Maureen O'Sullivan (Dublin Central, Independent)
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I acknowledge the progress that has been made with regard to breast cancer and prostate cancer. Survival rates are 92% for prostate cancer, 83% for breast cancer and 63% for bowel cancer. However, when it comes to lung cancer, the statistics are stark with a survival rate of 18%. More people are killed by lung cancer than by any other cancer. More people have died from lung cancer than have died from breast cancer and colorectal cancer combined. It is the leading cause of cancer deaths in Ireland. The lung cancer mortality rate in Irish women is the fourth highest in Europe - more than 50% above the European average - and is still increasing. Cancer has overtaken heart disease as the most common cause of death in Ireland as the population grows. This translates to 1,865 deaths per year. The incidence of lung cancer is expected to increase dramatically by 119% in the next 25 or so years.

There are very significant statistics relating to health inequalities in Ireland. Lung cancer rates are 60% higher in socio-economically deprived groups than in the least deprived groups. Survival rates are also significantly lower in poorer socio-economically groups than among the better off. The statistic relating to urban and rural areas is interesting. The rate among males in urban areas is 36% higher than it is in rural areas while the rate for women in urban areas is 38% than it is in rural areas. We are talking about over 2,500 new cases of lung cancer diagnosed every year. We know the economic cost but that does not take into account the cost to individuals and their families and loved ones when a diagnosis proves to be fatal. Lung cancer research gets lower levels of funding compared to other common cancers.

Research also shows that Ireland is falling behind other EU countries with regard to patients having timely access to the most innovative treatments. For example, in 2016, only 20% of new cancer medicines that had been launched in the previous two years were available in Ireland. The figure in Portugal was 40% while the figure in Germany was 76%. Lung cancer has the fourth highest percentage of emergency presentations at 25% of all cases. We know about the association with smoking but 20% of people with lung cancer will never have smoked. We know early detection is vital. Treatment can include surgery, radiotherapy, chemotherapy and cancer medicines. There are new treatments. Research indicates the potential of immuno-oncology to improve survival rates. Immuno-oncology medicines can be used as first-line and second-line treatment, on their own or in combination with other treatments like chemotherapy. There have been developments in biomarker testing, which means that doctors can identify which lung cancer patients are likely to benefit from these new immuno-oncology treatments. Again, this is progress and Ireland needs to be part of it. At the moment, we are falling behind other EU countries with regard to timely access to the most innovative techniques. In fact, we are last out of 13 western European countries when it comes to bringing new cancer medicines to patients. This is a shame when we think of the progress made with regard to breast cancer and prostate cancer.

What is the Government planning to do to make sure those with lung cancer have access to the innovative new treatments, include immuno-oncology therapy and combination therapies? These are the treatments that are making a difference to survival rates of those with lung cancer in the countries that offer those treatments. Lung cancer patients in Ireland need and deserve the same.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Maureen O'Sullivan for raising this issue. I know she has been a strong advocate in respect of cancer in Ireland for many years. I welcome the opportunity to speak on lung cancer. On average, 2,500 patients are diagnosed with lung cancer in Ireland annually with over 1,800 deaths each year attributable to this disease. However, much work has been done to address this. Survival rates for lung cancer are improving. In the last two decades, lung cancer five-year survival rates have increased from 8% to 16% in males and from 9% to 21% in females.

Prevention is a cornerstone of the national cancer strategy for 2017 to 2026. It is estimated that the proportion of cancers attributable to lifestyle and environmental risks that can be modified is in the region of 30% to 40%. It is vital that we are effective in getting the message across to the population that each person can impact significantly on their level of risk in developing cancer. Effective health promotion and disease prevention initiatives result in less chronic disease. The Government has already initiated policy to improve our nation's health through the Healthy Ireland programme. The Healthy Ireland programme takes a whole-of-Government and whole-of-society approach to improving health and well-being with a focus on prevention. With at least 85% of lung cancer attributable to smoking, Tobacco Free Ireland, the national tobacco control strategy, is an important initiative in reducing the incidence of lung cancer in Ireland.

It has the key goal of making Ireland tobacco free by 2025. There is evidence that past changes in behaviour with regard to smoking have led to current better health for individuals and this is something which can be built on to promote further behavioural change.

Increasing the number of cancers diagnosed at an early stage is a key aspect of the cancer strategy. Cancers that are diagnosed at an earlier stage are generally more likely to lead to better treatment options and improve survival outcomes. Raising awareness in people that unusual or persistent symptoms need to be checked out is a critical step in the early diagnoses of cancers.

Recommendation seven of the national cancer strategy states that the HSE national cancer control programme, in partnership with the HSE's health and well-being directorate and voluntary sector, will develop a rolling programme of public awareness campaigns aimed at the early detection of specific cancers. Work is now progressing on the development of such a campaign for lung cancer.

Rapid access clinics for patients with suspected lung cancer have been established in eight designated cancer centres. These clinics seek to ensure that lung cancer is diagnosed and patients enter treatment as soon as possible. So far this year, 87% of patients referred to these clinics have been seen within ten days. With the ongoing implementation of the national cancer strategy, I look forward to increasingly successful prevention measures for lung cancer with early diagnoses and effective treatment leading to further improvements for patients.

Maureen O'Sullivan (Dublin Central, Independent)
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It is probably opportune that the Minister of State is taking this himself because of his own personal interest in this topic as a smoker.

We have to acknowledge the different rates for those with lung cancer and I think stigma is an issue. While there are common denominators for all cancers, we know lung cancer is predominantly linked with smoking, in spite of the fact that 20% of those with lung cancer have never smoked. The stigma is also reflected in a survey which showed that 30% of those surveyed thought that non-smokers should have preferential treatment for lung cancer over smokers. Is stigma preventing people from presenting earlier, especially in lower socioeconomic areas? It is very serious because we know how vital early intervention is.

Lung cancer needs to figure more prominently in the Healthy Ireland strategy. There will be a cancer patient advisory committee and expressions of interest for membership had to be in by 19 October. It is important that all cancers are represented there. I hope that tackling stigma and early intervention would be part of the work of the committee.

I have previously raised the issue of the heavy workload and pressure on nursing staff in the oncology wards in hospitals in Dublin with nurses, some still in their training years with no oncology treatment training, administering the medicines. We have a national cancer strategy, so how will the steps to increase the number of lung cancer specialist nurses be implemented?

We also need a patient advocacy group for lung cancer. We need more of the "I am lung cancer" campaigns. We know that BreastCheck has been effective. We also need a lung check campaign. The social inequalities associated with lung cancer could be looked at by the cancer patient advisory committee.

We need to look at the cancer strategy with a checklist on the recommendations and the timeline. We also need to take into account the facts about lung cancer which indicate that it needs more attention and work. In his reply, the Minister of State said that 87% of patients referred to the clinics have been seen within ten days but we do not know what that is 87% of, or to what that translates in numbers.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Maureen O'Sullivan for raising these issues and I take her point that I am vulnerable on this issue as somebody who is addicted to nicotine. I acknowledge the points she makes and will bring her views back to the Minister for Health, Deputy Simon Harris.

I totally acknowledge the points that the Deputy raised in the debate. Through initiatives under Healthy Ireland and Tobacco Free Ireland, it is hoped that we will see a reduction in smoking levels and a consequent decrease in the number of people diagnosed with lung cancer. I am very committed to the implementation of the national cancer strategy 2017-2026 which was launched last year. We are focused on preventing cancer, early diagnosis, the provision of quality treatment and the health and well-being of those living with and beyond cancer. Our efforts, in recent years, have led to significant improvements in survival. The five-year survival rate for lung cancer now stands at 16% in males and 21% in females. I am confident these figures will continue to rise.

Through the implementation of the national cancer strategy, I look forward to increasing successful prevention measures for lung cancer, with early detection and diagnosis leading to further improvements for patients. Of course, I will bring the other points Deputy O'Sullivan raised back to the Minister.