Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I first became aware of this issue on Thursday or Friday of last week. Obviously, I tried to spend as much of the weekend as I had free reading up on it and trying to understand it. Even now, I do not think it is the case that anyone or everyone in this House knows all the facts. That is why it is necessary to have the statutory inquiry that has been initiated by the Minister, Deputy Harris.

The decision to proceed with outsourcing to the laboratories in the US was made in 2008. The Deputy is correct when she says that Mr. Tony O'Brien was the head of the cancer screening service at the time. To this day, there are differing views on whether that was the right decision. It is important to mention some facts that might not yet be in the public domain. Approximately half of smears are read in laboratories in Ireland and approximately half are read in laboratories in the US. Three different laboratories are used - two in the US and one in the Coombe Hospital. We do not yet have any evidence that there are significant statistical differences between the numbers of false negatives emanating from each of these laboratories. If there are such differences, we need to know that is the case. We should not jump to conclusions until we know that such differences exist. Of course that will have to form part of the inquiry. Three laboratories are used. It probably makes sense for us to use different laboratories because it allows us to see if there is an outlier for some reason. We now need to examine that. I am told that the audit which was done did not show any significant statistical differences between the results of the three laboratories.

I would like to speak more generally about cancer care in Ireland. I know this is about women's health and women's lives. Like everyone in the House, I am among the many people who are very worried and upset about this. I do not think we should lose sight of the wider truth that cancer care in Ireland has improved considerably in recent years. More people now survive cancer than ever before. We have better treatment, quicker diagnosis and more prevention. Cancer screening works. In 2011, the incidence of cervical cancer in Ireland was 14 per 100,000. It is now ten per 100,000. Such a big decrease in a relatively short period can be attributed to things like the HPV vaccine and the screening programme. I want to encourage everyone who is offered BreastCheck, CervicalCheck or BowelScreen to go ahead and take up the appointment. These initiatives save many lives.

It might be useful for me to explain briefly how population cancer screening works. Before we had screening, a person was not diagnosed with cancer until he or she had symptoms. A person went to his or her doctor if he or she was bleeding from somewhere, was jaundiced, had a lump or a bump or had lost weight. A person might have been diagnosed with cancer on foot of tests organised by his or her doctor and he or she then received treatment on that basis. Cancer screening has changed all of that. Cancer can now be detected before it is symptomatic. A key factor is that these tests are not diagnostic. It is a screening test, rather than a diagnostic test. For that reason, it is not 100% sensitive or specific. There is a margin of error. If 1,000 women are screened for cervical cancer, for example, in 980 of those 1,000 cases the woman will be given the all-clear and can be confident that she has the all-clear.

In 12 of those cases, the cancer will be detected. In approximately eight from 1,000 cases, it will be missed. It is an error of approximately 0.8%. That error is not necessarily because anybody is negligent or incompetent. Even with two sets of eyes, or four eyes, looking at every film, there is an error rate of 0.8%. We need to explain that and try to get that message across. I want to encourage people to go for those smear tests, to have that BreastCheck and send back the colorectal screening. These tests are not 100% but they pick up many cancers early. By picking up those cancers early, people's lives are saved. Whatever we do in this House over the next couple of weeks, let us make sure that message keeps coming through.

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