Liam Twomey (Wexford, Fine Gael)

This motion concerns two cancers that affect women of all age groups. Breast cancer is more common in women over 50 and women with a strong family history of the disease. Cervical cancer, or cancer of the cervix, which is part of the uterus or womb, has a number of risk factors. These factors include smoking, the incidence of which is increasing among young women, and the human papilloma virus, the incidence of which is also increasing in the female population. The more sexual partners a woman has, the more likely she is to contract cervical cancer. In the treatment of all cancers, time is of the essence and early detection through screening is critically important.

In two years, Fianna Fáil will have been in power for ten years and we will still not have a nationwide breast cancer screening programme. It is now five years since phase one of the service commenced in the eastern region. It is four years since the publication of the national cancer strategy, which promised that breast and cervical cancer screening would be extended nationwide. In the intervening period, we have had nothing but a litany of announcements that amounted to nothing. The former Minister for Health and Children was well known for the number of press releases he issued. He issued them almost on a daily basis. It is therefore no wonder that patients in the south and west were expecting breast cancer screening in 2005 but, sadly, as we now know, that will not be the case.

Serious questions must be asked about why the roll-out has been delayed so severely. For example, capital funding for the roll-out of BreastCheck was not allocated until 18 months after the Department of Health and Children announced its national extension. Why? Why have BreastCheck's press releases indicated that its understanding of the roll-out timeframe was at odds with that of the Department? This kind of disarray has become increasingly common under the Government. Tragically, the implications of the delay in the roll-out of these services have been under estimated.

One of the former Minister's press statements from February 2003 states:

In relation to the extension to the remaining counties, the Minister said that the Board of BreastCheck has submitted a Business Plan to his Department. A number of key issues have been raised by health boards and health professionals in relation to the national roll out of BreastCheck which need to be addressed in advance of further expansion. I am fully committed to the extension of the programme to the remaining counties in the West and South and I will be meeting with BreastCheck shortly to discuss these issues.

We on this side of the House would dearly like to know what those issues were and the concerns of the professionals and the health boards. In the two years since that announcement, there has been zero movement in regard to BreastCheck and breast screening in the south and west.

Women are being told they will have to wait until 2008 to be screened and treated for breast cancer on an equal basis. In 2008, women in Northern Ireland will celebrate 15 years of breast cancer screening and a reduction of one fifth in deaths from the disease. By that time, because of delays in the roll-out of the programme, hundreds of women in the Republic of Ireland will have lost their lives in their battle against breast cancer. This is not an exaggeration. Hundreds more will have endured devastating and radical surgery to control advanced breast carcinoma. This is terrible.

The late diagnosis of cancer will require more severe chemotherapy for the patients involved and women will suffer the terrible side effects of the radiotherapy required to bring advanced cancer under control. At the same time, many women will have had their uteruses removed because cancers will have spread before treatment can be given, denying some women the chance to have children. This is because it is often a disease of young women. It will deny some children the chance of having a mother. These are the implications of a delay in the roll-out of a screening programme. Such a programme is taken for granted by our near neighbours in Northern Ireland.

The Government has no idea of the cost to the quality of life of all the women who endure cancer treatment, nor does it know what is entailed. This is the case for all cancer patients but I refer in particular to those who could benefit from two very vital screening programmes that would have been implemented long before now if the Government was really serious about the health service. It is not a question of what we have been reading in the papers for the past six months.

There are changes in our society and behaviour that make the roll-out of cervical cancer screening more urgent than is generally acknowledged. I have already pointed out some of these changes in regard to cervical cancer and the risk factors involved, such as smoking, the human papilloma virus and the number of sexual partners a woman may have. Given the risk factors, screening should begin six months after a woman becomes sexually active. Screening is relatively straightforward and involves a smear test. Thousands of these tests are carried out each year in many general practitioners' surgeries. It is known as opportunistic screening because it is done by general practitioners when they offer the service to patients or when the patients request it from them.

Is it not strange that the smear test, which can be carried out in the general practitioner's surgery by either the general practitioner or practice nurse, has been available for more than two decades in Northern Ireland? It is a good question to ask where we stand in the South. Five years ago, a pilot programme started in the Limerick region but five years later it has made precisely zero progress.

The national cancer strategy itself contains some inequalities which should be addressed and which I have raised before in the House with the Minister. For example, the cancer screening test, the smear test for cervical cancer, is not available to medical card patients or young women on low incomes. Young women are particularly at risk of cervical cancer.

The cavalier attitude of the former Minister for Health and Children and his Minister of State with responsibility for the elderly is reflected in the ageism associated with restricting the planned breast screening services to those aged between 50 and 64 and cervical cancer screening to those aged up to 60.

It is acceptable that there be a starting point for every screening programme but the end point should be based on the same medical criteria. I would accept the Minister's attaching an age limit to the programme if it was just to get it off the ground in two or three years. However, the age limit is unacceptable given that half the female population has had to wait five years for the programme to reach them. Cervical cancer can be diagnosed after the age of 60 and breast cancer can be diagnosed after 65. The average female lifespan in Ireland is approximately 82 years which should be reflected in any screening programme. Stopping a screening programme 22 years before the average woman may die is ageism.

Unfortunately, the Government has no commitment to any form of primary screening. The piecemeal and incoherent roll-out of a national programme for BreastCheck and cervical screening is a sad reflection on the Government and is leading to a devastating outcome for the women of Ireland.

Fianna Fáil has not only failed to provide cancer screening but it has also failed to provide proper facilities for the treatment of all cancers. It has failed to publish reports, including the radiotherapy report that sat in the Department of Health and Children for almost the full tenure of the former Minister, Deputy Martin. He received the report in 2000 and did not publish it until shortly before he left the Department. He almost made it his trademark to issue reports but cancer screening and treatment services are at Third World standard. This Government can have no excuse for this.

Just over half the population can avail of BreastCheck. It might be important for politicians in whose constituencies there is no BreastCheck facility to see what happens. An appointment for a routine mammogram can take between six and 12 months in an area which does not have access to BreastCheck. I have seen women who missed early diagnosis because the wait for the appointment was too long or because to make an earlier appointment they had to pay for it, and were later diagnosed with breast cancer. These women may not have had palpable lumps but had risk factors.

BreastCheck has made a dramatic improvement in patient care and reducing the morbidity associated with breast cancer. Morbidity refers to the side effects of cancer, for example, swollen arms, losing a breast and all the related psychological problems. Affected women may also die. The Government should take this on board and do something about it immediately. I hope the Government parties will accept the points we make tonight and demand that the Government roll out BreastCheck and the national cervical screening programme and stop the dallying of the past four years.

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