Liam Twomey (Wexford, Fine Gael)
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Question 84: To ask the Minister for Health and Children her views on a national cervical cancer screening programme; the role a cervical cancer vaccine may play; and if she will make a statement on the matter. [6488/07]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The roll-out of a national cervical screening programme is the most efficient population approach to preventing and controlling cervical cancer. It is my objective to have such a programme rolled out, beginning late this year, based on an affordable model. For that purpose, on 1 January this year, I established a national cancer screening service which amalgamates BreastCheck and the Irish cervical screening programme. The total allocation to the new service is €33 million, a 71% increase on the 2006 allocation to the services. It includes additional revenue funding of €5 million to commence roll-out of the cervical screening programme and €8 million to commence roll-out of BreastCheck. Significant preparatory work is well under way in respect of the roll-out of cervical screening, involving the introduction of new and improved cervical tests, improved quality assurance training and the preparation of a national population register.

In parallel with the roll-out of cervical screening and as is the case in other jurisdictions, we are examining the potential role of vaccination against human papilloma virus. One vaccine, Gardasil, has been shown to be effective against four types of this virus, including two that cause 70% of cervical cancers. However, there would remain at least 30% of women whose cervical cancer would not be prevented by the vaccine. The national immunisation advisory committee has been asked to advise on its potential use.

Liam Twomey (Wexford, Fine Gael)
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The Minister has stated the vaccine, Gardasil, would protect approximately 70% of patients from cervical cancer and that the other 30% could be protected by a national cervical cancer screening programme. When added together, those figures show that under the Government 100% of women are not being protected because a national screening programme in not in place and the vaccine, Gardasil, is not to be made available to women with medical cards. A pilot scheme for cervical cancer screening has been in operation for six years but, on the other hand, the Minister is referring the vital question with regard to Gardasil to be considered by another committee. This weekend there will be a big row about whether the anthem "God Save the Queen" should be sung in Croke Park but at least the Brits have had a cervical cancer screening programme in place for the past 40 years, while we are talking about something that the Minister is considering doing or is referring to a committee to be discussed. It is becoming a national joke that we have not yet sorted out a national cervical cancer screening programme. A pilot scheme is ridiculous in a sense.

Patients are waiting significant lengths of time. Current expenditure on a screening programme that is not working is approximately €10 million to €12 million. For the same sum of money we could have a proper programme. The Minister should show a clear commitment and move forward. A national cervical cancer screening programme needs to be undertaken urgently. The vaccine, Gardasil, could then be added to the programme for those women most at risk. There has been screening for cervical cancer for 40 years and it can be organised logistically. It amazes me that the Minister has failed to implement the programme. I am also amazed at her replies. In so far as cervical cancer screening is concerned, a total of 100% of Irish women are being let down by the Government because of its failure to take this issue seriously.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is true that there has been cervical cancer screening in other jurisdictions for some considerable time, including the United Kingdom and Canada, where it was introduced in the 1960s. I acknowledge that we are way behind in many areas. However, we have in place a co-ordinated programme for the roll-out of both BreastCheck and a cervical cancer screening programme on a sustainable basis. The vaccine has not been rolled out in either the United Kingdom or Canada. Everybody is examining the most effective way of rolling it out. It would not be appropriate to simply provide for it on the medical card. Any immunisation programme would have to be targeted at the whole population to be effective. Some countries have decided what course they will take — I understand the Canadians are considering a programme aimed at nine year old children while others are considering beginning with 11 year old children. We have asked the national expert group, which advises on immunisation programmes, first, whether we should do it and, second, how we should do it. The most effective way to do it would be on a whole-population basis among the age group to be targeted, probably utilising the schools.

To take as an example BreastCheck, a national screening programme, of the women contacted, 70% come forward for screening and 30% do not. The most effective way to implement screening programmes is to seek the most appropriate way to reach the whole population. If we decide to introduce a vaccine for nine, ten or 11 year old girls, we should do this through a school programme.

The cervical screening programme will begin later this year and the screening group has been put in place. In addition to a roll-out of the screening programme, we must also deal with cytology facilities, which, as the Deputy knows, are inadequate. Due to these inadequacies, a number of smears had to be sent abroad recently so that results were expedited and not delayed. The HSE is currently working with hospitals to improve cytology facilities so smear tests give accurate results. As a general practitioner, the Deputy will know there have been hundreds of thousands of opportunistic smears. The results have been questionable and in one case it was necessary to close down a screening clinic given the dubious results.

Huge action is being taken. As I said, later this year we will have both the screening programme and, I hope, a decision with regard to the vaccine.

Liam Twomey (Wexford, Fine Gael)
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Huge action is not being taken. Rather, no action is being taken. The issue to which the Minister refers in regard to the workload of cytology clinics has been known for years. Another point on screening is that non-attendance decreases dramatically on second and subsequent calls for attendance at any screening programme, whether it is BreastCheck or cervical screening. The problem is there is no nationwide screening programme for anything. The Minister has let everybody down with regard to screening. That is the point we need to make. The Minister is doing nothing.

Mary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy is aware, no country has eliminated cervical cancer.

Liam Twomey (Wexford, Fine Gael)
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At least they tried.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Screening plays a major part, as it does with other cancers. We are currently rolling out BreastCheck and in April it will be rolled out to the rest of the country. Clearly, rolling it out on a population basis cannot be done overnight. Particular issues arise with regard to lower socio-economic groups, which is why the issues of education and awareness, and the huge efforts being made in that regard, as well as the provision of mobile facilities to try to bring screening closer to the population, are so important.

With regard to cervical screening specifically, a pilot project has been in operation in the mid-west for several years. We have learned from that experience and this will inform the manner in which the new screening board, established on 1 January last, will later this year begin the roll-out of a national programme for 25 to 60 year olds.