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Dáil Éireann debate -
Wednesday, 5 Dec 2001

Vol. 545 No. 5

Other Questions. - Cancer Incidence.

Austin Deasy

Question:

32 Mr. Deasy asked the Minister for Health and Children if he has identified serious variations in the occurrence of cancer in different areas here; if so, if the sources have been detected; the remedial action being taken; and if he will make a statement on the matter. [30942/01]

The National Cancer Registry is the statutory body responsible for collating data on the incidence of and mortality from cancer in Ireland. I have been advised by the Director of the National Cancer Registry that the most recent data for national cancer incidence are for 1998. Analysis of the 1994-98 data by health board area showed that the Eastern Health Board had the highest overall cancer incidence in Ireland. In 1997 analysis was carried out by county. This did not give any statistically significant results. Full details are available in the National Cancer Registry's report, "Cancer in Ireland, 1997". I might give some details on that during supplementary questions.

There has been considerable development in the care and treatment of patients with cancer in recent years. More than £60 million has been invested to date under the national cancer strategy since 1997. This funding has enabled the appointment of 62 additional consultant posts in key areas of medical oncology, haematology, histopathology and palliative care. The two underlying principles of the strategy are to take all measures possible to reduce rates of illness and death from cancer, in line with the targets established in the health strategy, "Shaping a Healthier Future", and to ensure that those who develop cancer receive the most effective care and treatment and that their quality of life is enhanced to the greatest extent possible. Underlying these objectives is the need for a high quality and patient focused service. One of the specific objectives of the strategy is to ensure that all patients have access to an equitable, effective service with a uniformly high quality of care wherever they live.

Cancer is a multifactorial disease and it is vital that our focus is both on the prevention of cancer where possible and on early and appropriate intervention for those who develop cancer. The health promotion unit of my Department supports an extensive range of initiatives, a number of which have an impact on levels of knowledge and awareness of risk factors associated with many cancers. In the context of the national health strategy, I will continue to be advised by the National Cancer Forum on the planning, development and implementation of cancer services for the country. In this context, commitment has been given to the completion by the end of next year of a new implementation plan for the national cancer strategy. My Department will continue to work with the National Cancer Forum and the regional directors of cancer services in identifying priorities for the further development of cancer services in all regions, building on the major progress made to date.

This is a sensitive issue. We all know people who are dying from cancer. Are deaths from cancer more frequent now than they were in the past? Can the Minister give me a breakdown of the figures for the past ten, 20, 30 or 40 years? As regards geographical variations, are there any specific areas where the incidence is greater and, if so, why? We hear stories about telecommunications masts, which most of us do not believe. Perhaps the Minister could clarify that.

I have received further information from the Director of the National Cancer Registry which is contained in the 1997 report to which I referred and which I can send to the Deputy. The most recent data are for 1998. An analysis of the 1994-98 data by the health boards shows that the Eastern Health Board had the highest overall cancer incidence in Ireland and it was statistically significant. The incidence of breast cancer, lung cancer, prostate cancer and bladder cancer was also significantly above average in the Eastern Health Board. The incidence of colorectal cancer was significantly higher than the national average in females in the Southern Health Board and in males in the Eastern Health Board. The North-Eastern Health Board had a significantly higher incidence of stomach cancer in females, while the incidence in the Eastern Health Board was significantly higher in males.

In 1997 an analysis was carried out on a county basis. This did not give many statistically significant results. It was found that the overall incidence of common cancers was significantly higher in Dublin. The incidence of skin cancer and lung cancer was also significantly higher in Dublin. A number of counties had a lower than average cancer incidence. In Tipperary, for example, bowel cancer was lower than average while breast cancer in Wexford and prostate cancer in Kerry were lower than average. Full details are contained in the National Cancer Registry report, "Cancer in Ireland, 1997".

What are the sources of cancer?

Causation is multifactorial. Smoking is a key factor, but we have identified a range of factors.

Everyone says their area is worse in terms of the incidence of cancer than anyone else's area. Will the Minister speak to the Minister of State at the Department of Public Enterprise, Deputy Jacob, about the influence of radon gas? Has a study been done on areas with high levels of radon gas? Has a cross-departmental approach been adopted to encourage an independent research study or a doctoral study of this and other geological or physical factors which could influence the incidence of cancer? The Minister mentioned that cancer rates are higher in the Eastern Health Board. Are the figures based on a percentage of the people in the area or do they reflect the fact that the largest population is in that region?

Does the Minister accept that screening and early detection are important in the successful treatment of cancer? If so, how can he stand over a situation in the North-Eastern Health Board area where a mammography machine, which was installed in Cavan General Hospital more than two years ago with funding from the Friends of Cavan General Hospital, has not yet been commissioned?

I relate this question to the current controversy over Sellafield. Is there anything in the Minister's figures which would shed some light on that controversy? Does he agree it might be useful to get the figures for County Antrim and County Down to see if there is any significant difference in those two counties from the counties further south?

As regards Deputy Keaveney's question, I am aware that the Radiological Protection Institute of Ireland has embarked on a nationwide survey to identify concentrations of radon in certain locations and it has taken remedial steps in that direction. When I was Minister for Education and Science I initiated a survey with the Radiological Protection Institute of Ireland of all schools throughout the country. Where high levels were found, it was decided to take remedial measures, which are simple in some instances, to reduce the levels of radon and people's exposure to it in buildings, particularly in schools. I undertake to talk to the Minister of State at the Department of Public Enterprise, Deputy Jacob, about that issue.

As regards Deputy Boylan's question, screening is extremely important. That is why last year we developed for the first time a national breast screening programme which is confined to three health board areas at present. There are significant logistical and capacity issues in terms of personnel and having expertise in place to roll that out nationally. The board responsible for the BreastCheck programme felt it was important to get it right in terms of the initial phase before the second roll-out phase took place. My understanding is that it will bring recommendations to me about subsequent roll-outs of the breast screening programme. The cervical screening programme is taking place in the mid-west. Analysis must be carried out of its evaluation phase to point out the direction in terms of its subsequent roll-out. A lot has happened in recent years, although it has not happened quickly enough for many people.

As regards causation, there is no evidence in the figures which points in any direction, including Sellafield. The governing criteria for the causation of cancer seem to revert to lifestyle issues, particularly smoking. The one thing we could do to dramatically reduce certain forms of cancer is to dramatically reduce the incidence of smoking.

What about the communications masts?

There is no evidence about the communications masts.

We all know that.

The Deputy should allow the Minister to reply without interruption.

The question was more of a statistical nature. Diet, lifestyle and smoking are key issues in terms of the prevention of cancer. Genetic factors could also be involved.

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