Seanad Éireann debate -
Tuesday, 7 Apr 2009

Vol. 194 No. 16

Bowel Cancer Awareness: Statements.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I welcome the opportunity to address the Seanad on the topic of bowel cancer awareness. In Ireland there is a relatively high incidence of this type of cancer, also known as colorectal cancer. It is the second most commonly diagnosed cancer in this country. This is why initiatives such as the Irish Cancer Society's bowel cancer awareness month are so important. Early diagnosis is a significant factor in improving outcomes for all types of cancer and this initiative will help to make people more aware of the signs of colorectal cancer and encourage them to take action where needed.

The Government published a national strategy for cancer control in 2006. This sets out the blueprint for addressing the burden of cancer. Under the strategy there are four main areas to cancer control: prevention, early detection, treatment and after care. In response to the strategy, the Health Service Executive established a national cancer control programme in 2007. Under Professor Tom Keane, the interim director of the programme, the HSE is reconfiguring the present fragmented cancer care system by the establishment of eight designated cancer specialist centres. Progress under the programme must be on an incremental basis and the initial focus has been on the development of breast cancer services in the eight centres, together with addressing the gaps in treatment for other major cancers. At present approximately 27,000 people are diagnosed with cancer each year. The number of newly diagnosed cancers is increasing by 6% to 7% annually and unless a major reversal of trends occurs in the near future the number is likely to double in the next 20 years.

Approximately 2,200 cases of colorectal cancer are diagnosed in Ireland each year and more than 900 people die from the disease. According to projections from the National Cancer Registry, the numbers are set to increase significantly. By 2030, the number of new cases diagnosed is projected to rise by 110% in men and by 83% in women. The rise in this type of cancer is mainly due to demographic factors,essentially an increasing and ageing population. Incidence generally increases with age, with more than four fifths of cases occurring in those over the age of 55. However, survival rates have been increasing slowly over time. Over the five-year periods between 1994-1999 and 2000-2004, relative survival from colorectal cancer, at five years after diagnosis, increased from 46% to 51%. The increase for men was from 45% to 49% and for women from 47% to 53%. We wish to see relative survival rates improve further.

In the context of the national colorectal cancer screening programme, the optimum approach to population screening has not been fully defined, but as with all screening programmes, it must be acceptable, sensitive, specific and cost effective. It is against this background that the Minister, Deputy Harney, requested the board of the national cancer screening service to advise her on the introduction of a population-based colorectal screening programme, including who should be screened, at what intervals screening should take place, the type of screening test that should be used and so on.

In this context, the Health Information and Quality Authority, HIQA, has been asked to conduct a health technology assessment on a colorectal screening programme to examine the cost effectiveness and resource implications of a population-based colorectal cancer screening programme in Ireland. The Minister has received an expert report from the screening service. I understand the health technology assessment is also complete and the Minister expects to receive this shortly. At that stage, she will be in a position to consider further the introduction of a colorectal screening programme and the resources that would be necessary for this.

A population-based screening programme would be aimed at prevention and early diagnosis for people who do not have symptoms but who nevertheless may be at risk. Separately, however, it is important to ensure we can provide speedy diagnosis for symptomatic patients as well as timely and appropriate treatment for those who do receive a diagnosis of colorectal cancer. There has been a great deal of media coverage in recent times on waiting times for colonoscopy services. Colonoscopy is not the only diagnostic tool available for patients with symptoms that may indicate colorectal cancer but it is one of the most important.

While most patients referred for colonoscopy will not have a diagnosis of cancer, timely access to colonoscopy is necessary to ensure appropriate treatment for those who receive a diagnosis of colorectal cancer as well as those whose symptoms relate to another condition. For this reason, all hospitals have been instructed to refer anyone waiting more than three months for a colonoscopy to the National Treatment Purchase Fund. In addition, a target of four weeks from date of referral for urgent colonoscopies has been set and the Minister has asked the HSE to report to her under the service planning process on its compliance with this target. Overall, therefore, there has been a significant reduction in waiting lists for colonoscopies and the HSE is continuing to work towards the target of four weeks for urgent referrals.

There is a strong link between improved cancer outcomes and high levels of hospital activity for those diagnosed with colorectal cancer. In this regard, the national cancer control programme continues to make progress in the implementation of the cancer control strategy and the centralisation of all cancer services over time into the eight designated cancer services. Despite the difficult economic circumstances, the Government was able to allocate significant additional funds and posts this year to further develop services for the diagnosis and treatment of cancer.

On colorectal cancer specifically, the NCCP has focused initially on rectal cancer surgery. This is a technically demanding surgical procedure and there is widespread agreement that it must be performed by surgeons who specialise in this area. At the request of the national cancer control programme the National Cancer Registry in collaboration with the Royal College of Surgeons of Ireland has recently completed the first national audit of rectal cancer surgery. The audit showed that in 2007, a large number of hospitals were performing small numbers of rectal cancer surgeries. The programme has accepted a recommendation from the Irish Society of Coloproctology that the number of hospitals performing rectal cancer surgery should be reduced, with the ultimate goal of reducing this number to the eight designated cancer centres as surgical capacity is created. A directive to reflect those recommendations will issue shortly.

The national cancer control programme has not as yet taken a policy position on a timetable for the centralisation of colon cancer surgery. Inevitably, there will be a requirement to reduce the number of hospitals performing colon cancer surgery. The programme will continue to engage with the Irish Society of Coloproctology prior to adopting a policy statement. Guidelines for the management of colorectal cancer have been issued by the Association of Coloproctology of Great Britain and Ireland. Those are supported by the programme, which is currently in dialogue with the Irish Association of Coloproctology in regard to formally adopting and implementing those as national guidelines.

As we know, prevention, early diagnosis and timely and appropriate treatment are all of vital importance in the battle to improve outcomes and survival for this type of cancer, as for all cancers. Much progress has been made in recent years on all these areas. In terms of prevention and early diagnosis, for certain cancers screening is one of the ways that we can do that and a health technology assessment is due to be submitted to the Minister, Deputy Harney, shortly on a screening programme for colorectal cancer.

Two national screening programmes are already in place: BreastCheck and CervicalCheck. CervicalCheck was launched nationally in September 2008. To date, approximately 90,000 cervical smears have been performed under the programme, with approximately 40,000 of those being in March. Given that a successful cervical screening programme has the potential to reduce deaths from cervical cancer by up to 80%, it is encouraging to see this programme being availed of in such significant numbers.

BreastCheck is now available in 22 counties and by the end of this year will have been rolled out in all 26 counties and the number of women screened is increasing year on year. In 2007, a total of 66,527 women were screened, in 2008 it was 90,335 and this year the target is 140,000, with more than 27,000 women already screened this year. Validated figures on the number of cancers detected for 2007 show that in that year 396 cancers were detected by the BreastCheck programme. Where cancer is detected, appropriate treatment and follow-up is provided within the BreastCheck programme.

Improving outcomes is also a key objective of the work being done under the national cancer control programme. I have already outlined the work being done by the programme in terms of colorectal cancer. That is one element of the reorganisation of Irish cancer services. The programme is also continuing to focus this year on a number of other site-specific cancers.

Centralising breast cancer diagnosis and surgery was the first priority for the programme. There is worldwide evidence to show that centres treating higher volumes of patients have better treatment outcomes. In mid-2007, a total of 33 hospitals were providing breast cancer diagnosis and surgery, but by the end of 2008 just 12 hospitals were providing those services. The process of transferring services to the eight designated centres is almost complete. The key objectives of this initiative are to ensure that where breast cancer services are provided, they comply with the national quality assurance standards for symptomatic breast disease services and that outcome and survival rates improve.

This year the cancer programme is also focusing on lung cancer and prostate cancer in particular. Access to early diagnosis for these two cancers has been problematic and that is an area that must be addressed. In this regard, the programme has decided that earlier diagnosis and multidisciplinary decision-making must be enhanced for both of those cancers. A key initiative this year, therefore, is the establishment of rapid access diagnostic clinics in the designated cancer centres for those cancers. Based on agreed referral criteria, patients will be fast-tracked to the rapid access clinics from which they can receive a definitive diagnosis within two weeks.

This year the national cancer control programme is also focusing on the reorganisation of services for brain tumours, pancreatic cancer and reconstructive surgery for head and neck cancer. It has been agreed that there will be a single national programme for the management of brain tumours and other central nervous system tumours across the two sites of Beaumont and Cork University Hospital.

Through the HSE's national cancer control programme and in conjunction with voluntary agencies, we will continue to work towards our stated goals of better cancer prevention, detection and survival for all cancers, including colorectal cancer. Some members of the Irish Cancer Society are with us in the Visitor's Gallery today. I very much welcome its awareness campaign given the relatively high incidence of bowel cancer in Ireland and also because of the importance of awareness campaigns in terms of prevention and early diagnosis. The Irish Cancer Society has produced some excellent information materials and I am sure many people will benefit from the current campaign. I reiterate that anyone who has any concerns about colorectal cancer should consult their GP, as the earlier problems are detected the better the outcomes.

Senator Frances Fitzgerald

Given the amount of money we have had here in the past ten years and the amount of money that has been put into the health service, it is very disappointing that a colorectal screening programme was not developed during the period of the Celtic tiger to address this disease that kills 900 people in this country every year and that affects so many others. I hoped the Minister would announce today in the House the allocation of at least €1 million to kick start the screening required.

I welcome the representatives of the Irish Cancer Society, and the volunteers who work with them. I congratulate it on the impact its awareness month is having. I understand the freefone line is receiving more than 100 calls a day. There is no doubt that there is a new awareness in the country about this serious disease. We must remember that approximately 2,200 cases of colorectal cancer are diagnosed and more than 900 people die from it each year. It is difficult to believe the number is so high. It is the second most commonly diagnosed cancer in the country. I do not think people realise that unless they have been personally affected by it or know somebody affected. I congratulate the Minister of State, Deputy Tony Killeen, Bill O'Herlihy and the various people who fronted the campaign because awareness is critical.

In her script the Minister reminded us that the BreastCheck programme is still not available in 26 counties. Given the amount of money that has been invested in the health service, what is it about the failure of health planning in this country that we cannot have universal screening and that it is taking so long to implement it? Screening saves lives. We should have a colorectal screening programme in place. That is absolutely clear when one considers the seriousness of the disease and the number of people dying from it. Irishmen have the fourth highest death rate internationally from this disease. Surely a screening programme should be a priority in the health service. In her speech, the Minister did not give any clear indications as to when a screening programme would be put in place. At the end of this debate, I want the Minister of State to try to give some indication of the timeframe for delivering a screening programme for colorectal cancer. It will not happen overnight, as we know. Will the €1 million to start the process be made available very soon or in the next few months? If we are to reduce mortality rates associated with bowel cancer and promote early detection, this is critical.

It is very worrying that 50% of patients with bowel cancer in Ireland are not diagnosed until the late stages of the disease. This is why the information campaign is so important. We must circulate the information, raise awareness and put the national colorectal screening programme in place. Research shows that 70% of people would definitely attend screening for bowel cancer if the Government offered the service free of charge to all adults over 50.

There is embarrassment about this illness. People with symptoms are reluctant to go to general practitioners or specialists. With the right type of awareness campaign people will begin to go to their general practitioners, to whom they should go in the first place. It is hoped they would then be referred for proper tests.

What is the most up-to-date position on colorectal screening plans for Ireland? Could we have a clear statement from the Minister of State in this regard? It is not in her script. People want to know the position. What is the timeframe and deadline and what actions are to be taken to ensure there will be colorectal screening in the near future?

Has a decision been made on the €1 million that was due to be given to the National Cancer Screening Service this year to prepare for the programme? If not, when will one be made? What is the timeline and financial provision in this regard? If the Minister of State could cast some light on this issue today, it would be extremely helpful.

The Minister of State referred to the Minister receiving a report on the health technology assessment for the bowel cancer screening programme. Has she the report? If not, when does she expect it? What is the current position on the assessment and when will the report be presented to the Government? These are critical questions I hoped would be answered on this very important day on which many serious budgetary decisions must be made.

There is also concern over the waiting time for a colonoscopy. We all remember our shock and upset when we listened to Susie Long before she died and to her husband after she died. Her husband referred to the stress on the family. Since Ms Long waited for a public service appointment, she did not catch her cancer in time. It is critical that the waiting time be short.

Best practice suggests a colonoscopy should be carried out within a very short period on those who are considered to be seriously at risk or who have serious symptoms. The Minister of State said there should be a four-week waiting time. Last November, 1,636 people were waiting more than three months and 900 people were waiting more than six months. It seems as if some progress has been made in this regard; the Minister of State referred to four-week waiting periods. I understand 194 people are waiting for more than six months – I will double-check this – and people are still waiting much longer than the optimal period. Will the Minister of State inform the House about the action to be taken to address waiting lists and ensure colonoscopies are carried out as quickly as possible after referral by a general practitioner?

It is not easy to solve this problem. If one considers statistics on the number of gastro-enterologists per capita, one will realise Ireland is not well resourced by comparison to other European countries. Austria has more than three gastro-enterologists per 100,000 while we have 0.65 per 100,000. Is there a plan in place to address this staffing shortfall? It is a critical issue. How can the tests be carried out if sufficient staff are not in place?

It is absolutely clear that there are many difficulties in this area. We need to hear from the Minister on screening, access to colonoscopies and gastro-enterologists. The Government needs to co-operate actively with voluntary organisations such as the Irish Cancer Society and set its mind and resources to dramatically reducing mortality from bowel cancer and promoting preventive measures alongside screening, which measures would lead to early detection and treatment.

We all know of the dreadful upset to families when cancer is discovered at a late stage. We know of the importance of early detection of symptoms, referral, screening and treatment. I refer not only to the personal cost and upset caused by late diagnosis, which are considerable, but also to its effect on treatment. Treatment is far more complex and expensive in cases of late diagnosis and the outcome is less favourable. For these reasons, I welcome the awareness month that is under way. It will do a great deal of good in promoting recognition of the disease and encouraging people not to be embarrassed and nervous but to seek the kind of help they need if they have the symptoms.

The Irish Cancer Society commissioned a survey of more than 1,000 adults nationwide. Some of its key findings are that 36% of people cannot name one sign or symptom of bowel cancer, 25% do not know factors that might increase their risk of developing bowel cancer, and 40% of people believe people under 50 years are most at risk of developing bowel cancer. Ninety percent of people diagnosed with the disease in 2005 were over the age of 50 and, therefore, there is a very false perception about the illness and a considerable lack of correct information. These factors inhibit people from seeking help.

The results of the survey show there is a worrying lack of awareness of the early warning signs of bowel cancer. This is why the Irish Cancer Society launched its awareness campaign. It gives very useful advice on what people can do to reduce the risk of developing bowel cancer. One should be aware of any family history of the disease, have a regular diet, take regular exercise and go to one's general practitioner if one has symptoms. All we can do today is state that, at national level, we want the screening process in place and the money to be given soon this year to start the process. We want the waiting lists to be tackled such that, if people are referred, they will be seen quickly. We want the public awareness campaign to continue so people will not be diagnosed at such a late stage of the disease, thereby allowing them to receive the intervention that will lead to better outcomes.

Senator Geraldine Feeney

I, too, welcome the Minister of State, Deputy Máire Hoctor, and thank her for taking the debate. I welcome the representatives of the Irish Cancer Society in the Visitors Gallery. Two of the society's members, Ms Lorna Jennings and Ms Kathleen O'Meara, are very well known to Members of the House. They leave no stone unturned in chasing us up. If they do not get us in one way, they get us in another. It is fair to say that it was easy for them to gain access to Senators' offices as we are all singing from the one hymn sheet on this issue.

I first heard about the bowel cancer awareness campaign on the radio some days ago and was very impressed. I went home at the weekend and noted I had received the relevant documentation from the Irish Cancer Society. I brought it with me today because I believe that, if ever money was well spent, it was well spent on this. The brochure is very attractive and catches one's eye. There is red for danger and a balloon that would appeal to a child. One is immediately attracted to it. Senators will agree that we have plenty of expensive literature sent to our offices and we say it is a waste of money. Whatever was spent on this was well spent and I congratulate the Irish Cancer Society on it.

This is the first bowel cancer awareness month and, as Senator Fitzgerald pointed out, every year 900 people die from it. More than half of those diagnosed are at advanced stages, namely, stages 3 and 4. Sadly, only 42% of this group will survive. This is very sad because, like all cancers, if it is caught early it is treatable. This is why it is so important to have education and educators. I look on the Irish Cancer Society as the educators and I congratulate it on this.

October is breast cancer awareness month and November is lung cancer awareness month. Given that we know so much about breast cancer from the Irish Cancer Society, people are now less afraid than they used to be and women in particular, the minute they feel any abnormality to their breast, go to the doctor. What a shame there is such a stigma and almost an embarrassment around all cancers. We speak about it in hushed tones. If we discuss somebody who has died we ask whether it was the big C. We do not ask whether he or she died of cancer. There is fear in all of us when we speak about it and there should be because it is a killer. It knows no boundaries and it stops nowhere. It penetrates all classes, boundaries, countries and races.

I smiled when I saw Senator Feargal Quinn come in because until then three women Members of the Seanad were debating bowel cancer. When we debate prostate cancer there will probably be all women in the Chamber also. I state this with tongue in cheek because women speak about it more easily. Men do not like going to the doctor. Women do not like it either but they are more inclined to handle it, deal with it and speak about it.

Education is the key and we need to be informed. When I was researching this subject I saw that one in three people could not name any of the symptoms associated with bowel cancer. It is important to name them and I know when I do there will be blushes. They include change in bowel habits and bleeding from the back passage. They are not nice matters to speak about but we must speak about them. The symptoms also include a regular feeling of trapped wind in one's stomach, a feeling that one still has something to pass having gone to the loo, pain in one's tummy, ongoing tiredness and weight loss. Yes, we blush and it is a little embarrassing to name these, but that is ridiculous. What about them? In my office, my PA stated that it will be hard to say these words but I said that I would say them. Blushing never killed anybody but bowel and other cancers do. I would rather blush for Ireland than continue to have a disease that is not diagnosed on time.

How can we reduce the risk of getting cancer? One way is to know our family history because if a family member has had the disease it is more like that one will get it because it is in the genes. Unfortunately, only a year ago I lost a very close friend to bowel cancer. Her cancer was at stage 4 when it was diagnosed. It was horrific. Not a day goes by when I do not think of her. Everybody is affected by this. As she stated to me often, she thought she had an upset tummy. For about five weeks, she treated herself for an upset tummy. By the time she was diagnosed she had a secondary. She said that as she did not know about the primary how was she to know about the secondary. That is why today I say to hell with the blushes and the embarrassment, let us talk about this and make people aware.

It was with sadness and glee that I read the story of the Minister of State, Deputy Tony Killeen. A number of people stated to me that they did not know that he had bowel cancer and that it was great to be able to read about these matters. The same is the case with Bill O'Herlihy. We will reduce risks by examining diet and exercise. Nowadays we are all far too busy, but even 30 minutes a day of exercise would help. I never knew about pilates until a few months ago and now I think it is the greatest thing ever. Recently, I heard somebody state that the first thing an animal does when it gets up to move is to stretch. What do humans do? We get up, we crouch over and we hold our back or some part of us, and the older we get the more places we hold. Lifestyle and exercise are important as is eating the right foods such as fruit, vegetables and fibre and keeping fat intake low. Unfortunately, because it is in our nature we all like a little bit of fat. We all like chips and the rind on the rasher. It is endemic in us and what we were born into. It is part of our DNA.

We are all singing from the same hymn sheet on this matter and we will repeat much of what we found when we were researching. However, it is no harm to repeat it. Most cases are detected in those aged between 50 and 60 but one can be diagnosed before one reaches the age of 50. The Minister of State, Deputy Hoctor, stated that 55 is a common age for diagnosis. It is common in both genders and the breakdown is almost 50:50. In 2005, there were 48 cases in Sligo, where I live, which was 10% of the national figure. If 900 people die of it now it means the incidence is higher in every county.

The Government has moved on the waiting lists for colonoscopies. There should not be waiting lists and everybody, including the Minister of State, Deputy Hoctor, would agree with that. Nobody wants waiting lists and the sooner they are eradicated the better. Anybody waiting for more than one month should be referred to the National Treatment Purchase Fund. I say to consultants, practitioners and doctors, do not be afraid to refer people. The Minister for Health and Children, Deputy Harney, stated that she would like to see colonoscopies carried out immediately someone goes to the doctor.

I know that the Government, including the Minister, and the Minister of State, Deputy Hoctor, are committed to breaking through the barriers and introducing various screening processes. I was glad to hear the Minister of State say that the report of HIQA's health technology assessment group is ready and perhaps we will hear about it in the near future.

When looking out for bower cancer we should take into account those in the 50 to 60 year old age group, family history, unhealthy lifestyle and heavy drinkers and smokers. I take my hat off to the Irish Cancer Society and I bow to the work it does. Without its valuable input we would not be where we are today. It should keep the pressure on. It is seeking a national screening programme for bowel cancer and I promise I will go every length of the way with it on this. Until we get this nothing can be done with regard to people with stage 3 and stage 4 cancer. We see the uptake for cervical and breast cancer screening. People are no longer afraid to speak about breast cancer. In the near future we will not be afraid to speak about cervical cancer. Neither will we be afraid to speak about bowel cancer, as unsavoury as it might be. Until that time comes, and it will come through screening, there will be no breakthrough in early detection. Early detection will lead to more cures and we will be curing more than we are today. We will not hear the stories of young women and men being cut down in the prime of their lives, families having to do without mothers and fathers and, in some cases, parents burying adult sons and daughters who have their own children.

We are all committed on this. In the same way that cancer knows no boundaries, no barriers and no differentiation between races, we in politics should not know any barriers on this. We should not fight it on a party political basis but should be united on it. We should all push for the early detection and early screening programmes.

Senator Feargal Quinn

I welcome the Minister of State. There has been a certain questioning and criticism of the very existence of the Seanad in recent weeks. I think today is an example of the sort of work that can take place and that can give the benefits to the nation that might not otherwise have taken place. Today's debate is a very good example of that. Senator Feeney has spoken about education. There is little doubt that having this debate will not achieve what we are setting out to do unless we manage to get somewhere further with it.

The debate has been very useful, and it was interesting to hear Senator Fitzgerald's words as well. I was impressed with Senator Feeney's words when she pointed out she was glad to see me come in. Senator Buttimer was not here at the time, and other than the Leas-Chathaoirleach, I was the only man here. What Senator Feeney said had not dawned on me before, but maybe men are just unwilling to discuss things and unwilling to open their minds, their thoughts and their words to such a threat. Today's debate is another step along the way in what the Irish Cancer Society has managed to achieve, by putting this on the agenda.

All of us know somebody who has suffered from cancer. All of us probably know somebody who has suffered from bowel cancer. Senator Fitzgerald touched on the lack of awareness of how important it is, that it is treatable and we can do something about it. From that point of view, I congratulate the Irish Cancer Society for putting it high on the agenda, and for putting it on the agenda here today. I welcome the launch of its campaign to increase awareness of bowel cancer signs and symptoms, as well as the importance of early detection. Bowel cancer is the second most common cause of cancer deaths in Ireland. Every year, 2,000 cases are diagnosed and 900 people die from the disease. The campaign is concentrating on the message that discovering the cancer early makes all the difference.

More than 50% of cancer patients in Ireland are diagnosed with an advanced stage of cancer with a very poor survival rate. We as a nation can do something about that. The Irish Cancer Society states that 36% of people cannot name one sign or symptom of bowel cancer, with one quarter not knowing what factors might increase their risk of developing the disease. If only we could make sure that the whole nation was able to hear this debate, more people would be educated about this issue.

The Minister for Health and Children recently told the Joint Committee on Health and Children that no funding has yet been allocated to a national colorectal screening programme. She stated that she would consider the introduction of such a programme and the resources needed when she receives the assessment. Given the scale of the problem we have, that is not good enough. There should be a programme to help those most at risk from the disease, namely, those over 50. I support the call of the Irish Cancer Society for the roll out of a free national bowel cancer screening programme for everybody over 50. Screening saves lives and that is the important thing. There is evidence to show that a bowel cancer screening programme would start to save lives immediately. It is not a long-term thing and is also the least expensive of all the screening programmes. It is estimated to pay for itself in a period of five years. The financial crisis is putting everything under threat, but doing away with the €1 million set aside to begin a national screening programme would be a major step backwards.

Recently I read an article in The Sunday Business Post of the case of a bowel cancer patient, Mr. Roddy Carter from Dublin, who was diagnosed with late stage bowel cancer after presenting with pains at St. Vincent’s Hospital emergency department. He had been on the waiting list at Tallaght Hospital for a colonoscopy for a year. Each time he inquired about the procedure, he was told he would just have to wait. Such was the seriousness of his condition, he was operated on within three days of his visit to St. Vincent’s Hospital. He needed radical surgery, and is now receiving radiation therapy as a follow up. If he had not taken the initiative and gone to the emergency ward in St. Vincent’s Hospital, he would probably still be waiting for a colonoscopy in Tallaght Hospital.

Cases like these highlight the need for the introduction of a bowel cancer screening system for everybody over 50. Ireland's cancer survival rates are way behind those of our western European neighbours. Introducing the screening programme would go a long way to help improve the terrible record we have when it comes to cancer survival. Let me touch on one or two of the figures. A total of 25% of people do not know the factors which might increase their risk of developing bowel cancer, while 40% believe that people under 50 years of age are most at risk of developing bowel cancer. In fact, 90% of people diagnosed with bowel cancer in 2005 were over 50. Bowel cancer is the second most common cause of cancer death in Ireland. In 2005, 2,184 new cases of bowel cancer were diagnosed, and 924 people died from the disease. Over 50% of patients in Ireland are diagnosed with stage three or stage four bowel cancer, the most advanced stages that have very poor survival rates. The risk factors are age, family history, abnormal growth of tissue in the lining of the bowel, diet and obesity. I thank Senator Feeney for being so blunt with words that I avoided when I was preparing my thoughts. The most common symptoms of the disease are a change in bowel habits lasting more than a month, rectal bleeding, constipation and the other things she talked about.

We can do something about this, but only if we are educated and determined to let it be known that this is solvable. We need to put all our thoughts and actions together on this. This debate has given us food for though and fuel for action. We know what we can do, so let us make sure we do it.

Senator Dan Boyle

My father died of cancer of the colon. He was 52 years of age when he was first diagnosed. I was 17 and in my leaving certificate year. He was lucky that the diagnosis was relatively quick. In spite of that, and having an excellent surgeon and team of nurses, he went through three very debilitating operations in six months before he came home. It was a cancer that recurred over ten year periods. The second time, ten years later, he was more prepared to deal with it, knew what it was about and was more used to the side effects such as the use of colostomy bags. When discussing awareness, we should not only consider the onset of the condition, but living with it as well, and today's debate is very useful in airing these matters. The third time it occurred, he was 73 years of age and had lost the reserves to fight it. During the intervening 20 years, which was a gift, he lived a very normal life and was, as people in the Chamber are aware, a colourful character. My family were also lucky that my mother was a full-time nurse which meant we had advantages other families would not have had in identifying the causes and living with the condition.

I am conscious that I am not too many years shy of when my father was first diagnosed. Having listened to many of the risk factors outlined today, my personal awareness has been heightened especially. As Senator Quinn stated, the value of the Chamber is in discoursing on subjects in a broader sense which do not receive an airing in the other House and in helping to inform a public debate which would not occur otherwise.

There is a need to be more open about the existence of the condition, its prevalence and the fact the many thousands of people in families are living with this every day. We must be more pre-emptive in helping to identify it through our health service. The level of access to and use of colonoscopies is unacceptable. The political system must ask the necessary questions, such as why the barriers which exist are in place how they can be prevented. As Senator Quinn stated, there is a reluctance to air and discuss these issues and there may even be a gender issue concerning how we discuss them in general. In terms of a national cancer strategy, I hope the existence of debates such as this will help to promote and inform what we need to know in this area.

Apart from the lifestyle issues and issues of physical condition that are relevant factors, the issue of family history is also very important. Subsequent to the death of my father, a brother of his also succumbed to the same condition. We should be especially aware of the genetic factors when alerting people to the diagnostic facilities available. They should be available as much as possible and to as many people as possible to give a general sense of the prevalence and onset of the condition, and this is not the case at present. One could argue that lack of resources is the reason behind this, but it is probably more a matter of political will and commitment. This is not a criticism of the Government or even of the political system. One good aspect of this debate is that points are being made in a cross-party way and more out of sadness and sorrow for the fact that we have a difficulty within our system which must be tackled.

In terms of general awareness, there is a lack of openness in our society and we should encourage a greater level of it among younger people. I find myself in my mid-40s nudging towards the end of my fourth decade and these are subjects about which I would not have thought of or talked about previously and to which the generations behind me give no consideration whatsoever. However, the lifestyle factors inherent in increasing the risk of the condition are borne by the lives of some people in their late 20s, 30s and early 40s. The job of work which must be done in terms of health promotion and awareness should be especially directed at such age groups. While the discussion refers to the group at risk, namely, those aged 50 years and above, and those living with and suffering from the condition, far more needs to be done in the education area and in identifying the risks before people reach that age. I hope this debate is an important part of that. The Seanad should play a greater role in highlighting the issue. The debate will be better served by whatever individual and personal stories we have to help inform it.

Senator Phil Prendergast

I welcome the Minister of State at the Department of Health and Children, Deputy Máire Hoctor, to the Chamber and I thank the other speakers for their contributions. It is apparent that the homework has been done because invariably we all have the same statistics from which to quote. As Senator Feeney stated, it is no harm to repeat a message because it is by repetition and by highlighting statistics that it becomes part of the psyche. Having worked in the health service for many years I am aware that thousands of colonoscopies are carried out each year in South Tipperary General Hospital. The procedure is very successful as a diagnostic aid, but there are simpler ways.

I welcome the opportunity to speak on the subject and we are well into bowel cancer awareness month. It is a shame that the debate will be overshadowed by events later today, because this is a very important issue. It is the second most common cause of cancer, as the Minister of State said. Depressingly, it is probably the easiest to treat and detect at an early stage. However, if reaches stage three or four, survival chances diminish rapidly. The most recent figures indicate 900 people die each year from bowel cancer. The figure is that high because it is difficult to detect and because people are not aware of the symptoms. It is always a matter of great surprise to me now because I am of a similar age to Senator Boyle——

Senator Dan Boyle

I would never have guessed; the Senator looks far younger.

Senator Jerry Buttimer

Senator Prendergast is looking well though and is a long way from owning a free bus pass.

Senator Phil Prendergast

We are great at keeping an eye on our cars and phones. We are quick to upgrade and update them, have them checked out and put on new wheels. However, we are not as great when it comes to ourselves. Senator Feeney spoke at length about the embarrassment in respect of bowel cancer. Perhaps it is because I have been so surrounded by issues in respect of the body that I have no embarrassment in discussing cancer of any part of the body. In the course of my career I have encountered issues in respect of vulval cancer and cancers in areas which are difficult to treat. If exposure is part of the treatment it is even more difficult to treat. Sensitivity aside, it is a very important subject for debate. Public attitudes are very relevant.

The work of the Irish Cancer Society in promoting the issue with some very high-profile figures is warranted and welcome. I extend a very warm welcome to the former Senator, Ms Kathleen O'Meara, and the other members of the society present in the Visitors Gallery. It is great to see them any time, but especially important in highlighting this issue. The survey conducted by the society last summer, which has been emphasised, revealed 36% of people could not name a cancer symptom and 25% of people did not know what factors could increase the risk of developing bowel cancer. It was startling and alarming that such a common ailment is so little understood.

The health authorities in the UK have taken a simple step to reduce the rate of fatalities from bowel cancer by distributing a self-testing kit as part of a national screening programme. The fecal occult blood test, FOBT, is sent to people who simply provide a sample and send it to be tested. If a blood trace is found, they are invited for a colonoscopy. The test should be repeated every two years and is expected to detect approximately half of any bowel cancers according to the Institute of Cancer Research in Britain. Occasionally there are false positives if a person has haemorrhoids or piles, which can sometimes bleed. This may lead to a false positive and, obviously, it is a mater of great relief upon being told this is the case.

The FOBT is a good, cheap test. During trials of the test in Scotland, the positive predictive value was 10.9% for cancer and exactly 35% for adenoma. Adenoma is benign but if untreated can lead to cancer. It is a very simple and inexpensive process and will save money in the long run. Early detection of cancer can reduce the need for invasive surgery. The testing kit consists of little more than a cardboard swab and a cardboard receptacle. In the USA each test costs $5, such that there is no comparison to the cost of visiting a general practitioner, although I am not advocating cost as a factor for not going to the GP. In the UK the scheme is currently aimed at the highest risk group, namely, those between 60 and 69 years of age and it will gradually be rolled out to other target groups. In Canada, the scheme is free for over 50s and kits are given out at health centres. As Ireland does not have such a scheme, the Irish Cancer Society hopes that bowel cancer awareness month will help with its call for a screening programme. This is supported by the Minister of State, Deputy Killeen, who is still recovering from bowel cancer. We wish him and everyone diagnosed with any type of cancer or illness well. I am glad to add my voice to the campaign, which is something that the HSE should focus on instead of giving a mere endorsement.

Given that nearly 300 patients have been on colonoscopy waiting lists for more than six months and more than half of bowel cancers are diagnosed late, testing must be implemented as a matter of urgency. In Canada, it is reckoned that 90% of bowel cancer is curable when detected early. This means that nearly 800 people are dying needlessly in this country, which is an appalling statistic. Everyone would be shocked by a mass of 800 deaths, but that is the number involved.

The UK has committed to and is rolling out a national programme, which is due to start in Northern Ireland this year. As long ago as 2003, Dr. Richard E. Schabas, the then chief of staff at York Central Hospital in Ontario, analysed the evidence of regional screening programmes and concluded that "colorectal screening with FOB testing is simply too good an opportunity to ignore". The institutes of health research in Canada conducted a cost benefit analysis of the scheme that it has been running for 50 to 74 year olds since 2000 and it concluded that screening appears to be cost effective under all the scenarios considered. That was in 2007.

Our system is failing dismally in terms of health outcomes and, given the evidence, cost effectiveness. It is slow and cumbersome, with half of all diagnoses being for late stage cancer. This means that the cost of treatment is more expensive than the treatment for early stage detection. It is also contrary to the philosophy outlined in the cancer control strategy, which supports screening for bowel cancers and the further benefits of early detection initiatives. The latter educate the public about recognising symptoms, performing self-examination and the importance of early presentation of symptoms to doctors. While bowel cancer screening is not perfect, it is a better system than the current one and I call on the HSE to start implementing it.

Senator Maria Corrigan

Will the Cathaoirleach let me know when I have one minute remaining?

An Cathaoirleach

I will.

Senator Maria Corrigan

I welcome the opportunity to speak in this debate and to discuss the causes, effects and prevention of bowel cancer. I welcome the Minister of State, Deputy Barry Andrews. A number of speakers mentioned that we seem to have similar statistics and information regarding symptoms. Repeating them will not hurt, but I will try to keep the repetition to a minimum.

Bowel cancer is the second most commonly diagnosed cancer among Irish men and women and the second most common cause of cancer deaths in the United States. Each year, more than 1,000 men and 800 women are diagnosed with bowel cancer while 500 men and 400 women die from the disease annually. In 2005, 2,184 new cases of bowel cancer were diagnosed and 924 people died from the disease. Most striking is that more than 50% of patients when initially identified as having bowel cancer are diagnosed with stage 3 or 4, which are the most advanced stages and have poor survival rates. In light of this alarming statistic, it is crucial that symptoms are detected early to improve chances of survival.

I congratulate the Irish Cancer Society on its bowel cancer awareness month. I hope that the Government's commitment to tackling the issue and the awareness month will increase public awareness and the number of screening tests. Opportunities such as that presented by this debate increase public awareness, information and education, as does the use of the information and posters forwarded to each Senator by the Irish Cancer Society with the request that we highlight them in the most appropriate manner to those with whom we come into contact.

Ireland has the highest mortality rate for colorectal cancer in western Europe and the fourth highest mortality rate among men worldwide. Yet, if caught early, bowel cancer is one of the most treatable cancers. Screening is essential. However, without an accompanying knowledge and awareness, its full potential will not be realised. Therefore, education about the symptoms is essential. I was struck by Senator Feeney's contribution and her forthright comments on our need to be open and to overcome any apprehension or embarrassment that we might have regarding this subject. She also raised a critical issue for us regarding the need to be educated about practical measures that we can undertake to prevent the occurrence of bowel cancer.

We must promote awareness and education concerning the symptoms. We must send the message that this applies not only to bowel cancer. Through BreastCheck and cervical screening, for example, we have been effective in getting the message across to the public about the importance of early detection. We must ensure that the same message is heard in terms of bowel health.

Many studies have been undertaken and a great deal of information is available from various institutes, including the European Institute of Women's Health, regarding the factors that contribute to the risk of bowel cancer. These include age, a family history of bowel cancer, a diet that is high in fat and low in fruit, vegetables and fibre, lack of physical activity, weight, alcohol consumption and smoking. While early screening is imperative, the situation can be helped by individuals taking care of themselves.

In a study carried out by the Irish Cancer Society in 2008, 36% of people could not name one sign of bowel cancer while four in ten believed that people under 50 years of age are most at risk of developing bowel cancer when 90% of people diagnosed with bowel cancer in 2005 were over the age of 50. This finding highlights the need for education. Without education and awareness, we will not see the potential for screening. Therefore, education and promotion of the awareness of this fatal disease is crucial. I commend the Irish Cancer Society on its work this month and support it in its fight against this common type of cancer.

The Minister of Health and Children, Deputy Harney, asked the board of the National Cancer Screening Service, NCSS, to explore the establishment of a national colorectal cancer screening programme. I welcome her announcement this afternoon that the report of the NCSS is complete and is expected to be with her in the coming weeks. I look forward to learning about its contents and recommendations.

A key advantage of such a programme is that it can detect pre-cancerous adenoma and is, therefore, a preventive health measure. In April 2007, the NCSS established an expert group on colorectal screening to make recommendations on a population-based colorectal screening programme. This group, chaired by Professor Niall O'Higgins, has evaluated the clinical and operational requirements for the establishment of an effective, well organised and quality assured service.

In 2009, Professor O'Higgins remarked that the abundant global evidence "indicates that deaths from colorectal cancer, a common and potentially fatal condition in men and women, can be prevented by high-quality screening". With Professors Wendy Atkin and Robert Steele from the United Kingdom and others, this expert group's clinical recommendations form a basis of a modern, best practice and quality assured screening programme for colorectal cancer. Furthermore, this expert group noted that screening should be introduced as soon as possible, with a national bowel cancer screening programme to be established by January 2011. It should be noted the expert group pointed out that through screening, a number of cancers could be found and a number of preventative actions could be taken to reduce the risk of developing colorectal cancer. It also should be noted that England and Scotland are in the process of introducing a similar programme at present.

It is worth noting that a survey carried out by the Irish Cancer Society in July 2008 found that 70% of people definitely would attend screening for bowel cancer, were the Government to offer the service free of charge to all adults over the age of 50. I welcome the Government's role in developing the National Treatment Purchase Fund, NTPF, for public patients who have been on waiting lists for more than three months. Lists of those waiting more than six months for a colonoscopy now have been reduced by more than 80%, which was a crucial step. Despite the hard economic times the country is experiencing at present, health is an issue that cannot be and will not be ignored by the Government. Both BreastCheck and the cervical cancer screening programme exemplify how screening and tests are crucial for the well-being of Irish citizens and that they are effective.

I welcome the funding allocated and the results that have emerged recently from BreastCheck. All available evidence illustrates that early detection is crucial . Life is precious and one only gets one shot at it. As cancer is one of the biggest causes of deaths in our society, screening will help to increase a family's health and well-being, if the diagnosis is detected early. The most striking and welcome message that can emerge from this debate or from the Irish Cancer Society's bowel cancer awareness week is one of hope. Education, prevention, screening and early detection increase our opportunity to enjoy longer the preciousness of life.

Senator Jerry Buttimer

Cuirim fáilte roimh an Aire Stáit. I dtús, gabhaim buíochas le muintir na hÉireann agus go mórmhór, the Irish Cancer Society. I thank the organisers of Daffodil Day and pay tribute to the many thousands of volunteers who collected money on that day. In particular, I pay tribute to my local co-ordinator, Breda Ryan, who I know well and who did a great job in organising it. At the outset, the Irish Cancer Society deserves great thanks for its ability to raise awareness, to educate people and to fund-raise. I also thank it for the briefing notes it provided to Members in advance of today's debate. It is important to consider this debate from both a political and a personal perspective. People must take charge of, and be responsible for, their own health. That said, it also requires a Government health policy to help them and to make it easier. I fear this does not always happen in our case.

Many Members have alluded to the importance of talking, communicating and discussing issues regarding cancer services and cancer in general. This debate is political in nature because it highlights the lack of action of the Government. It also has personal implications for the lives of everyone and in many ways it is about life and death. I approach this debate as a public representative to advocate on behalf of the people. I also approach it as the son of a mother who died from ovarian cancer and as a friend of many people who have died of bowel cancer. While it is important that Members should not be overtly politically adversarial about this debate, they must hold to account the Government and the HSE. As Members are aware, cancer poses one of the greatest threats to the lives of all. It must be on the political agenda as otherwise, Members are codding themselves and deluding those who are in the Visitors Gallery to support this debate.

The HSE and the Government can spin, talk or use rhetoric but what happened during the Celtic tiger era, when billions of euro were at our disposal? While I will not discuss them in detail, Members should consider the statistics provided to them for today's debate by the Irish Cancer Society, which deserves great praise for highlighting such statistics. In the context of this debate, what is the Government's role in, or plan for, raising awareness with which all Members agree in respect of early detection? What programme does it have for visiting schools and third level colleges to educate through health promotion? Everyone who deals with people understands and recognises the importance of early cancer detection, going to a general practitioner, getting early referral, the screening programme, recognising the symptoms and of personal awareness. This a fundamental starting point from which Members should engage.

Many Members, including Senator Quinn, referred to the issue of men's health. I hope men's health can be put forward as a major issue before the male segment of our population. There must be a new focus on men in particular to engage in a preventative programme and in respect of health awareness and on educating. While everyone is agreed that education is the way forward, I am alarmed by the number of men who do not take their health seriously. I count myself among them and note that Senator Boyle also referred to himself during his remarks. However, this mind set must be changed and premature death rates of men must be significantly reduced.

Why does no colorectal screening programme exist? What is the date for it and when will it be set? There are three questions, namely, when, when and when. This is the second most prevalent cause of cancer death and like other Members, I am amazed that one in three people cannot name a symptom. It is staggering, alarming and frightening that this statistic exists in this modern age and this issue must be addressed. Why does Ireland not have a national bowel cancer screening programme? As Members recognise that screening saves lives, where is such a programme? Why has it not been unfurled or unleashed? This question deserves an answer. Where is the €1 million that is needed to kick-start this programme and why has it not been granted?

While I acknowledge there is a recession involving cut-backs and that a freeze is in place, this issue pertains to people's lives. Are Members serious about this? I am disappointed that the Minister for Health and Children, Deputy Harney, is not present. While I have great respect for her at one level, I am amazed by the manner in which she gets away with it every time. Although she makes promises repeatedly, the HSE reform is in shambles. As for cystic fibrosis, I refer Members to this morning's broadcast of "Morning Ireland". People should not be obliged to appear on national radio to talk about their health and the lack of programmes available to them. I commend Orla Tinsley for having the courage to appear on that radio programme this morning.

Cervical screening constitutes another example of the Minister's abdication of her responsibility. As for the bowel cancer strategy under discussion today, where is it? Are Members talking about people's lives or an agenda in which people's health is put first or are they simply playing to the gallery and playing with bureaucrats? While I mean no disrespect to anyone, when I hear Civil Service-speak about outcomes, efficiencies, collaboration and a timetable for decentralisation, I become worried because to me, that constitutes gobbledegook.

I refer to the great work being done by the staff in Marymount Hospice and in St. Bernard's ward in the Bons Secours Hospital, Cork. The debate should be about the work done by such people, as well as about the effect that cancer has on the thousands of men and women in Ireland who die every year. This is an outcome, as is recovery. Members should desist from using words like "outcome" because this is about people and I am greatly concerned by some of the language used. Members can discuss education, checking, symptoms, diet and lifestyle, all of which is fine and must be done. In tandem with so doing, however, there must be action from the Government. There must be a reduction in the annual rate of 900 deaths and 2,200 diagnoses in Ireland. We need an early screening programme that is resourced.

I refer to the comments of Professor Niall O'Higgins: "Abundant evidence from all around the globe indicates that deaths from colorectal cancer, a common and potentially fatal condition in men and women, can be prevented by high-quality screening". I am not an expert, nor a genius, but because both my parents are nurses and taught me the importance of health and the body, if there is something wrong with me I will get it checked. Thousands of our citizens do not have that confidence, ability and awareness. When an expert group comes forward with the proposal that screening should be introduced here, and fast, I become concerned when it is not done and no progress is being made. The Minister of State referred to certain things but this is 2009 and we have had 12 years of the Celtic tiger. Why was it not done? We do not have BreastCheck in every county. Who are we codding? We are dealing with people.

I am not being political but I have been in wards where people are looking for help and inspiration. They expect to find it from the Government and its officials in the Health Service Executive. When roadblocks are put in their way, it is very difficult when they are angry. I do not blame those who protest outside the House. Political action requires leadership and leadership requires early screening and helping people to reduce the number of cancer diagnoses and deaths. I hope this can be achieved because, if not, all of us have failed the people.

Senator Camillus Glynn

I proposed to share time with Senator Keaveney.

An Cathaoirleach

Is that agreed? Agreed.

Senator Camillus Glynn

I welcome this important and timely debate. I have had two members of my family die from cancer. One brother died from pulmonary cancer and the other from cancer of the oesophagus. I understand and appreciate the grave nature of the debate. In the past 24 hours a young man I knew since I moved to Mullingar has been diagnosed with bowel cancer. The cold fingers of cancer have touched the hearts and minds of everyone in society. Every family has been affected in some way.

Colorectal cancer is a common and lethal disease, the fourth most common cancer in the world and the second most common cause of cancer in Ireland after lung cancer. The prospects of preventing death from colorectal cancer are now more promising than ever. Focus on preventing death from cancer has shifted from treatment of established cancer to prevention of cancer in the form of screening. Screening for breast and cervical cancer is already under way in Ireland under the auspices of the national cancer screening service. The screening for colorectal cancer is performed in the USA and the UK.

The basic goal of colorectal cancer screening is to lower the number of people who die from the disease. This is done by a test that will detect lesions in the bowel that will turn into cancer if left too long. These lesions, or adenomas, are growths that slowly develop over ten years into cancer. Some cancers have a similar pre-malignant state making them suitable for screening. It is not the role of screening to find early or young cancer but rather to find the precursor lesions that can be removed easily and cheaply to remove the risk of cancer to that patient.

I welcome members of the Irish Cancer Society in the Visitors Gallery and a former Member, Kathleen O'Meara, who has a deep and ongoing interest in this matter. I also welcome Ms Lorna Jennings, who worked in this House in another capacity and is performing an important role with the association.

The Irish Cancer Society is committed to ensuring patients referred for a colonoscopy are seen as quickly as possible because early detection is key to survival. It is fair to say that, in reference to what Senator Buttimer said, in the previous Seanad I called for and was responsible for a debate on men's health. I have called for it again recently.

Men are not as proactive in looking after their health as their female counterparts. Men look after their cars and bring it for a regular service but they do not visit the general practitioner or the consultant in the same way as women.

Senator Fidelma Healy Eames

Senator Glynn does himself down.

Senator Camillus Glynn

When they do go, it is following encouragement and prompting from the wife, partner, girlfriend, sister or aunt but they are not proactive in looking after their health. The basis of this debate is being proactive in dealing with cancer. Bowel cancer is treatable if identified in time. The ignorance of people of the symptoms associated with the existence of bowel cancer is a worry. The debate to highlight the incidence of bowel cancer is welcome.

Senator Cecilia Keaveney

I am glad to speak on this issue today. As with all types of cancer, prevention is better than cure but cure is available more than in previous times. What was absent from the speech of the Minister of State were the symptoms of bowel cancer. We cannot say this often enough. We have a forum for people to speak about bowel cancer and to encourage people to come forward if they have the symptoms. Having read the speech of the Minister of State, I still do not know what the symptoms are. We must use these opportunities to say what the symptoms are. We must keep saying what the success rates are, which are gradually improving for men and women. That addresses the main issue, which is fear. It does not make a difference whether one is a man or woman. If people think there is something wrong, the last thing they want to do is go to the doctor and be told there is something wrong, especially if they think it is bad news.

I remember we thought there was something wrong with my father when he stopped swallowing. He stopped having fries and we did not know what the story was. Then he stopped having other types of food and we did not know what was wrong. We all stopped having these foods when he did and only after a certain amount of time and when he could no longer hide it did we discover he had cancer of the oesophagus. We forced him to go to the doctor because we thought it might be a hiatus hernia but his attitude was that the doctor would get him under the knife soon enough. He left it too long and, unfortunately, he died of oesophagal cancer. I refer to the issue of fear and getting the message out that there are more successful treatments and a greater chance of survival if one gets there early. I have raised this on the Adjournment and on the Order of Business. The Government made a commitment to a personal health check in the programme for Government. We should revert to that.

I do not know if I have anything wrong with me. I almost go too hard and too fast in this job to stop. Sometimes when I stop I know I am very tired and blame everything on this. I might be as healthy as a trout or I may not be but I cannot remember the last time I was at the doctor. People should be encouraged more.

I went to college in Belfast and every two years I get a letter from a northern general practitioner asking me to come for a cervical smear. I must write to the GP to refuse a cervical smear. The GP must, by law, offer it and I, by law, must write to refuse it and explain why or else take it. We have a long way to go before everyone has that access to information. BreastCheck is still not rolled out in an area where breast cancer gets more of an airing than any other cancer.

I have an uncle who was a cardiovascular surgeon and I realise there are other issues. If I was to convey one other message today it would be that I hope the Minister for Finance will put a significant tariff on cigarettes today. Not all cancers begin and end with cigarettes but having done much work in the area, I know cigarettes have a very big impact not only on fatal illnesses but with regard to people having to live with very significant illnesses for long periods. This does not only relate to cancer but is also relevant to stroke and so on.

I wish the campaign well and I wish a colleague of ours and Minister of State, Deputy Tony Killeen, well. The more people who can talk about this issue, the better, and we will continue to advocate for early detection and prevention.

Senator David Norris

I am also glad to have the opportunity to take part in this debate and I would like to take up something which my colleague, Senator Keaveney, said in reference to a Minister of State, Deputy Tony Killeen. I commend him on his courage as this is quite a private and sensitive matter. It took courage for him to come out and say that he had this form of cancer. This will encourage people to get screened. It was a very important and courageous act and we should salute it.

Speaker after speaker has said that we all seem to have been supplied with the same statistics but there is no harm in repeating them. There may be no active harm but it is a pain in the fanny. It does not do much good because what do we have for an audience? We have distinguished people from the Irish Cancer Society and former Senator O'Meara. Although they may take up some of the ideas we have, it is unlikely to be covered by the broadcast media. Perhaps it will be by one person. I do not see much point in repeating the statistics, although the incidence and late diagnosis is very worrying.

Like some of my colleagues, I will speak from personal experience, as my oldest school friend died of cancer of the colon on Friday night and I will be at his funeral tomorrow. I learned an enormous amount from him, primarily about the very high standards in Irish nursing and the remarkable facilities we have. We must bear in mind that there are a several matters that are important from the patient's perspective.

This was particularly difficult for him because he was a very gentlemanly person, although not in any effete way, as he was quite a masculine man. He was refined, fastidious and disliked anything to do with mess or unpleasantness. It was terribly ironic that this horrible illness should have struck him in that area of the body. One must be sensitive but I learned an enormous amount and my life has been enriched by the six or eight weeks that he lived since the diagnosis.

I saw the way somebody in considerable distress could face with dignity a judicious approach to everything, with kindness and understanding for the people and friends around him who were distressed by this illness. I also learned that it is sometimes selfish and cruel to try to persuade people to take the chance of prolonging their lives with chemotherapy. This man had seen his sister and other relatives die awfully in the same way.

Things have improved and I have let positive issues out in order to keep both options open. Eventually my friend went for chemotherapy and it seemed to be doing an enormous amount of good. I do not know whether it was because chemotherapy was so severe as to weaken the wall of the bowel but there was a rupture and he had to have invasive surgery, which was very unpleasant. Two days later he had a massive heart attack in the intensive care unit. I am quite glad for him because that was the best outcome.

I am glad that he took the chance of having chemotherapy but in those matters it is a question for the individual. It is unfair when somebody has what is very probably a terminal illness to bully them, either family or surgeons. Doctors should be very careful about what they say. For example, it is not helpful to say when somebody has been operated on that a stent was inserted into a liver, for example, to drain poison but the spread or severity of the cancer is much worse than first thought. I am not accusing the particular surgeon in this case and there were other elements involved. It can have a depressing effect to be told that so bluntly.

When people say they are dealing with such issues every day, it is meant to be helpful but it is not, because each individual diagnosis and progress towards death is quite personal and unique. My friend was extraordinarily lucky because he had a very strong religious faith, which I happen to share. That cannot be overestimated because it is as good as or better than the drugs, although I do not undervalue drugs. We must consider such options.

We must also understand that apparently small issues such as diet are very important. When people are at that stage they must be allowed eat whatever they want. They do not need to be told that they should eat this, that or the other. They should be left at it.

Looking at the broader scheme, I have been aware since I was a student of bowel cancer because one of my great pals was a medical student. She told me the story of a young man, just married, who had bowel cancer. I asked if anything could be done and she told me it was too late, which was awful. We know the old phrase that justice delayed is justice denied but screening denied is fatal.

I will put on record some comparative statistics. We have cervical screening, which costs €42 million and breast screening at a cost of €24 million. The cost of bowel screening would be €14 million or €15 million, which is comparatively small. Considering the first two figures I mentioned — they were not put on the record before — deal only with one very valued half of the human race, women, bowel cancer screening would get twice the value, and it would pay for itself inside five years. The Minister of State would know better than I do that we are approaching a five-year plan, according to the Taoiseach. Let us consider including in the five-year plan this financially sound approach to medicine.

We understand 70% of people would attend for bowel screening, which is a very high rate. I have certain intestinal difficulties and although I do not believe they are cancerous, we are trying to find out what is going on. I have had things stuck in everywhere. The minute I felt a bit awkward, I went to the doctor as I do not give a damn and I have absolutely no shame. I got on to the problem straight away and had a colonoscopy immediately. This was because I am on Plan E in the VHI; I was not going to give my place to another person as I am not that much of a Christian.

However, that is not appropriate and in matters of life and death we should not have a two-tier system. We need to do what we can to reduce this problem, as a four-week result system is the best. We still have people waiting more than six months, which can do real damage to their health. We need investment in more gastroenterologists. Prevention is possible, although not in all cases, if people have a good diet, watch their weight and enjoy pleasures moderately with not too much smoking and drinking.

Will the Minister of State be kind enough to pass on to his colleague, the Minister, Deputy Harney, a message from all sides of the House concerning cystic fibrosis? I raise this because we were invited to do so by the Leader, Senator Cassidy. When we tried to raise the matter this morning, he said we would have an opportunity to do it when the Minister for Health came to the House. She is not here so I hope the Minister of State does not think it inappropriate for me to ask him to carry the message to her that we are all thrilled that this commitment has been given.

It is very difficult to believe that any builder will engage in a major building programme in this way. May we have facts, figures and a commitment to a commencement date? It would be cruel in the extreme to deceive people with cystic fibrosis. Will the Minister of State use his good offices to persuade the Minister, Deputy Harney, to come into the House to give us a clear and cast-iron commitment on the matter?

Senator Fidelma Healy Eames

I wish to share time with Senator McFadden.

An Cathaoirleach

Is that agreed? Agreed.

Senator Fidelma Healy Eames

I welcome the opportunity to discuss bowel cancer awareness. How great is the problem of bowel cancer? The answer is that it is massive. Some 900 people die from bowel cancer each year. That is the same as the combined number who die as a result of suicide and road accidents. We hear a great deal about suicide and road accidents, and anything that ends the lives of 900 people must be dealt with and taken seriously.

I congratulate the Irish Cancer Society and former Senator Kathleen O'Meara on raising our awareness of this issue. As previous speakers stated, the leaflet provided by the Irish Cancer Society is extremely effective. Many Members indicated their surprise at the lack of awareness among people of the symptoms of bowel cancer, but I am not one bit surprised. I worked in health promotion and health education for many years but I was not aware of those symptoms because this issue received no attention. The level of awareness is extremely low and 36% of people cannot name one sign or symptom of bowel cancer.

The Irish Cancer Society is doing the right thing by devoting one month to promote awareness of this issue. Holding awareness days or weeks is somewhat of a joke because these are usually over by the time one realises that they were being held in the first instance. The society is taking the correct approach.

Previous speakers highlighted the statistics relating to this matter and the need for a national screening programme. Two issues arise with regard to personal health. Every individual should take responsibility for his or her health, but we know that this does not happen. It certainly cannot happen if one is not aware of the symptoms in the first instance. We are aware that screening programmes work and they are needed wherever a public health issue arises. If 900 deaths are taking place each year from bowel cancer and if only 2% of those who contract it survive, Ireland has a monstrous public health issue with this disease.

I accept that the Minister for Health and Children has many priorities at present, particularly in light of the state of our national finances, but any disease that is taking 900 lives each year must be tackled. It would only cost €14 million to €15 million to establish a national screening programme and such a programme would pay for itself within five years. A national screening programme will probably have paid for itself before Ireland emerges from the current recession.

In the absence of a screening programme, two steps must be taken immediately. First, the Department must make plans to launch a media campaign to raise public awareness so that people will take responsibility for their health, attend their GPs and seek colonoscopies. The second step which must be taken is that, as Senator Keaveney stated, each person should be given the right to a personal health check.

Medical error is prevalent when in terms of pathology. At the relevant laboratory in Galway, there have been two examples of medical error in the past two years whereby a pathologist got the results wrong on a second occasion. That is outrageous. If we cannot have faith in the system and trust the results provided by laboratories in this country, how can we have confidence in the health system? Medical error has serious implications for people's health. However, if one considers the trend, it appears that locums are causing the problem. Why are background checks not carried out in respect of locums? In the case of one fifth of locums hired in this country, references are not checked and in one third of cases, interviews are not carried out. Is this not a sign that the health system is, for want of a better description, all over the place? Decisions are rushed and patients' safety is placed at risk as a result.

The most recent difficulties in Galway, in respect of two late diagnoses and one unnecessary intervention, would not have come to light had they not been identified by the UK National Health Service. Where are the checks and balances in our health system? As much as there is a need to promote bowel cancer awareness and to put in place a screening programme, there is also a need for reliable pathology. As a report published in 2002 indicated, there is need for an ongoing review.

Senator Nicky McFadden

I thank Senator Healy Eames for sharing time. I welcome the Minister of State, Deputy Barry Andrews. I thank the Irish Cancer Society for providing Members with such comprehensive information in respect of this matter. The poster contained in our information packs is extremely good.

The briefing material we received indicates that people are dying because they are embarrassed to take steps to ensure the health of their bowels. Bowel cancer is the most treatable of cancers but it is regrettable that for most people bowel cancer is only detected in the second, third or fourth stages, when the damage has been done. As a result, survival rates are not as high as should be the case.

A close friend of mine who was in her early 50s died from bowel cancer. She was one of the lucky ones because she had access to private health care and was a medic so she was aware of how to handle her routine screening. It is outrageous that people in this country do not have access to regular screening. There must be universal screening for colorectal cancer. It is extraordinary that bowel cancer is not diagnosed until the disease has reached the latter stages.

I worked in a doctor's surgery and am aware that people are extremely private when it comes to their health. People should not be afraid or embarrassed to consult their GP if they believe they are at risk. Not eating properly, being overweight and smoking contribute to poor health. People's lives are so stressful nowadays that they are obliged to eat on the run. In addition, they do not eat enough vegetables and they consume considerable quantities of processed food. These are strong contributory factors for bowel cancer.

When we are young, we believe that we will live forever and that our health is perfect. If the Government did more to highlight the need for annual screening in respect of bowel cancer, this would encourage people to take care of their health. There would not, as a result, be over 900 deaths from this disease each year, particularly if it was diagnosed in the first stage. It is imperative that, as is the case with cervical cancer, there be annual screening in respect of bowel cancer, which is the second most common form of the disease in Ireland. I ask the Minister of State to take on board the points I have made.

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

I am glad to have the opportunity to speak on this issue and conclude the debate. I thank all the speakers for their insight, empathy and particularly the encouragement given to my colleague, the Minister of State, Deputy Killeen, in his bravery in highlighting the issue. Senator Glynn pointed out that men are not great at acknowledging their vulnerability at times and the Minister of State, Deputy Killeen, has done much work in that regard. It would have been easy for him to absorb the benefits of the medical system and of his treatment without giving anything back and for him to show that courage in the face of adversity is something many speakers highlighted, and I would like to add my voice to that as well.

The type of cancer we are referring to is of a relatively high incidence in this country. It is the second most commonly diagnosed cancer here. As this is bowel cancer awareness month, so designated by the Irish Cancer Society, it gives us all an opportunity to reflect on that. The society will be delighted to know that I have the poster in my constituency office in Blackrock. I thank it for circulating that and I hope that taking this initiative will serve the general population well.

I congratulate John McCormack and his team, who are present, for all the work they have done on behalf of sufferers and in raising awareness. I thank them for the many briefings they have given to me and other Members of the Oireachtas over the years. I know they have more than one item of interest in the proceedings of the Oireachtas today, and I wish them luck in all those matters as well.

For those patients who are referred by their general practitioner for further investigations following the noticing of symptoms, there is a need for speedy access to diagnostic procedures including colonoscopies, and while the Minister of State, Deputy Hoctor, on behalf of the Minister, Deputy Harney, acknowledged pressures in this area, the Minister, Deputy Harney, has requested the Health Service Executive to ensure that all those patients who require urgent access to colonoscopies should be seen promptly.

It is worth noting that waiting times have fallen considerably in the past 12 months. For those waiting longer than three months it is down by almost half. However, it is without question that great improvement must be made in this area in terms of waiting times. The National Treatment Purchase Fund has been requested to arrange colonoscopies for any patient waiting more than three months. At the same time, the HSE is working to address service pressures in this area to further reduce waiting times. Of all patients referred for colonoscopies only a small proportion will be diagnosed with cancer but for those who are, the next step is access to the most appropriate treatment, delivered within a framework that maximises optimal outcome.

In that regard, I take this opportunity to mention the national cancer control programme and the work it is doing in the reorganisation of cancer services here generally. It is important to acknowledge the considerable progress made in the implementation of this programme under the directorship of Professor Tom Keane. It is also worth noting that additional funding for this programme was allocated during 2009 despite the obvious circumstances in which we find ourselves generally.

Regarding colorectal cancer in particular, there is widespread agreement that rectal cancer surgery must be performed by surgeons who specialise in this area. Following the first national audit of rectal cancer services requested by the programme, the number of hospitals where rectal cancer surgery is performed will be reduced significantly to 14 in the first instance, before being centralised further to eight. It is notable that the Irish Society of Coloproctology backed this proposal, and I believe there is not much dispute about the benefits that will accrue to the general population by the carrying out of this type of surgery in designated centres. In regard to colon cancer, similarly, there will be a requirement to reduce the number of hospitals where this type of surgery is performed. The programme will continue to engage with the society in that regard.

The Irish Cancer Society is widely acknowledged as Ireland's primary cancer charity and has done enormous work fund-raising, in addition to the items mentioned earlier. Along with the Minister, Deputy Harney, I welcome its initiative in regard to this awareness month.

As much as it is vital to be aware of the symptoms, it is also very important from the point of view of prevention that people should be aware of the risk factors for colorectal cancers. Senator Keaveney raised the issue, as did others, of the symptoms. I understand that symptoms include blood in a stool, loss of weight and tiredness and the obvious recommendation, if any of those are noticed, is to refer to one's general practitioner without delay.

It must be noted that some of the risk factors cannot be avoided. Approximately 5% of those diagnosed with colorectal cancer have an inherited predisposition to colorectal cancer, and another 15% to 20% of patients are at increased risk because of family history.

A number of speakers referred to lifestyle factors and the importance of prevention over cure. They referred to obesity and lack of exercise, the failure to maintain a proper diet and smoking, which is at the heart of so much of our cancer problem. By addressing all of those factors, to which Senators Corrigan and Keaveney referred, we can help to reduce our own risk of developing this disease. People are rightly political in this House and because it is a political House there tends to be an over-emphasis on the failure of the Government rather than the responsibility of the population in general, but that is part and parcel of the manner of the debates we have here.

Senator Healy Eames raised the issue of the errors in laboratories in Galway. It is worth noting that those errors occurred in 2004 and 2005, since when the Faculty of Pathology has developed protocols that have been adopted generally by the HSE in hospital laboratories. New procedures have been adopted since the end of last year for the recruitment and monitoring of locums. References are always checked for locums. These developments have occurred since those errors came to light.

Senator Fitzgerald asked when a decision would be made about a national colorectal screening programme. The Minister requested the board of the National Cancer Screening Service to advise on the introduction of a population based screening programme for colorectal cancer. It was anticipated that the advice would include who should be screened, at what intervals screening should take place and the type of screening test that should be used. This expert report was submitted by the board to the Minister last December.

In addition, the Health Information Quality Authority was asked to conduct a health technology assessment on a colorectal screening programme. The Minister understands this assessment has been completed and will be submitted to her shortly, at which time she will give further consideration to the introduction of a screening programme and the resources necessary for that. Many speakers, including Senator Norris, referred to the obvious economic benefits in the long term from the rollout of the screening programme, which I do not believe anybody will dispute.

I again commend the role of the Irish Cancer Society in promoting public awareness of colorectal cancer. The Government remains committed to enhancing diagnostic and treatment services for patients with colorectal cancer, and I am confident that survival rates for patients will continue to improve.

An Cathaoirleach

The order provides for questions from group leaders. I call Senator Fitzgerald.

Senator Frances Fitzgerald

It would be helpful if the Minister of State could arrange for a copy of his speech to be sent to the spokespeople.

The point the majority of speakers made is that there is not a national colorectal screening programme in Ireland. An expert report has been published which recommends that there should be screening but as yet we do not have a timeframe, nor do we have a funding decision to begin the preliminary work. The question is when the national cancer screening service will get the go-ahead to begin preliminary work on this, which I understand involves an allocation of some money. A total of €1 million has been mentioned as the amount needed to begin the process. Can the Minister of State give the House any more information on whether the decision will be progressed? It is a question about decision making in this area at this stage. It is clear there is goodwill and the information. We do not have to reinvent the wheel on it because other countries have done this, and we know how to move forward. The question is whether the Minister has any information. Will the national cancer screening service get a decision, some financial provision and a timeline to begin the work towards developing a national screening programme? Does the Minister intend making a decision shortly on the health technology assessment, which report she will get very soon? Will that decision be made this year?

Senator Camillus Glynn

General practitioners have a pivotal role to play in this area, and a number of them are doing that. On the lack of attention Members of my gender pay to their own health, it is important that GPs encourage their patients of a certain age, say those over 40 or 45, to have a colonoscopy in view of the fact that, as was pointed out by a number of speakers, most people are unaware of at least one symptom or any symptoms that can indicate they have bowel cancer. It is important that GPs advise their patients in a certain age category to have a colonoscopy. There are many thousands of people walking around with type 2 diabetes who have no idea they have it and the same situation pertains to bowel cancer. General practitioners should play a role here and the Minister of State should exhort them to encourage patients to arrange a colonoscopy.

Senator Nicky McFadden

While I agree with Senator Glynn about the responsibility of GPs, the National Treatment Purchase Fund has issued frightening statistics showing that 164 people are on a waiting list for a colonoscopy as of 19 March. The lady whom I mentioned was lucky enough to be able to afford private care. It is outrageous that 164 people are on a waiting list for a colonoscopy.

Deputy Barry Andrews

I will raise these matters directly with the Minister. I acknowledge the role of GPs. HIQA has completed a report on laboratories and technology assessment. Once the Minister receives it, she will consider the introduction of a colorectal screening programme and the resources that would be necessary for this. Any delay is unwelcome but we have made progress. It is important we note the pattern rather than the situation at this time. The waiting lists have reduced.

Senator Nicky McFadden

Each person on the list is a patient with real needs and anxieties.

Deputy Barry Andrews

I acknowledge that we have some way to go but we are on an upward curve. No one has a monopoly on empathy with those suffering.

Senator Nicky McFadden

I do not think I do.

Senator Frances Fitzgerald

Is there further information on the national cancer screening programme? Funding for that programme was to kick-start the whole process.

Deputy Barry Andrews

I will raise that with the Minister.

Sitting suspended at 3.35 p.m. and resumed at 5.30 p.m.

An Leas-Chathaoirleach

When is it proposed to sit again?

Senator Diarmuid Wilson

At 10.30 tomorrow morning.