Vol. 469 No. 2
5 Mrs. Geoghegan-Quinn asked the Minister for Health the plans, if any, he has for a national cancer strategy; if his attention has been drawn to a new study which shows the death rate from breast cancer among Irish women is depressingly high, with eight in ten sufferers eventually dying from the disease; the action, if any, he proposes to take on foot of this study; and if he will make a statement on the matter. [17062/96]
24 Miss Quill asked the Minister for Health the reason for the delay in commencing the new national breast screening programme at the Mater Hospital, Dublin; and if he will make a statement on the matter. [16980/96]
44 Mr. B. Smith asked the Minister for Health the stage of preparation of the national cancer strategy; and if he will make a statement on the matter. [16880/96]
(Limerick East): I propose to take Questions Nos. 5, 24 and 44 together.
A series of initiatives relating to cancer, which includes a national cancer strategy, have been circulated to other Departments for their comments. It is my intention to bring these initiatives to Government in the very near future and I hope to be in a position to publish the national cancer strategy without delay.
The national breast screening programme is one of the initiatives which forms part of the National Cancer Strategy and it is intended to commence the first phase of the national programme in the Eastern, North-Eastern and Midland Health Boards as soon as possible.
I am not aware of the recent survey to which the Deputy refers. However I know that breast cancer is the most common cause of death among women in Ireland, accounting for approximately 650 deaths every year. The aim of screening is to detect breast cancer at an early stage, when it is amenable to treatment, before it has had the chance to spread. Medical evidence has shown that mortality can be reduced by up to approximately 25 per cent in women who attend for screening and that the benefit is greatest in women aged between 50 and 64 years.
A major factor affecting the success of a screening programme is the establishment of a population register, which will reach over 70 per cent of the target population, because at least 70 per cent of the target population must participate in the screening programme if the programme is to significantly reduce mortality. However, there are difficulties under current data protection legislation in obtaining names and addresses from existing data sources — e.g. the VHI, and the Department of Social Welfare — of women who should be offered screening. Following discussions with the Department of Justice and the Data Protection Commissioner and advice from the Attorney General, I am satisfied that the matter can be resolved by a minor legislative amendment under the Health Acts. I am giving this amendment immediate priority.
On the initiatives circulated by way of memo to other Departments, when did circulation take place and how long did the Minister give each Department to respond? We are all aware that some Departments are very good at responding while others would take forever if they got away with it. We have discussed the national breast screening programme with the Minister on a number of occasions including during Question Time. What do the words "as soon as possible" mean in terms of the commencement of the first phase? From the last information we received from the Minister and the Department, I thought the first phase would be up and running at this stage and that the second phase would commence at the beginning of 1997.
In view of the fact that women present very late with the disease, does the Minister believe that the full range of services should be available outside the capital and not confined to a number of hospitals in Dublin? We have discussed this matter before. I am not saying that services such as surgery, radiotherapy, chemotherapy and hormone therapy which are available in Dublin hospitals should be available in every hospital throughout the country but they should be available in at least two centres outside Dublin for convenience and equity reasons, if for no other. When does the Minister expect to be in a position to announce his decision?
(Limerick East): The timing of the announcement will depend to a large extent on the decision of my Cabinet colleagues. The memo was circulated to other Government Departments in mid-August. We have received the observations of all Departments except the Department of Finance which comes as no surprise. I hope to be in a position to go to Government in October and make an announcement shortly thereafter. There will be financial implications. The issue of centres of excellence is relevant and was addressed in the memorandum. It will be a matter for the Government to agree or disagree with my proposals.
I am also disappointed that the national breast screening programme is not up and running. Screening is of benefit to the woman concerned but, in terms of a national screening programme being effective as a preventive measure and in reducing mortality rates, at least 70 per cent of the targeted cohort need to be screened. The targeted cohort is women in the 50 to 64 age group or post-menopausal women, the group for whom screening proves most effective.
When those responsible for the programme in the Mater Hospital had discussions with the Department to try to put a national population register in place to select women in that age group we looked around for a database. The VHI and the Department of Social Welfare have extensive databases and between the two were satisfied we would have a database of sufficient precision which would allow us to do what is necessary but we immediately ran into a difficulty as, under the data protection legislation, the information contained in the VHI and Department of Social Welfare databases is confidential. There is a need for a minor technical amendment to the Act which would allow us, in the interests of public health, to access databases for this sole purpose.
I may be in contact with the Deputy. Deputy O'Donnell and others to see if this amendment can be made to the accountability Bill on Report Stage. I am in discussions with the Department of Justice which is responsible for the primary legislation to see if it will allow us to do so. That is what is stopping us from getting the programme up and running. Screening for which money has been provided in the Estimates cannot commence until that happens.
I will not wait for primary legislation to solve all of the problems which have been identified in recent years regarding data protection legislation. If I can make the necessary arrangements and receive the co-operation of the House I will make this minor technical amendment to move the matter forward.
The Minister has run into a technical difficulty in the establishment of a database because of the confidentiality provisions. Has this impacted on other areas such as the establishment of the database on drug addicts in Dublin? Is it of general application or confined to the national breast screening programme?
(Limerick East): It is of general application but has impacted in particular on the proposal to implement a national breast screening programme. While screening is of benefit to the women concerned in the relevant age group, in terms of a policy strategy succeeding in its objective, that is, reducing mortality rates, there needs to be a high take up, in excess of 70 per cent, in the relevant age group. To achieve this one must have access to a database to inform women that we would like them to avail of this service. We do not have such a database in the Department and if we were to use the material in other databases we would cross the legal line. The advice of the Attorney General is that we cannot do this and that an amendment is needed.
What does screening entail? Is it confined to mammography where the false positive-false negative rate can be as high as 10 to 20 per cent? The Minister said that the targeted cohort is women in the 50 to 64 age group. Many women have complained to me that they are not eligible because they are in a certain age group. Will the Department make it clear that it is not healthy for women under 50 years of age to undergo screening because of the negative effects?
(Limerick East): Unlike the Deputy I am not a medical doctor and can only give a layman's explanation. The Deputy touched on one of the reasons we are not implementing a national programme immediately. The issue of the false positive-false negative rate would be aggravated if the programme were introduced simultaneously in all parts of the country. The techniques and Protocols necessary to keep false negatives and false positives to a minimum can be guaranteed by controlling its expansion. In the pilot programmes the false positive-false negative rate was not as high as 15 to 20 per cent, rather it was kept very low by putting the right procedures in place.
As I understand it, mammography is not effective in accurately identifying breast cancer in women who are not post-menopausal. While there is a risk in the use of any medical machinery involving rays, that is not the primary reason, rather it is the breast of younger women as against post-menopausal women which causes the difficulty and creates the inaccuracy when mammography is used for screening purposes in younger women.
The Minister mentioned that in seeking to formulate the database a problem has been encountered with the data protection legislation. Is that one of the reasons the database on drug addicts in Dublin has not been finalised? There has been a delay in finding a reliable database for use in devising policy and implementing methadone maintenance and other programmes.
(Limerick East): That is not primarily the problem and it is not the problem that has been brought to my attention. There are a number of difficulties in respect of databases of, say, drug addicts in Dublin. Many drug addicts, unfortunately, are quite happy to continue in their search for heroin. They are not in any system where they can be listed as persons either looking for treatment or available for treatment. There is the additional problem of people attending clinics as well as their GPs. It is not a question of the same name being on the lists of a number of clinics; that would not be difficult to cross-match. The difficulty arises when names on GPs lists, which are confidential, cannot be matched with those on clinic lists. I do not want to give data in the House which would suggest that the waiting lists for methadone are exaggerated. On the contrary, they are understated but even in the understated figures there is some degree of duplication with regard to people on the official waiting lists. We are working on the problem but we have not yet come up against a data protection legislation barrier and, to be frank, I do want to raise the issue until somebody tells me to the contrary.
Will the Minister confirm that 1,500 to 1,800 people in the Southern Health Board area contract breast cancer every year, that the figure nationally is 8,000 to 10,000 and that it is possible that 8,000 to 10,000 people die every year from cancer? Regarding the national cancer strategy, I understood that report was to be published five or six months ago. Will the Minister say when the report will be published? Finally, there is no medical oncologist available to people living in the Southern Health Board areas of Cork and Kerry. Given that there are approximately 2,000 cases of cancer per year in that area, will the Minister indicate when we can expect the appointment of an oncologist in that health board area?
(Limerick East): The Deputy has asked a number of questions to which I have already given answers to Deputy Geoghegan-Quinn. I do not intend to repeat the replies in the interest of moving on to other Deputies' questions. In general terms, the answers to the questions the Deputy raised will be included in the cancer policy. As I said to Deputy Geoghegan-Quinn earlier, I will be taking that to Government in October and I hope my Cabinet colleagues will agree to publication immediately thereafter.
The appointment of an oncologist is a major issue in the Southern Health Board area. We have been waiting for this appointment for some time and I ask the Minister to indicate whether the appointment will be made in the near future.
(Limerick East): The difficulty is that there had not been any overview of policy in respect of cancer treatment until I initiated this programme which will range across the area of screening programmes and preventative methods through treatment methods including, where appropriate, centres of excellence for certain forms of treatment as well as the whole area of palliative care. I do not intend to announce piecemeal what is properly a matter for an overview, but it is vitally important that we have a cancer policy because the incidence of mortality from cancer in Ireland is approximately 15 per cent above the European average. That suggests to me that the range of our services are not up to average best practice in our Community neighbour countries.
