Cancer Screening Programmes

Dáil Éireann Debate, Thursday - 27 September 2012

Thursday, 27 September 2012

Ceisteanna (2)

Caoimhghín Ó Caoláin

Ceist:

2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the progress he has made towards the planned roll-out of a bowel cancer screening programme before the end of 2012; if he will ensure that it is targeted at the 55 to 74 years age group; if he will confirm full-funding for this prevention programme that will not only save the State significant costs in treatment of advanced bowel cancer but will save an untold number of lives; and if he will make a statement on the matter. [41081/12]

Freagraí ó Béal (5 píosaí cainte)

Deputy James Reilly

I am very pleased to confirm that the colorectal screening programme will commence, as promised, on a phased basis in the fourth quarter of this year. This delivers on a key commitment of the Government.

Colorectal cancer is the second most commonly diagnosed cancer among both men and women in Ireland. Approximately 2,200 new cases are diagnosed each year and it is the cause of death in around 950 people each year. Colorectal screening works on two fronts: it provides early detection and therefore earlier and more effective treatment and it helps to prevent cancer in the first place by detecting pre-cancerous growths such as polyps. It is therefore imperative that the programme commences and continues on a sustainable basis.

When fully implemented the programme will offer free screening to men and women aged 55 to 74. The programme will begin with the 60 to 69 age group, covering approximately 500,000 people.

The screening programme is the first call-recall screening programme in Ireland to be offered to men as well as women. Organising a national programme of this kind is very complex. To ensure quality and safety it is imperative that the programme is introduced in a carefully managed and monitored way to minimise risks to patients and maximise best clinical outcomes. We will gradually build up the programme to ensure that it is sustainable over time.

A small proportion of those screened will require a colonoscopy, which is the next stage of the screening process. The HSE and my Department have been working together to develop the appropriate capacity in colonoscopy services nationwide for this purpose. At the same time we are working to maintain and enhance the capability of the symptomatic endoscopy service. The focus is on improving quality and access at all publicly-funded screening colonoscopy units, not just for those referred for colonoscopy as part of the screening programme, but for all men and women who require a colonoscopy or any other diagnostic endoscopic procedure. This will be achieved by building sufficient capacity in endoscopy services nationwide to sustain the implementation of the national screening programme, while maintaining and enhancing the symptomatic service.

I regard the colorectal screening programme as a national priority. I am pleased that it will now go ahead and I am committed to supporting it as it develops.

Deputy Caoimhghín Ó Caoláin

My question is focused first and foremost on how lives can be saved and, without doubt, that can and will happen with screening programmes and early diagnosis. It is not a small point to add that it will also save our health services enormously in terms of the cost of treatment for advanced bowel cancer. The quicker that this is rolled out the greater number of people that it can directly apply to will result in a very beneficial outcome, not only for the small number of people who will require treatment but in regard to the health budget.

I welcome the bowel cancer screening programme to be implemented by the National Cancer Screening Service and due to begin by the end of the year, and the Minister's confirmation of that. However, there is a problem. The Minister referred to a phased basis in his reply and indicated that the programme will be confined initially to the 60 to 69 age group. I am expertly advised. The Irish Cancer Society has strongly emphasised the need to widen the remit to the 55 to 74 age group to be most effective. The Minister has indicated that he intends to extend it in due course to cover that age cohort but will he undertake to widen the age group from the outset? All the information that has been shared with Members here indicates that is hugely important but not only in regard to the widening of the remit. We also need a commitment from the Minister on full funding for this programme as anything less will prove to be a false economy.

Deputy James Reilly

I agree with the Deputy that this programme will save many lives and it will save money, but it will not save money now. It will save money in the years to come. It has always been the struggle with preventative medicine and with screening that the savings come later but the saving of lives is immediate and that is something on which we have to put the priority. However, most people would agree that this being the first of its kind we need to walk before we run and we need to road test it to make sure it is working and is safe. That is sensible, but I undertake that it will be extended in due course.

Deputy Caoimhghín Ó Caoláin

Can the Minister be more specific? He referred to a phased basis and "in due course". The Irish Cancer Society is adamant. It did a briefing here last week of members of all parties and none and the clear message received by Deputies was the importance of the rollout covering the 55 to 74 age group, the body of people to whom this most especially applies, and not waiting for somebody to reach 60 years of age when polyps may be showing already since their mid-50s. The earlier detection will ensure the best outcomes and the greater saving in the long term. I implore the Minister again either to outline his programmatised approach to this as early as possible or accept the arguments put and widen the age group from the outset. If we do not ensure that there is full funding for the programme we are only storing up for the future the problems we are trying to avoid that will have real human costs in terms of life and real costs in terms of our health services.

Deputy James Reilly

The Deputy mentioned the Irish Cancer Society which does fantastic work in terms of fund-raising to create awareness among people of the dangers of lifestyle, the risks people take if they smoke and in encouraging men in particular who had a notoriously poor attitude to self-care in the past. I have often said that they are inclined to wait until they have a serious pain in their chest, as in going blue in the face, before they seek medical attention. That has been effective but we have to do more, although men, and women, are becoming more aware of their health and their health risks.

I would love to be in a position to say precisely when I can extend this programme but I am not in a position to do that at the moment. However, I want to reassure people that this is a screening service but as in the case of a woman who finds a breast lump, that is symptomatic and they should get it checked out. If someone develops symptoms suggestive of a change in bowel habit, bleeding or passing mucus, and I do not want to go into too much detail here, they should see their doctor. Anybody who has symptoms such as weight loss or abdominal pain should get that checked out, and the screening will be there for them. It is a different thing; it is symptomatic. I want to reassure people that within our service we have made sure, in terms of the prioritisation of people, that those with serious symptoms get seen quickly. Other questions have been tabled on this and the outpatient waiting lists etc. which I will answer when we reach them but the reality is that we need people to be aware of signs and symptoms that should be a cause of concern for them and about which they should see their doctor. I can assure them that with the new plans for protocols for referring, and electronic referrals, they can be assured that they will be seen quickly when their symptoms indicate that is necessary.