The next two matters are similar; each Deputy will have five minutes and the Minister will have ten minutes to reply.
Adjournment Debate. - Cancer Screening Programme.
I thank the Ceann Comhairle for selecting this item for the Adjournment debate. It is vital that the national breast screening programme is extended nationwide. Irish women are more likely to die of breast cancer than many of their European counterparts.
It is unacceptable that the programme is only reaching women in the North Eastern Health Board, Midland Health Board and the Eastern Regional Health Authority areas. It must be extended nationwide immediately. Will the Minister give the House an indication when the next phases of the programme will be implemented? A total of 1,670 women are newly diagnosed with breast cancer annually and approximately 650 die from the disease each year. In Ireland, 43% of women who develop breast cancer die compared with an overall mortality rate of 37% for the European Union and 30% in some countries.
Why are the figures so high in Ireland? What can we do to reduce these appalling statistics and how quickly can we do it? We must improve them dramatically. The Minister will agree that screening will play an important part in that. I am also calling for a nationwide information campaign. Some work has been done in this regard to ensure that the take up rate of the screening service is increased from the current low rate of 50% to 55% in the areas where the pilot programme is being run. Whatever the reasons for the low take up, whether it is poor information, poor access or fear, these issues must be addressed and women must be encouraged to take up the service available in those areas. Hopefully, it will be available throughout the country as soon as possible.
I take this opportunity to congratulate the Sunday Independent on the recent work it has done. We must ensure that women who are vulnerable avail of the service. I also call for the urgent establishment of specialist units throughout the country. Women will travel if they believe the specialist help is available. I look forward to hearing the Minister's comments on the extension of the national breast cancer screening programme.
I thank the Ceann Comhairle for allowing me to raise this issue. It is vital to have a national breast cancer screening programme. The decision to initiate a national screening programme was part of the national cancer strategy action plan set up in 1997 by the then Minister for Health, Deputy Noonan. There was a widespread welcome for the plan.
Irish women are more likely to die of breast cancer than women in other European countries. They are twice as likely to die from the disease as a woman in the United States. There has been much discussion about treatment. Stronger emphasis must be put on early intervention and early detection. This has a significant impact on the survival rate from this frightening disease which affects many families in this country.
I attended the launch by the Minister and the Taoiseach of the national breast cancer screening programme two months ago in Dublin Castle. The title of the programme as a national programme is somewhat flawed in that it is not reaching all parts of the country. The programme will invite women in the 50 to 64 year old age group to participate in the screening process. However, only women in the Eastern Regional Health Authority area and the North Eastern Health Board and Midland Health Board areas can benefit. Women living outside these areas must wait until the Minister has had a chance to evaluate the first phase. He will then make a decision on whether to extend the programme.
The programme should be extended. I concur with Deputy Fitzgerald's comments on the reports in the Sunday Independent and I compliment the newspaper on its radio advertisements. A brave woman, Brighid McLoughlin, made public the experience she had with breast cancer and said that if five women came forward for breast cancer screening and testing, her efforts would have been a success. It focused me on the fact that this programme is really only reaching half the population. The aim of the programme is to reduce the cancer mortality rate by at least 20% in the target age group, and given the resources and with the proper management structures in place, I have no doubt it can be successful. However, the discrimination against the other 50% of women in the target group should be addressed immediately. If we are convinced of the necessity for such a programme, surely at this time when we see escalating costs of medical care, it makes sense to channel resources into a preventative programme. The programme will be a success and there is no doubting the figures from other jurisdictions. In the UK, for instance, the mortality rate for breast cancer has fallen by over 20% in the 55 to 69 year age group. Of this, 6.5% can be attributed directly to screening.
There was some disquiet that the initial offers of screening had been quite low, as low as 50% or even lower in some cases. That can be addressed. The programme is in its initial stages and a public awareness campaign and the campaign we have seen over the past weekend will contribute to eliminating some of its teething problems. I do not understand why we cannot have a commitment at this stage to a timescale. Surely the success of the screening programme has been proven in other jurisdictions in other countries and now is the time to do it when we have the finances. We have a budget tomorrow in which I hope there will be some provision towards extending such a very valuable programme on a nationwide basis.
I thank Deputies Clune and Fitzgerald for raising the important topic of the national breast screening programme on the Adjournment this evening. The Deputies may be aware that BreastCheck, the national breast screening programme, was formally launched on 10 October 2000. Phase 1 of the programme will cover the Eastern, North Eastern and Midland Health Board areas and will target 140,000 women in the age cohort 50 to 64, which represents approximately 50% of the national target population.
The service is being delivered by two central units, the Eccles unit on the Mater Hospital campus and the Merrion Unit on St. Vincent's Hospital campus, with outreach to the community by means of three mobile units. The Eccles unit is now fully commissioned and screening commenced there in February 2000. Limited screening is also in progress in St. Vincent's Hospital pending the construction of the new Merrion unit. The first mobile unit commenced screening on 21 August 2000 in Longford and moved to the Navan area on 13 November 2000. The decision to proceed on a phased basis is a reflection of the complexities involved in the screening process rather than the costs involved and my Department's key objective is to ensure that the Irish programme meets the necessary quality assurance criteria. It is for this reason that the Irish national breast screening programme must be driven by international quality assurance standards and best practice. Specifically, the phasing will take account of the following critical success factors: the achievement of acceptable compliance levels among the target population, on-going evaluation of the programme from the quality perspective, availability of the necessary clinical expertise to conduct the programme and supporting facilities.
Phase II will involve the extension of the programme to the rest of the country. The national breast screening board is currently examining the proposal for the phase II roll-out of the screening programme to the rest of Ireland. At the recent launch, the chairman stated that the programme covered half of the country's eligible population and when the first year's results were evaluated, it was hoped to be able to advise me that they have achieved a world class service that should be extended as quickly as is practicable to the rest of the country and perhaps to an even wider age cohort of women. At the opening I took the opportunity to speak to the board and to the chairperson of the board, Dr. Sheelah Ryan, who made those comments at the time. I have spoken to a number of people on the board since. I am very anxious that we roll out phase II as quickly as possible.
Any new programme needs to be evaluated. One needs to find out what works and what does not. One also needs to make sure that the base is firmly established on which such a programme is built. It is easy to announce things and say we are going to do them but what is important is that once we make the announcement, all of the preparations are in place, that clinical expertise and centres are there and most importantly that the protocols and the standards can be met by phase II. I am committed to extending it as quickly as I can, which I communicated to the board. It is revising its projections in that context with a view to perhaps rolling-out phase II earlier than anticipated. It had anticipated phase II at the commencement of next year, in other words, at the end of 2001 and the beginning of 2002. I asked it to review that with a view to seeing if we can bring it forward a little earlier.
A comprehensive communication strategy comprising advertising and public relations and a contact programme is under way. Details of this were announced at the official opening of the units in Dublin Castle in October. A partnership with the health boards in the areas being screened has been agreed to promote the programme to as wide an audience as possible and to encourage uptake. A BreastCheck symposium took place in the Northern Area Health Board to maximise the uptake there. This exercise will be repeated in other areas as the programme expands. A comprehensive contact programme targeting women's groups on the ground has also been ramped-up to further inform women of the programme and the need to participate.
BreastCheck has been working in partnership with other groups such as the Irish College of General Practitioners. A GP co-ordinator and 13 GP facilitators have been appointed to ensure that local GPs are informed about the programme and their help is sought to promote the service. Information evenings in the GP units take place at regular intervals.
Information packs have been distributed to all GPs who are key to the success of the programme and a tailored information pack has also been distributed to the relevant nursing groups, e.g., practice nurses and public health nurses. Publicity to date has centred on the current screening locations using outdoor advertising and regional press and local radio advertising. Advertising recently extended to the national media with national press coverage and a new radio advertisement featuring Marian Finucane designed to raise awareness about the service. It is planned to develop this campaign further for 2001. In terms of communication, they were anxious to get the campaign down in the regions where it was happening. They were slightly worried in the beginning that if we did a national campaign of advertising one might mislead many people in the areas that are not covered. Nonetheless we realised with all the debate about the symptomatic breast centre that we need a far greater public education campaign in relation to cancer services generally because, as Deputies know, we had many misinformed comments about what we are trying to do vis-à-vis the establishment of centres of excellence countrywide.
We are conscious of the importance of early access to symptomatic mammography services and of the provision of an equivalent standard of excellence in both symptomatic and screening mammography services. A review of symptomatic breast cancer services was carried out by a sub-group of the National Cancer Forum at the request of my predecessor, the Minister for Foreign Affairs, Deputy Cowen. This review commenced in 1999 and I received the report of the review in April this year. Having considered the report entitled "Development of Services for Symptomatic Breast Disease", I accept the broad thrust of its recommendations. This report is essentially about the development of centres of excellence for the specialist treatment of breast disease. The report refers to the strong evidence which exists that women with breast cancer are at a lower risk of relapse and have a better opportunity of long-term survival if they are treated in a multi-disciplinary setting. This means that surgeons, radiologists, pathologists, medical oncologists, radiotherapists, plastic surgeons, nurses, counsellors and others all bring expertise together to provide the best care for each patient. The report recommends the establishment of these specialist units.
It is in this context that I emphasise the importance of prioritising women's health over and above geopolitical considerations. Having considered the report, I established an expert advisory group to assist and liaise with health boards in formulating the health boards' implementation plans for the development of specialist breast units. This advisory group under the chairmanship of Professor Niall O'Higgins met with all of the health boards recently. I expect to be in a position shortly to announce the establishment of the first phase of these centres of excellence.
Further evidence of our commitment is the increased funding provided for the programme. A total of £2 million was made available over the period 1997 and 1998. In 1999, this amount was increased to £3.8 million capital and £2.9 million revenue. In 2000, a sum totalling £5.3 million revenue has been provided and this is supported with a sum of £1.1 million in capital moneys. I propose to provide a further £1.5 million revenue in 2001 to the Eastern Regional Health Authority specifically to provide for the increased demand on the symptomatic service arising from the screening service in the Mater and St. Vincent's Hospitals.
From all of the foregoing it is clear that we are embarking on a well thought out and planned national breast cancer screening programme which forms part of the wider national cancer strategy. The national breast screening programme is resourced and possesses in-built mechanisms to assess our progress and effectiveness. Most of all, it has the essential patient focus enshrined in its women's charter which should serve to encourage and attract women to participate in the programme. A dedicated team is implementing it. Let us now build on the foundations that have been laid to date.