I am pleased to be given the opportunity today to brief the House on developments to date under the national cancer strategy and outline the areas of cancer services which have been particularly targeted under the strategy with regard to women's health and women's cancers.
The reorganisation of our cancer treatment services was an integral part of the 1994 health strategy, Shaping a Healthier Future, and targets were set for reducing the mortality from cancer in the under 65 year old age group by 15 % in the period 1994 to 2004. Health care services were to be focused on improvements in health status and quality of life and increased emphasis was to be placed on the provision of the most appropriate care for patients. Cancer was identified as one of the major sources of premature mortality in Ireland. The effect of cancer on health status in Ireland is striking. There was a clear need to address this and the national cancer strategy emerged as an evidence based initiative to enable high quality cancer services to be developed throughout the country. Included in the national cancer strategy was the commitment to develop screening programmes in the area of breast cancer and cervical cancer.
The two principal objectives of the national cancer strategy are; to take all measures possible to reduce rates of illness and death from cancer, in line with the targets established in Shaping a Healthier Future and ensure those who develop cancer receive the most effective care and treatment and that their quality of life is enhanced to the greatest extent possible.
There are specific objectives in relation to key elements of the cancer strategy concerning such areas as prevention of cancers for which a cause is known or suspected, access to equitable, effective, quality services throughout the country, improved quality of life for patients, appropriate multi-disciplinary treatment administered safely and in accordance with best practice guidelines, greater co-ordination of cancer treatment services from primary care to hospital care through to rehabilitation and palliative care, promotion of arrangements for appropriate research and education for those providing cancer services and a co-ordinated approach by all those involved in the care and treatment of patients with cancer to ensure all services are provided in a cost-effective manner.
There are specific objectives in relation to key elements of the cancer strategy concerning such areas as prevention of cancers for which a cause is known or suspected; access to equitable, effective, quality services throughout the country; improved quality of life for patients; appropriate multi-disciplinary treatment administered safely and in accordance with best practice guidelines; greater co-ordination of cancer treatment services from primary care to hospital care through to rehabilitation and palliative care; promotion of arrangements for appropriate research and education for those providing cancer services; and a co-ordinated approach by all those involved in the care and treatment of patients with cancer to ensure that all services are provided in a cost-effective manner.
A range of support structures were put in place to co-ordinate and take a lead role in the implementation of the national cancer strategy. The first National Cancer Forum, under the chairmanship of Professor James Fennelly, was established. The forum, a multi-disciplinary body, proved to be an extremely useful body and advised on many issues central to the successful implementation of the strategy. The term of office of the first forum expired last year and I subsequently appointed Professor Paul Redmond as chairman of the second National Cancer Forum. The forum 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 and audit and evaluation of our services are all important component parts of the appro priate future development of cancer services, and the forum, as the established expert advisory body, will report to me on these issues.
Regional directors of cancer services were appointed in each health board area 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. The regional directors are proving to be of great benefit in assisting in the development of appropriate future cancer services.
I am very pleased to report to the House today that there has been considerable and tangible progress to date under the national cancer strategy. The strategy has been progressed far beyond the original commitments made in the action plan for its implementation.
The implementation of the national cancer strategy was estimated to cost £25 million when it was launched. The sum allocated for the strategy in 1997 was £6 million. Since then the Government has invested £54 million in cancer prevention, treatment and care services, including £11 million last year and almost £19 million this year. All the commitments made in the action plan for the implementation of the strategy have been fully funded and are implemented or are in the course of implementation. The main implementation elements of the strategy included the areas of cancer prevention, early detection and screening, additional consultant appointments in key areas of cancer treatment and care and cancer research.
There have been a number of key consultant appointments since the commencement of implementation of the national cancer strategy. There have been 55 additional consultant appointments in the areas of medical oncology, haematology, histopathology, palliative care and specialist surgery. In addition, new consultant appointments have been approved in the specialty of radiation and clinical oncology at St. Luke's Hospital, Dublin.
Cancers occur as a result of the interplay between genetic and environmental factors. Risk of cancer depends on age, sex, genetic make-up and where and how people live. To some extent certain aspects of cancer risk are within our control. There is strong evidence that lifestyle and environmental factors play an important role in the development of cancer. The use of tobacco, the excessive consumption of alcohol and unhealthy diet contribute to increasing the risk of developing cancer. It is important that the public is made aware of the scope for preventing many cancers by making appropriate lifestyle changes. To this end, 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.
As more and more people are aware, the prevention and reduction of skin cancer can be achieved by a vigilant approach to sun exposure and artificial forms of UV radiation. Utilising sun protective clothing and creams as well as early detection can reduce deaths from skin cancer. Early detection of melanoma can be facilitated by consulting a physician if a mole changes shape, size or colour. People must be informed of the risk associated with sunburn. To this end the health promotion unit has put concise information on this subject into booklet form and made it widely available.
BreastCheck, the national breast screening programme, commenced in February 2000. Phase one of the programme covers the Eastern Regional Health Authority, the North Eastern Health Board and the Midland Health Board areas. Screening is being offered free of charge to all women in the target age group of 50 to 64 years on an area by area basis.
In the period January to March 2001 approximately 2,700 women per month were screened at the BreastCheck units and approximately 700 women per month were screened on the mobile unit. Less than 1% of those screened are admitted to hospital for further management.
The board of BreastCheck has reviewed progress to date and has informed me that it is pleased with the uptake of women in the areas screened so far, with uptake having virtually reached its target level of 70%, while meeting the quality parameters set and providing evidence of a significant level of screen detected cancers.
The successful roll-out of the programme is dependent on a number of factors, including the availability of appropriately trained staff. BreastCheck offers suitably skilled radiographers the opportunity of working in state-of-the-art facilities as well as an attractive employment package. The board has taken a number of initiatives to address the issue of the current shortage of suitably skilled radiographers, including an international advertising programme. BreastCheck, in conjunction with the School of Diagnostic Imaging at the Faculty of Medicine, UCD, has set up a post-graduate diploma in mammographic imaging, the first of its kind in Ireland. This joint initiative aims to increase levels of mammographic trained radiographers in Ireland and share the experiences of BreastCheck with other mammography services.
The board of BreastCheck plans to carry out a feasibility study nationally on the availability of skilled staff for the programme and this is expected to be complete in a number of months. It expects to make recommendations to me regarding the extension of the programme to the rest of the country later this year. Breast screening has a significant part to play in reducing morbidity and mortality from breast cancer. I am committed to the extension of BreastCheck to ensure that women throughout the country have the highest quality breast screening services available to them. This involves not only screening services, but also the availability of quality symptomatic services so that an equally high standard of hospital care is available for those who may require it following a screening detected cancer.
BreastCheck is providing an excellent, intensely quality assured service for screened women who believe that they are healthy and for the treatment of the women who, through screening, are discovered to have breast cancer. It is essential that this service is matched by an equally excellent service for those with symptomatic breast disease. As the plans for the commencement of BreastCheck progressed, it soon became apparent that the symptomatic breast cancer services in this country were not provided in the manner which would or should lead to the best outcomes for women. International experience tells us that women who are treated in a multi-disciplinary centre where all the relevant medical expertise is on one site and where there is a minimum number of patients with similar disease treated by the same team have a greater chance of long-term survival and have less of a chance of their disease recurring than those treated in smaller centres.
Having regard to these concerns, my predecessor, Deputy Cowen, requested the National Cancer Forum to review symptomatic breast disease services nationally. The forum established a sub-group to undertake this task. The report on the development of services for symptomatic breast disease was presented to me in April last year. I accepted the broad thrust of this report and established an advisory group to meet all the health boards to advise and assist in formulating regional plans for the implementation of the report.
Concerns were raised in many areas because of a perceived notion that certain smaller hospitals around the country would be downgraded if they did not maintain their mammography services. I stress to the House that this report was not about the downgrading or closure of any hospital. It is about the reorganisation and development of breast disease services in centres of excellence to ensure that every effort is made to reduce the number of women in this country who die from breast cancer every year. I have provided funding of over £4 million this year to enable a number of agencies to commence the development of at least seven centres of excellence for the treatment of symptomatic breast disease. Funding has been allocated to the Eastern Regional Health Authority, the Midland Health Board, the North Eastern Health Board, the South Eastern Health Board, the Southern Health Board and the Western Health Board.
The National Registry Board reports that between 1994 and 1997 cervical cancer accounted for an average of 74 deaths in Ireland each year, with cervical cancer being more common in older women. The report, Developing a Policy for Women's Health, states that while cervical screening is simple, quick and relatively inexpensive, not all women respond to requests to attend for screening. It has been found that women in the lower socio-economic groups may fail to do so and it is mainly among these groups that deaths from cervical cancer occur. Experts in the Europe Against Cancer programme recommend that women between the age of 25 and 60 years should have a cervical smear regularly and should participate in organised screening programmes where available.
With these considerations in mind, phase one of the national cervical screening programme commenced in the Mid-Western Health Board area in October 2000. Under the programme, in the region of 67,000 women aged from 25 to 60 years will be screened free of charge at minimum intervals of five years. The question of extending the programme to the rest of the country is under consideration by my Department in conjunction with the chief executive officers of the health boards and the expert advisory group on cervical screening.
As the House will gather, I am very well aware of the issues relating to women's cancers. The considerable investment under the national cancer strategy will undoubtedly enhance the quality of services available to women, provide further ease of access to these services by providing for the development of quality services on a regional basis and ensure that those who develop cancer receive the appropriate treatment administered safely in accordance with established best practice. I am committed to the further implementation of the national cancer strategy to ensure that women who develop cancer have available to them the best, safest and most effective treatment and so have the best opportunity for long-term survival.