 to the Tánaiste last month. This strategy will include recommendations on the criteria for decisions on the introduction of a population-based screening programme.
The Government is determined to make the full range of cancer services available to cancer patients throughout Ireland. This must and will be done in line with best international practice. I commend the Tánaiste, the Minister of State, the Department, the HSE and the dedicated experts and medical practitioners on the progress we are making. I urge them to continue on this course.
Mr. Browne Mr. Browne
Mr. Browne: I welcome the Minister of State and his officials to the House. First, I want to compliment the former Minister for Health and Children, Deputy Martin, on the excellent decision to introduce the smoking ban. The more one travels abroad, the more one realises what a positive decision it was and how generations to come will thank their lucky stars, especially passive smokers who do not want to inhale smoke. I compliment the Government on that issue. I was in France recently and the thoughts of a pub full of smoke would deter one from going into pubs there. This decision will play a significant role in reducing the rates of cancer in the country. Perhaps we can now take matters a step further and try to encourage smokers to either cease smoking or cut down on it because there is a clear link with cancer. However, I am critical of the Government for not increasing the tax on cigarettes or alcohol in the budget, which should have happened. Given the clear link between alcohol and cigarettes, this would create an incentive to  reduce the use of cigarettes and alcohol which are linked to cancer.
I was in Blanchardstown hospital this morning for a check-up for a recurring asthma problem. I was very impressed with the facilities and the way the clinic operated. I was attended to immediately. I had X-rays taken and the level of service was fantastic. All of this was free of charge, which amazed me. One might ask what has this to do with the debate, but it proves that these clinics can work. We do not need to centralise massive hospitals as clinics such as the respiratory one to which I refer can work very effectively. While we often criticise the health service, we should also admit when it works well, as happens most of the time. Unfortunately, the media tends to focus on the negative aspects.
I disagree with the motion which excludes men. Men should always be included in a motion on cancer treatment. I agree with Senator Ryan who said that the Government’s amendment is ambiguous. The Department of Health and Children should be directing the HSE to roll out cancer services rather than the idea of the Minister asking the HSE for a roll-out of these services. In fact, the HSE should be doing so automatically.
I was confused listening to Senator White because I am not sure whether she was for or against the motion. She appeared to be praising and criticising the current Minister, Deputy Harney, and criticising previous Ministers, Deputies Cowen and Martin. She appeared to be attacking the officials in the Department as if the Ministers did not have the final say. Ultimately, the Minister has the final say. Blaming officials is taking the easy option but, ultimately, responsibility and accountability lies with the Minister. It is not fair to blame anonymous civil servants when the job of the politician in charge of the Department is to make decisions. I hope this trait which may be lacking in some Ministers will change over time.
When I examine the record of this and the previous Government, Senator Minihan will be pleased to hear that between the Fianna Fáil manifesto and the programme for Government——
Mr. Minihan Mr. Minihan
Mr. Minihan: I am pleased the Senator has learned something in four years.
Mr. Browne Mr. Browne
Mr. Browne: I am learning slowly.
Mr. Dardis Mr. Dardis
Mr. Dardis: The Senator without interruption.
Mr. Browne Mr. Browne
Mr. Browne: In 1997, the full implementation of the national cancer strategy, including centres of excellence in Dublin, Cork, Galway and eight regional centres, was promised in the Fianna Fáil manifesto. By 2001 its full implementation had been watered-down. The Fianna Fáil manifesto stated it would implement, as a matter of urgency, cervical smear testing for GMS patients for screening as well as diagnostic purposes. It also stated programmes for breast and cervical cancer scre ening would be extended nationally. The national cancer strategy stated that services at local, regional and national levels would be agreed by end 2003. It also stated that a revised implementation plan would be published by end 2002. In June 2002 the agreed programme for Government between Fianna Fáil and the Progressive Democrats recognised the particular need to ensure that people in all parts of the country would have reasonable access to cancer services and stated that it would ensure this objective would be achieved.
As other speakers said, BreastCheck is not available nationwide so this idea of a national programme is a bit of a mockery. Where one lives can be a significant factor in one’s treatment for cancer. Cervical screening is not available nationwide and we have not learned from the great experience in the Limerick area. Many specialists have left their posts. For example, I believe in Cork two years ago, a leading specialist left his post due to frustration with the system. I understand Senator White’s criticism of the Government and perhaps of previous Ministers.
I accept Senator Minihan’s point about people living longer as a result of which the rate of cancer increases. Unfortunately, cancer affects all age groups and that is why it is regrettable the Government included an age limit in its amendment to the motion. Unfortunately, we all know people who got cancer in their 20s, 30s and 40s. A relation of mine who got cancer was lucky he was able to travel from Carlow to Dublin by train each day. One might only get cancer treatment for one or two minutes per day but if one lives a distance from the hospital, must commute, feels nauseous following treatment and perhaps is incontinent, it can have a significant effect. That is why the best facilities should be available to people being treated for cancer. People should have the option of staying close to the hospital.
I helped a person in Carlow who did not have a medical card. We got him a medical card and an allowance so that he could stay in bed and breakfast accommodation close to the hospital. He was not able to afford to stay in Dublin in a hotel and he did not have any relatives in the city. Obviously, he was not in a position physically to travel to and from Carlow each day. He made a great recovery as his treatment was successful. We need to consider the rights of patients who do not have family or transport. They should be entitled to a subsidy or assistance to make their treatment less painful and more comfortable.
Much good work has been done. The smoking ban has been a great success and it will have had a major impact in 30 years time when we debate this issue. Hopefully, we will see a reduction in the incidence of cancer.
Exercise is a key issue. Yesterday on the Order of Business, many Senators spoke about the great sporting successes last week, including the successes of the Irish rugby team, Derval O’Rourke from Cork at the World Indoor Championships and Irish racehorses at Cheltenham. I was going  to point out that we have major problems in this country. As far as I know, the athlete from Cork had to get a part-time job as she was not able——
Acting Chairman Acting Chairman
Acting Chairman: The Senator is moving a little way from the subject.
Mr. Browne Mr. Browne
Mr. Browne: The point I make is about exercise. Unfortunately, we have more golf courses than playgrounds which suits me but not many of the children in the country. We need better sporting facilities. We cannot tell people to avoid going into pubs without giving them an alternative. Communities lack basic sporting facilities. We must keep in mind that we need to take a multi-faceted approach.
Mr. Minihan Mr. Minihan
Mr. Minihan: We will make Senator Browne a world champion if he moves to Cork.
Mr. T. O’Malley Mr. T. O’Malley
Mr. T. O’Malley: I have listened carefully to the views of Senators who have contributed to a good debate and I am pleased to have the opportunity to describe the substantial developments which have taken place in recent years in all of the main elements of a comprehensive cancer policy. Specifically, I propose to outline the substantial investment that has supported cancer services throughout the country; the progress to date on achieving the target of next year for commencement of the roll-out of BreastCheck nationally; the increased investment in the cervical screening programme and the recent decision of the Tánaiste and Minister for Health and Children to ask the HSE to prepare for national roll-out; the significant developments in oncology cytogenetic services and in laboratory and clinical genetic services for families at risk of hereditary cancer; and the unprecedented investment in radiation oncology services under the Government’s national plan for radiation oncology services.
Improving cancer care is a major priority of this Government and there is broad recognition among health service providers of the significant changes that have taken place in recent years in oncology services. The key goal of the 1996 national cancer strategy was to achieve a 15% decrease in mortality from cancer in the under 65 age group in the ten-year period from 1994. An evaluation of the 1996 national cancer strategy demonstrated that this figure was achieved in 2001, which was three years ahead of target.
There is no doubt that cancer is a major challenge to our health services. It is a major cause of morbidity in Ireland, with 20,000 people diagnosed each year. There was little change in the number of cancer deaths between 1994 and 2001. The true risk of dying from cancer before age 75 — allowing for the effects of population change and aging — is decreasing by approximately 0.6% for women and 0.1% per year for men. Breast cancer remains the main cause of death for women but is decreasing in frequency.
 Between 1991 and 1994, the five-year relative survival rate for women with all cancers was 47% in Ireland and 52% in Europe. The current five year survival rate for Ireland is 73% which is 4% below the EU average for breast cancer so we are not doing too badly but as all speakers have said, we must continue to progress.
Effectively, tackling the problem of cancer means providing specialist services of a consistently high quality with sufficient capacity as well as appropriate support services for patients, their carers and their families. This Government’s focus is on ensuring there is access to services which deliver this experience for each person diagnosed with cancer. To this end, we have invested over €900 million in the development of cancer services since 1997. We have seen the appointment of over 100 additional consultants across the modalities of care. This investment has been reflected in the substantial increase in the level of activity, with the number of discharges from public hospitals with a diagnosis of cancer rising from 58,507 in 1998 to 92,508 in 2004 and the number of day cases in the same period increasing by 106%.
Population-based screening programmes for breast and cervical cancers have been proven to reduce mortality, with subsequent improvements in population health in terms of survival, morbidity and quality of life. The Tánaiste and Minister for Health and Children has publicly expressed her commitment to the extension of both programmes nationally.
BreastCheck, the national breast screening programme, is available to approximately 160,000 women in the 50 to 64 age group in the eastern, north-eastern, south-eastern and midland regions. Screening is offered free of charge to eligible women in these regions. Since the commencement of the screening programme in 2000, approximately €73 million cumulative funding has been provided to support it. Approximately 245,000 screening visits have taken place, a significant endorsement of the programme.
There are approximately 130,000 women in the target age group in the remaining regions. The Tánaiste recently met with representatives of BreastCheck and they are fully aware of her wish to have the programme rolled out nationally as quickly as possible.
Capital funding of €21 million for the development of the necessary infrastructure has been approved. The national rollout of the programme required detailed planning for the development of essential infrastructure to provide for two clinical units, one at the South Infirmary-Victoria Hospital in Cork and the other at University College Hospital, Galway. This detailed planning involved considerable work by BreastCheck, University College Hospital, Galway, the South Infirmary-Victoria Hospital, Cork, and the Department of Health and Children. Planning permission for both units has been granted and BreastCheck is now inviting tenders for construction.
 BreastCheck requires highly-skilled specialists working together to ensure best outcomes for patients. A key requirement and dependency for the national rollout of the programme is the recruitment of a wide range of specialist staff. The largest single requirement in terms of staff numbers is for specially-trained radiographers who will provide screening services, both at the static centres and at mobile clinics. BreastCheck interviewed for lead consultant radiologists and radiographers in 2005 for the two new units and the recruitment of these and other key clinical staff is continuing. While the exact date of rollout will depend on the availability of adequately trained staff, BreastCheck is confident that the target date of next year for commencement of the national rollout will be met.
The majority of women diagnosed with breast cancer will be diagnosed and treated outside of the BreastCheck programme. It is necessary, therefore, that we support both the symptomatic breast disease services and the screening services to ensure that comprehensive breast cancer services are available for all women. Breast cancer is the individual site-specific cancer which has received the most investment in recent years and more than €60 million has been made available for development of symptomatic services since 2000. The benefit of this investment is reflected in the significant increase in activity which has occurred with inpatient breast cancer procedures increasing from 1,386 cases in 1997 to 1,812 in 2003, an increase of over 30%.
The Tánaiste recently requested the Health Service Executive to prepare a detailed implementation plan for a national rollout of the cervical screening programme via effective governance structures that provide overall leadership and direction in terms of quality assurance, accountability and value for money. A pilot cervical screening programme commenced in the mid-west region in 2000. Under the programme, cervical screening is being offered, free of charge, to approximately 74,000 women in counties Limerick, Clare and north Tipperary.
The national rollout of the cervical screening programme is a major undertaking with significant logistical and resource implications. The Tánaiste has specifically requested that the general practitioner elements of a national cervical screening programme be tabled at the review of the contractual arrangements for the provision by general practitioners of publicly-funded primary care services being conducted at present under the auspices of the Labour Relations Commission. Any remuneration arrangements agreed must be capable of delivering a high uptake among women and payments must be primarily based on reaching acceptable targets.
The Tánaiste is convinced that we must also have in place tailored initiatives to encourage take up among disadvantaged and difficult to reach groups. She wishes to see the programme rolled out as quickly as possible but only when the essential infrastructure, organisation and  services are in place that are quality assured and meet international standards.
Outside the programme, many women present for opportunistic smear tests and the number of these tests has increased substantially in recent years. Overall, in the region of 230,000 smear tests are carried out in laboratories throughout the country each year. To meet this increased demand, additional cumulative funding of approximately €14.5 million has been provided by the Department of Health and Children since 2002 to enhance laboratory and colposcopy services. This funding has enabled the laboratories to employ additional personnel and to purchase new equipment, thereby increasing the volume of activity. These initiatives have resulted in a reduction in the waiting times for smear test results.
Additional revenue funding of €1.1 million was allocated to the programme on an ongoing basis to support the introduction of liquid-based technology in laboratories where the technology is not available and to support the development of quality assurance and training programmes. The introduction of this technology will result in fewer unsatisfactory slides that require women to return for repeat smears. It substantially improves throughput in the laboratories.
Senators referred to the failure to introduce a national colorectal screening programme. National population-based screening programmes for cancers are considered where clear evidence exists of benefit to the health of the whole population to be screened. There is evidence in some specific cancers which shows that population-based screening can improve population health in terms of survival, morbidity and quality of life. As part of the National Cancer Forum’s work in preparing a new national cancer control strategy, the forum developed a framework for evidence-based decision making on the introduction of population-based screening programmes, including colorectal screening.
In July 2005, the Tánaiste announced the Government’s approval for a national network for radiation oncology services to be put in place by 2011, commencing in 2008. The Department is working closely with the HSE in implementing this national plan and the Tánaiste has asked the HSE and the National Development Finance Agency, as a matter of priority, to develop and progress public private partnership arrangements to design, build, finance, maintain and partially operate the proposed services. The plan consists of four large radiation oncology centres in Dublin, Cork and Galway and two integrated satellite radiation oncology units in Limerick Regional Hospital and Waterford Regional Hospital, conditional on their conforming to certain quality assurance arrangements.
The Tánaiste has agreed with the Minister for Health for Northern Ireland, Mr. Shaun Woodward, that the new Belfast cancer centre, which is due to open this month, will treat patients from Donegal. Details of the arrange ments for access for patients in Donegal to Belfast City Hospital will be developed as a matter of priority at the request of both Departments. For this purpose, an assessment of the specific radiotherapy needs of cancer patients in Donegal is being developed by the HSE at present. These developments will result in a significant increase in the numbers of patients receiving radiation oncology treatment throughout the country over the coming years.
The National Centre for Medical Genetics is located at Our Lady’s children’s hospital, Crumlin, and currently runs clinics in Dublin, Cork and Galway for familial cancer. The unit has received funding in excess of €2.3 million over the past number of years to extend the oncology cytogenetic service nationwide and to provide laboratory and clinical genetics services for families at risk of hereditary cancer.
Four cytogenetic staff were appointed in 2004 to take on the additional workload to provide a national service and since mid-2005 the centre has taken samples for oncology cytogenetic analysis from the whole country. There has been a resultant doubling in sample numbers to about 1,700 samples annually and there is now a staff of nine in the oncology cytogenetic section, headed by a principal clinical cytogeneticist.
In 2005, the National Centre for Medical Genetics appointed five laboratory staff for the laboratory and clinical genetics services for families at risk of hereditary cancer. Two genetics counsellor posts were also filled; the first person is in place and the second is due to start this June. The additional genetic counsellor post has reduced the clinic waiting time significantly and the aim is to reduce it further by the end of 2006. Families are seen in clinics in Dublin, Cork and Galway. In 2005, the number of patients seen for clinical suspicion of hereditary cancer doubled in comparison with 2004, there was a growth of 30% in laboratory activity for molecular cancer genetics and a growth of 86% in laboratory activity for oncology cytogenetics.
In January of this year, the National Cancer Forum submitted a new national strategy for cancer control to the Tánaiste. The forum consulted widely on the strategy during 2005 and received significant endorsement and support for its recommendations. The strategy makes recommendations on organisation, governance, quality assurance and accreditation across the continuum of cancer care from prevention and health promotion through ten treatment services, palliative care and research. There is a strong emphasis in the strategy on health promotion, addressing inequalities and quality assurance. It is a policy document which aims to take Ireland up the international league table in terms of cancer control. The Tánaiste is examining this strategy prior to bringing it to Government and it will be published shortly.
The developments in cancer services I have outlined are a clear indication of the considerable progress which has been made in addressing the burden of cancer. These developments reflect the  priority given to cancer care by the Government. It is, therefore, appropriate that the House should commend the Government on its positive and demonstrable commitment to cancer services, especially cancer affecting women.
Mr. McHugh Mr. McHugh
Mr. McHugh: I welcome the Minister of State to the House and thank the Independent group for tabling this motion. It is important to be proactive rather than reactive in the debate on health services. It becomes clear that this is a live debate when one speaks to those directly or indirectly affected by cancer. Unfortunately, whether through family, friends or the local community, Senators will all know people who have experienced the ordeal of cancer or are undergoing cancer therapy.
I seek clarification on an issue I have raised previously. I am pleased to note a slight change in the language used in respect of cancer, radiation and oncology treatment for patients from County Donegal. Cancer patients in my county have had to endure the long trek to Dublin for cancer care. Options will, however, become available in Galway. A recent announcement that it may be possible to treat cancer patients from County Donegal in Belfast was met with confusion and derision. I intend no disrespect to the Tánaiste and Minister for Health and Children or her counterpart in Northern Ireland but this response was justified shortly afterwards when Mr. Shaun Woodward MP, the Minister with responsibility for health in Northern Ireland, stated on a radio programme in County Donegal that cancer patients from County Donegal would be treated in Belfast provided beds were available. This was a legitimate point and it was clearly based on demographic factors.
It is planned to establish four major radiation oncology units in the South, two in Dublin, one in Galway and one in Cork, as well as two outreach satellite centres, one in Limerick and one in Waterford. Six major centres will, therefore, cater for a population of 3.5 million. Viewed from a geographical perspective, service provision will follow an arc stretching from Galway in the west, south to Limerick, Cork and Waterford and north into Dublin. These units will cater for those living in the region extending from north County Louth southwards around the coast as far as south County Sligo. The people of the midlands will also have access to these services. When one subtracts from the population of the Twenty-six Counties the population of counties Donegal and Leitrim and north county Sligo — approximately 400,000 — one finds that the proposed plan will cater for 3.1 million people. The population of Northern Ireland, on the other hand, is more than 1.5 million. The reason Mr. Shaun Woodward MP made his remarks is that the new Belfast radiation oncology unit will cater for 1.5 million people and they will be given priority in terms of access to services. In contrast, we are establishing six centres to cater for a population of slightly more than 3 million. One does not need to be a rocket scientist to figure out that these figures  present a mathematical and numerical anomaly. The reason Mr. Woodward stated that County Donegal patients would be accommodated in Belfast provided beds were available was because he looked at the mathematics.
Not alone are people from north County Sligo, Donegal and Leitrim examining the complexities of the system, so too are the people of counties Tyrone, Fermanagh and Derry. This is the reason we must have ongoing cross-Border interaction and communication between Altnagelvin Hospital in Derry and Letterkenny General Hospital in County Donegal. While I am aware that negotiations and communications between the joint management teams at both hospitals are ongoing, we have not received much detail on progress.
In terms of service provision, the people of the north west have been overlooked and find themselves facing a dangerous anomaly. People in the North who live west of the River Bann, an area which includes much of counties Fermanagh, Tyrone and Derry, have long held that central government in London has neglected them. The proposed provision of cancer services in the South is an example of the same type of neglect being shown to the people of the north west who have long believed they have been abandoned by central government in Dublin. Cancer service provision is the proof in the pudding. Peripherality and distance have been blamed but the truth is the north-western regions have been neglected.
Why did the Scottish and Welsh want devolved government? The reason was that the centralisation of power does not work either in our democracy or in the United Kingdom. We must address the failure of central government in London and Dublin to meet the needs of the people of the north west and the forum for doing so is at joint ministerial level. We can talk about the Good Friday Agreement until the cows come home but we must start to act on it. We have cross-Border opportunities to accommodate and facilitate those whom we represent.
The geographical arc between Galway and Dublin which I described extends beyond health into such areas as transport, industry and infrastructure. We have failed to provide infrastructural investment or adequate health services to the people of the north west.
How can the radiation unit in Belfast accommodate cancer patients from County Donegal when it already covers a population of 1.5 million people? The figures do not add up. The north west was previously mentioned as a potential satellite centre and I want to know why reference was not made to that today.
Mr. Kitt Mr. Kitt
Mr. Kitt: With permission, I will share my time with Senator MacSharry.
Acting Chairman Acting Chairman
Acting Chairman: Is that agreed? Agreed.
Mr. Kitt Mr. Kitt
Mr. Kitt: I thank the Minister of State for attending this House and I was interested to hear  his contribution on this motion. For seven years, I was a member of the Western Health Board, which campaigned to make BreastCheck available in the west of Ireland. Senator Cox, who chaired the board in its last year, promoted this campaign and organised a petition which received thousands of signatures. The Minister of State clearly stated that BreastCheck is available to approximately 160,000 women in the 50 to 64 age group in the east, north east, south east and midlands. He went on to say that it will be introduced to Galway and the west in 2007 but we expected that it would be available by now. I hope that the 2007 target is met because we have fought for the service for a long time. The HSE is continuing that fight and it is significant that tenders for construction are being invited.
I concur with the remarks made by other speakers on the success of screening programmes in Scandinavian countries and in our neighbour, Great Britain. When we held a debate on male cancer, it was noted that men do not visit doctors as often as they should but that is not true in the case of women. The problem in the west of Ireland is that the facilities are not available. Cancer is not a death sentence but people worry about family histories. The Minister of State offered hope in his remarks on cervical screening, BreastCheck and the Tánaiste’s plan for a national cancer strategy.
Senator O’Toole asked whether we are prepared for an outbreak of avian flu. There was a significant mobilisation of forces when foot and mouth disease threatened this country and it is welcome that the person responsible for that, Professor Michael Monaghan, is chairman of the avian influenza advisory group. However, the threat of cancer hangs over the many people who do not have opportunities to avail of screening. Such opportunities must be provided and the sooner that is done through the national cancer strategy, the better.
Mr. MacSharry Mr. MacSharry
Mr. MacSharry: I am glad of the opportunity to speak on this motion. While I will support the amendment, I am grateful to Senator Henry for putting this issue on the agenda for debate. I commend the Government, the Tánaiste and the Minister of State on all they are doing. That is not to deny, however, that much more needs to be done.
I concur with much of what was said by Senator McHugh. We are behind schedule on BreastCheck and it was a mistake to roll it out in one area at a time rather than everywhere. We should not make the same mistake with cervical cancer screening, which must be available everywhere.
Along with my colleagues from the north, I take credit for the fact that the Galway centre for BreastCheck is nearing completion. I would like pressure to be exerted to ensure it is rolled out as quickly as possible. The Tánaiste gave an undertaking that the service will be available by 2007 and hinted that it may be ready by the end  of this year. I hope this is so because the life of a woman in Dublin is no more important than that of someone in Sligo or Donegal.
We should scrap the idea of pilot areas and start thinking about the problem as a whole. A pilot screening programme for cervical cancer was introduced in the midlands and international statistics show great benefits from such programmes. However, the programme should be made available nationally without delay because everybody must be included. Money should be no object when it comes to people’s lives and health.
I have consistently raised the lack of the infrastructure north of a line from Dublin to Galway and west of Mullingar, and radiotherapy is no different. Under the Hollywood proposals, two centres will be provided in Dublin, one in Galway and one in Cork, which is fantastic. Due to political pressure, agreement has been reached on satellite units for Limerick and Waterford. Again, however, nothing has been provided north of the line between Dublin and Galway and west of Mullingar. People are advised to go to Belfast but that is unrealistic because people want centres for treatment rather than for diagnosis. As it is not reasonable for a mother of young children who suffers from breast cancer to travel to St. Luke’s for radiotherapy, we want the service to be brought closer to home. It is a delusion to think it is easier to travel to Belfast or Galway than to Dublin. We require radiotherapy services in Sligo. That means one linear accelerator at an approximate cost of €3 million to €6 million in capital expenditure. I am aware that is a significant amount and that running the service will require even more but there is no excuse. My colleagues, Deputy Devins and Senators Feeney and Scanlon, are most anxious about this issue. We demand a linear accelerator for Sligo which will service the north west.
Dr. Henry Dr. Henry
Dr. Henry: May I give Senator Dardis the first minute of my time?
Acting Chairman Acting Chairman
Acting Chairman: I would prefer that it be given to Senator Norris.
Mr. Norris Mr. Norris
Mr. Norris: I am flattered by the confusion.
Acting Chairman Acting Chairman
Acting Chairman: The first minute? That worries me.
Mr. Norris Mr. Norris
Mr. Norris: It is so that Senator Henry will have the last word. She has shown herself to be an ornament of the House in these areas and we are lucky to have her because she speaks calmly and in a measured way with considerable knowledge and without partisanship. For that reason, I am disappointed that an amendment was proposed because the Senator’s motion was carefully worded. She used the word “regret” and not a word like “failure”, which Governments tend to find unacceptable. When we are dealing with people’s health, we must keep the human element in mind.
I deprecate the attempts of politicians from all around the country to provide linear accelerators  everywhere, which are simply vote catching exercises. We must have centres of excellence and listen to the people who know what they are talking about. I hope the Minister of State will not be misled by this kind of politicking, which I completely understand but which does not work and is not in the interest of people’s health.
Mr. McHugh Mr. McHugh
Mr. McHugh: Give us the roads. It takes seven hours to travel from Malin Head to Dublin.
Mr. Norris Mr. Norris
Mr. Norris: While battling cancer is important in terms of women’s health, there are also high rates of colorectal cancer among men, so we should consider the possibility of introducing a coherent programme which does not specify gender, except where people like Senator Henry advise us of particular sexual predispositions. Even though breast cancer is unusual in men, I know of two male sufferers.
Acting Chairman Acting Chairman
Acting Chairman: The Senator has now gone 100% over his time.
Dr. Henry Dr. Henry
Dr. Henry: I find the Government amendment depressing, and the Minister of State’s speech profoundly depressing. The Government seems determined to carry out this action and that, but when? Senator Minihan asked for a national population register, but I asked for that over ten years ago. It is absolutely essential for screening.
The idea came to me during the debate that I would try to get the Minister for Justice, Equality and Law Reform to put this in his criminal law legislation, which is causing such chaos in the Dáil. Hundreds of amendments have been tabled to the legislation. If I ask him to include a national population register in the Bill and tell him that it will help him keep track of people in the country more easily, he may do it.
Mr. Norris Mr. Norris
Mr. Norris: Well done.
Dr. Henry Dr. Henry
Dr. Henry: It would be a way to get it done. It is dreadful to ask Irish women to congratulate the Government on the fact that the survival rate at five years for breast and cervical cancer is only 4% below the EU average. The Minister of State cannot do it. We know the only countries lower than us are Estonia, Slovakia, Poland and Scotland. We cannot ask Irish women not to query why they should not be up with Finland, Sweden, France, Italy and Germany.
Mr. Norris Mr. Norris
Mr. Norris: Hear, hear.
Dr. Henry Dr. Henry
Dr. Henry: We cannot accept such a ridiculous statement. We cannot accept that opportunistic screening is apparently to suffice for the moment all over the country, while we sort out general practitioners. We know this is not even free to  those women with medical cards. The Minister of State could tell me that his Department will provide opportunistic cervical cancer screening free to every woman with a medical card. A doctor-only medical card would suffice in this case. I would accept such a proposal for the moment, as it would show that something is being done. It is women in poor socioeconomic conditions who are most affected by these conditions. The Minister of State could enforce such a provision immediately.
Acting Chairman Acting Chairman
Acting Chairman: I ask the Senator to conclude.
Dr. Henry Dr. Henry
Dr. Henry: There is another important factor in the increase of breast and colorectal cancers in this country, obesity. Since the Progressive Democrats and Fianna Fáil have entered Government, the obesity rate in the population has increased from 9% in 1997 to 18% now. That is another factor which will increase the incidence of cancer in this country. It is fine to state that there has been a doubling of the number of people getting genetic screening since 2004.
Acting Chairman Acting Chairman
Acting Chairman: The time used by the Senator is also doubling.
Mr. Norris Mr. Norris
Mr. Norris: The Senator has plenty of time.
Dr. Henry Dr. Henry
Dr. Henry: This doubling has come from a figure close to zero. This will not do. The Health Research Board is of course doing tremendous work in cancer research, but the population is not getting the benefit.
Senator Browne mentioned that two oncologists left Cork and went to Dublin due to lack of facilities and backup. I had great trouble in persuading an oncologist in another centre, which I will not mention, to stay here. He told me he had no beds despite being back two years from America. He stated he was going to return to America because he was so sickened by the matter, although I persuaded him to stay. We have good people here and we should have a much better service.
The Government is not taking this issue seriously enough. Senator O’Toole was correct in stating that if we heard that 640 people would die from avian flu next year, there would be chaos. The same number of women will die from breast cancer. Thousands are cured of breast cancer in this country, and the disease is curable now. We must increase the numbers of people in this country who are cured of cancer, and not congratulate ourselves for the little bits and pieces we are doing here and there.
Mr. Norris Mr. Norris
Mr. Norris: Bravo.
 The Seanad divided: Tá, 28; Níl, 19.
 Amendment agreed to.
Motion, as amended, put and declared carried.
An Cathaoirleach An Cathaoirleach
An Cathaoirleach: When is it proposed to sit again?
Ms O’Rourke Ms O’Rourke
Ms O’Rourke: At 10.30 a.m. tomorrow.
Seanad Éireann 183 Cancer Services: Motion.