I thank Deputy Gormley and others for raising this issue. The work of the National Cancer Registry Board is vital in our continuing fight against cancer in that it provides a national data set critical for epidemiological and research purposes and valuable information on cancer rates. I welcome the publication of the fifth report of the National Cancer Registry Board which summarises the first five years of data collection by the board and presents comprehensive data on treatment and survival patterns nationally between 1994 and 1998.
Regarding the Deputy's concerns, the years covered by the report, 1994 to 1998, pre-date the significant investment made in cancer services, especially by the Government, since the implementation of the national cancer strategy in 1997. As Dr. Harry Comber, director of the National Cancer Registry Board pointed out at the launch of the report last week, it will obviously take time for this investment to be reflected in cancer treatment services, particularly in relation to such statistics as five year survival rates.
It is also worth noting that the report states there was no significant change in the risk of developing or dying from cancer between 1994 and 1998. Cancer incidence in Ireland was similar to that in neighbouring countries. Overall, and for most common cancers, cancer rates were lower than in Scotland, Wales and Northern Ireland, higher than in England and close to EU averages. Exceptions were breast cancer, where our risk was lower than that of the neighbouring countries, and lung cancer in women, for which our risk was well above the EU average.
From 1997 to date, more than €103 million has been invested in the development of appropriate treatment and care services for people with cancer. Among a range of other initiatives, this investment has enabled the funding of 62 additional consultant posts in key areas such as medical oncology, radiology, symptomatic breast disease, palliative care, histopathology and haematology, together with support staff throughout the country. This includes approval which has been given for eight new consultant surgeon posts with a special interest in breast surgery.
This level of funding far exceeds the £25 million which was initially envisaged in 1996 and is a clear indication of the Government's continued commitment to the development of co-ordinated and patient-focused cancer treatment in line with the recommendations of the national cancer strategy.
Under the national cancer strategy, the national cancer forum was established to advise on appropriate developments and structures in the area of cancer. The term of office of the first forum expired in 2000 and I subsequently appointed Professor Paul Redmond as chairman of the second national cancer forum. The forum is representative of the medical, the palliative and the voluntary organisations involved in cancer services and continues to play a very important role in the provision of quality services to people with cancer.
Regional directors of cancer services have also been appointed in each of the health boards to oversee and co-ordinate the development of cancer services in their respective areas in conjunction with the chief executive officers of the health boards. These posts are proving to be of great benefit in assisting in the development of appropriate future cancer services.
In 2000, national screening programmes for both breast and cervical cancer were initiated on a phased basis. BreastCheck, the national breast screening programme, commenced in March 2000 with phase one of the programme covering the Eastern Regional Health Authority, Midland Health Board and North Eastern Health Board areas. Screening is being offered free of charge to all women in those areas in the target age group, 50 to 64 years of age. BreastCheck, as with many other sectors of the health services has found it difficult to recruit specialised radiographers. This shortage of staff has meant the programme has been unable to screen women as quickly as anticipated. BreastCheck recognised this difficulty some time ago and took a number of initiatives to address this shortage, including running both national and international recruitment campaigns. This has resulted in the recruitment of additional radiographers to the programme, and of BreastCheck's total number of 18 radiographer posts, 15.5 are currently filled. BreastCheck continues to explore other recruitment possibilities and reports that the targets achieved in all other areas are exemplary in comparison with breast screening programmes in Holland, Sweden and the United Kingdom. It is expected that phase one of the programme will be completed by December 2002. To date, more than 50,000 women have been called for screening and more than 34,000 women have been screened. This represents a 70% uptake.
Phase one of the national cervical screening programme was launched in October 2000 covering the Mid-Western Health Board area. Under phase one, cervical screening is being offered free of charge, to approximately 67,000 women in the 25-60 age group at five yearly intervals.
The provision of screening programmes, underpinned by international quality assurance criteria and best practice, is a key objective and the experience gained in phase one will facilitate the process of planning and organising the roll-out of these programmes countrywide. Both BreastCheck, the national breast screening programme, and the national cervical screening programme are currently in discussion with health boards concerning expansion of the programmes nationwide.
The report identifies that incidence rates for prostate cancer in men in all age groups showed statistically significant increases. Incidence rates in men under 65 years increased by 8.2%. Mortality rates showed no evidence of an upward or downward trend. The evidence of a divergence between incidence and mortality rates may be due to better case-finding, more incidental diagnoses or a genuine increase in survival.
In December 2001, €320,000 was announced by my colleague the Minister for Finance, Deputy McCreevy, for the Irish Cancer Society to support a study of prostate cancer, including diagnosis. A sub-group of the national cancer forum has recently been established on generic screening. This group, which is chaired by Mr. Michael Lyons, chief executive officer, East Coast Area Health Board, will review all issues relating to screening, including looking at specific diseases such as colorectal and prostate cancer. Their recommendations will help to inform policy developments in this area on an ongoing basis.
The National Cancer Registry Board's report shows clear evidence of a divergence between female incidence and mortality rates in relation to breast cancer, with a statistically significant upward trend in breast cancer incidence in women under 65 years and downward trends in mortality rates in all age groups combined. This divergence in trends is expected to continue as a result of continuing improvements in treatments and as a result of the BreastCheck screening programme.
A sub-committee of the national cancer forum was established to report and make recommendations on the development of symptomatic breast disease services nationally. Its report, which was published in March 2000, provides a comprehensive plan for the co-ordination and best delivery of symptomatic breast disease services nationwide.
I set particular emphasis on the central recommendations of this report. As breast cancer remains a major public health issue, it is vitally important that quality services are developed for symptomatic breast disease. It is generally accepted that women with breast disease are best served by a team of specialists working together and that women experience better outcomes if their cancer is managed in centres developed along the lines recommended in the sub-group report.
I am glad to confirm that during the past year, there have been extensive consultations between my Department and the health boards on the best way forward for the development of symptomatic breast disease services in their functional areas. More than 12 months ago I gave financial approval to the boards on condition that they would operate to agreed protocols and standards of care in accordance with national guidelines and quality assurance arrangements to ensure compliance with best international practice and to achieve optimum outcomes. The boards deliberated for some time before coming forward with the best solutions for their particular areas.
As well as investing funding in the delivery of services to people with cancer and in developing
screening services for particular cancers, I have also complemented these actions by initiatives in the field of health promotion. The health promotion unit of my Department supports an extensive range of initiatives that have an impact on the levels of knowledge and awareness of the risk factors associated with many cancers. These include mass media campaigns on anti-smoking, alcohol awareness and healthy eating. The unit also provides funding to the Irish Cancer Society in support of cancer prevention initiatives including the yearly Europe against cancer campaign.
The statistics on lung cancer published in the report reaffirm the need for comprehensive, strengthened legislative measures to tackle tobacco use in this country. The Health (Miscellaneous Provisions) Act, 2001 raised the age limit at which tobacco products could legally be sold to young persons from 16 years to 18 years with effect from 1 August last year. The House will also be aware that I advised the tobacco industry here that no further advertising or sponsorship, other than limited retail and trade advertising, would be allowed after 1 July 2000. The Public Health (Tobacco) Bill will now be enacted and implemented as a matter of urgency and a reduction in smoking will continue to be targeted through Government fiscal policies. The Bill confers enabling powers on the Minister for Health and Children to extend environmental controls on smoking to a range of public areas and public facilities not already covered by existing legislation.
The main provisions of the Bill include the establishment of the Office of Tobacco Control on a statutory basis; a comprehensive ban on tobacco advertising and on all forms of sponsorship by the tobacco industry; a system of retail registration and fees to be administered by the Office of Tobacco Control; a ban on the sale of packets of less than 20 cigarettes and restrictions on self service; full disclosure to the public on all aspects of tobacco; improved protection for people against passive smoking; and much tougher enforcement.
Health information is fundamental to assessing and implementing quality programmes. It is also vital to the wider areas of value for money, information for management, information for the public, knowledge management systems and knowledge bases. The national health strategy provides for the establishment of an independent health information and quality authority to lead the development of health information to support these requirements. The soon to be published national health information strategy will provide the context for future development in this area.
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. It is currently examining a number of issues of tremendous importance to the effective progression of the development of cancer services in this country. Areas such as protocols for the care and treatment of cancer patients, information requirements, audit and evaluation of our services, genetics issues and further screening programmes are important component parts of the appropriate future development of cancer service and the forum, as the established expert advisory body will report to me on these issues.
The Government is constantly striving to provide the best and most appropriate cancer services for the country. In recognition of the need to further develop cancer services, the national health strategy has identified the need for the preparation by the end of 2002 of a revised implementation plan for the national cancer strategy. This plan will be prepared by my Department in conjunction with the National Cancer Forum and will set out the key areas to be targeted for the development of cancer services in the next seven years. This will have regard to existing policies in the areas of symptomatic breast disease and palliative care and the forthcoming recommendations of the expert group on radiotherapy services. The work of that group is ongoing and I am awaiting the final draft report.
The work of the National Cancer Registry Board provides a vital contribution to informing the ongoing implementation of the national cancer strategy in terms of directing the way in which investment takes place, ensuring integration of services and that the objectives of the national cancer strategy are realised. The health strategy provides a significant opportunity for the forum to shape its work. It is also intended that the National Cancer Forum will work with the National Hospitals Agency and the Health Information and Quality Authority to ensure service, quality, accessibility and responsiveness. Furthermore, under the Ireland-Northern Ireland National Cancer Institute Cancer Consortium initiative, a research programme has been launched. This will allow hospitals throughout Ireland to participate in high quality clinical trials of new therapies for cancer, helping to ensure new and effective treatments are made available more quickly.
The developments I have outlined here today describe an overall framework through which cancer services can be developed and provided in a co-ordinated and effective manner. The Government is committed to ensuring a cancer strategy will form an integral part of the implementation of the overall health strategy which is aimed at ensuring quality and fairness in the provision of services to all. I look forward to ongoing reports from the National Cancer Registry Board, particularly in the years ahead, which should reflect the success and impact of the level of investment which has taken place since 1997 in particular.