Brian Lenihan Jnr (Dublin West, Fianna Fail)

I thank Senator Henry for raising this issue on the Adjournment. I welcome the opportunity to outline the Government's position on population-based colorectal screening.

The European Commission's recommendations on cancer screening were adopted by the European Council in December 2003. The Commission recommended that screening tests which have demonstrated their efficacy should be seriously considered. Any decision to implement a screening programme should be based on available professional expertise and the priority given to health care resources in each member state. The proposals recognise that ethical, legal, social, medical, organisational and economic matters have to be considered before decisions can be made on the implementation of screening programmes.

The Commission's recommendations, which encompass breast and cervical screening, suggest that consideration be given to the introduction of faecal occult blood screening for colorectal cancer in men and women between the ages of 50 and 74. Almost 60% of Irish cases of colorectal cancer occur in that age group. International randomised controlled trials have demonstrated that faecal occult blood testing reduces mortality for colorectal cancer. While such testing has been well evaluated and its benefits have been demonstrated, it has limited sensitivity and needs to be repeated every one or two years.

That a large number of people must undergo faecal occult blood testing to prevent death is a major deterrent to its use as a screening test. Although it is an effective test, its efficacy makes it unsuitable as a population screening tool. As it is just a screening test, it will not save lives without the use of colonoscopy or sigmoidoscopy to evaluate positive test results. The follow-up test for positive faecal occult blood tests remains to be clarified. Therefore, based on current evidence, general population screening for colorectal cancer is not recommended at this time. It is important that we keep our approach to colorectal screening under review, however. For example, we should consider the outcome of the well-advanced pilot screening programme in the UK.

A new national cancer strategy is being developed by the National Cancer Forum in conjunction with the Department of Health and Children. I am sure the Senator is aware that the forum comprises a multi-disciplinary group of cancer experts and representatives of voluntary and professional groups. A subgroup of the National Cancer Forum has been established to deal with generic screening. The multi-disciplinary group is reviewing all issues relating to screening and is developing the criteria under which future screening programmes will be assessed. The group has undertaken a review of international literature and evidence in respect of cancer screening. I understand that the position I have outlined is consistent with the forum's approach.

Population-based screening programmes for breast and cervical cancer have been proven to reduce mortality, with subsequent improvements in the population's survival, morbidity and quality of life. Screening aims to improve survival from cancer, limit morbidity and improve the quality of life of those who have developed cancer. The current priorities of the population screening programmes relate to the two specific cancers I have mentioned. Over €60 million has been made available to support the national breast screening programme, BreastCheck, since 2000. The programme is available to women in the 50 to 64 age group in the eastern, north-eastern and midlands areas, as well as parts of the south-eastern area. More than 165,000 screenings were conducted under the BreastCheck programme between 2000 and September 2004. Approximately 1,250 cases of breast cancer were detected during that period. Plans are under way for the extension of the screening programme to the remaining counties. Capital funding of €21 million has been approved to provide for the necessary infrastructure in that regard.

A pilot cervical screening programme commenced in October 2000 in the mid-west region. Under the pilot programme, screening is being offered free of charge to approximately 74,000 women between the ages of 25 and 60. An international expert has recently completed a report on the feasibility and implications of a national roll-out of the screening programme. The Department of Health and Children is consulting relevant professional representative and advocacy groups about the report. Approximately 230,000 cervical smear tests are conducted in this country each year. The Department of Health and Children has provided approximately €14.5 million since 2002 to enhance laboratory and colposcopy services. A further €1.1 million has been allocated to the screening programme on an ongoing basis to support the introduction of new and more effective testing in the remaining laboratories and the development of quality assurance and training programmes.

The Department's current priorities in respect of population-based screening are to complete the roll-out of BreastCheck to the remaining counties and then to consider extending the upper age limit from 65 to 69. The Department also needs to need to develop an implementation programme for cervical screening. It needs to keep international evidence on colorectal screening under review, particularly in respect of high-risk groups.