Professor Donal Brennan:

On ante-natal vaccination, we do advise the influenza vaccination to all ante-natal patients and also pertussis vaccination in the second or early third trimester. As Dr. Butler will confirm, we have had a number of cases of neo-natal pertussis in Dublin and a number of neo-natal deaths as a result, so we advise it. There is a logistical issue about where the vaccine is given which needs to be addressed and without doubt, there is an understandable worry among pregnant ladies about whether they should take any medication. That is part of all our roles as health care professionals to advise on the safety of the vaccination but also the dangers of influenza infection in the pregnant population as highlighted earlier.

I will spend a few minutes highlighting some of the consequences of cervical cancer in particular. We have talked a lot about death today. One of the reasons people have this issue about getting information down is that it is very hard for a person to think that his or her 13 year old daughter will die of cervical cancer. Many of us will believe that our 13 year old daughters are immortal. It is a very hard concept to understand but unfortunately there is much more to cervical cancer than death. There are more than 3,000 women alive today suffering the consequences of those treatments, as Deputy O'Connell spoke about, many of whom have been treated in what is an excellent service. We do meet all international standards in regard to seeing patients and treatments and our outcomes are comparable to all international standards. It is very important that we highlight some of the success stories in that. Possibly the greatest success story has been the cervical screening programme. We were late to the party but thanks to Dr. Gráinne Flannelly who is the clinical director of Cervical Check and the national screening programme, we are now meeting all international standards in that.

However, there are still 300 patients a year diagnosed with cervical cancer and they come into our clinics in the Mater Hospital and St. Vincent's Hospital on a weekly basis. The surgery or radiation that those patients have to endure is life changing. Many of those patients will tell one the treatment is worse than the disease. I have had numerous patients tell me that they came in feeling fine and three years later they feel terrible, asking what had I done to them.

We obviously perform surgery on a proportion of patients and in many cases this means that a young woman will lose all fertility. The long-term consequences of this are huge. Remember half of the women diagnosed are under the age of 50. They are mothers, daughters, aunts and they are all working in normal, important jobs and they often do not go back to work. The consequences are huge.

I will finish with a case. We recently had a lady who presented to us, having had six failed cycles of IVF. She presented with early bleeding in pregnancy and we diagnosed an advanced stage cervical cancer. This was obviously a very sought-after baby and she advised us that she did not want to do anything that would harm the baby so we proceeded after a long consultation to give this woman chemotherapy during the pregnancy. She proceeded to have four cycles of chemotherapy and delivered her baby at 34 weeks, which was a little early. She had to have a caesarian section and a radical hysterectomy which involved the removal of her uterus and all her cervix and part of her vagina and all the lymph nodes as well. Then she had to have radiotherapy.

She has had a year of very severe, hard medical treatment and unfortunately her little girl, who is beautiful, has significant hearing loss. I saw her last week, and before we came in here, I asked her if she would vaccinate her daughter and she said, "What do you think, doctor?" It is not just about the patients who die, which are very unfortunate, it is the patients who sometimes survive.

Just next week, we have a young woman, she is 38 years of age, who is going to come in and have her bladder, uterus and rectum removed because of her cervical cancer. She will spend the rest of her life with a stoma bag on one side for faeces and one on the other for urine. These are the real life stories that people need to understand. It not just those who die of cervical cancer, it is the survivors. Sometimes in cancer care in particular, we forget about the survivors because we think that once they survive that is all that matters.

I thank the committee for listening to us today and I hope that we have highlighted some of the issues around cervical cancer.