Mary Henry (Independent)

I move:

That, in view of the fact that cancer is the second most common cause of death in Irish women and that death rates from cancer are higher in women in Ireland than in women in other European countries, Seanad Éireann regrets the lack of progress in:

—expanding the very successful cervical screening programme in the Limerick area all over the country;

—the slow progress of rolling out BreastCheck throughout the country;

—the failure to set up a pilot programme for colorectal cancer screening;

—the paucity of clinics for those families who may have a genetic predisposition to certain cancers; and

—the lack of equity of access to specialist treatment throughout the country.

It is important to remember that these initiatives are not technical or academic exercises. We want the establishment of good, proven medical practice to which people in this country, one of the richest in Europe, are entitled. Cancer is the second most common cause of death in Ireland among both men and women and represents a significant burden on the health services. The incidence of and death rate from cancer have been steadily increasing in Ireland during the past decade. This is due in part to the increased age of the population. This year the recently published Women and Cancer in Ireland 1994-2001, compiled by the Women's Health Council and the National Cancer Registry, stated we could expect 7,400 Irish women to be diagnosed with cancer.

Early diagnosis of cancer is most important in effecting a cure. This fact is nowhere more relevant or obvious than in cancer of the cervix and the uterus. Last year a young woman friend of mine who lived in Dublin died of cancer of the cervix in her 40s. She was diagnosed a year earlier when the cancer had already invaded other tissues but it was too late for curative treatment. I believe that if my friend had lived in Limerick she would be alive today. This is because in Limerick a general cervical cancer screening programme has been in place for six years.

In 1992 the then Minister for Health appointed a cervical screening committee to review cervical screening in Ireland. In 1996 it recommended that a national cervical screening programme on an age-sex register be established to screen women between the ages of 25 and 60 at five-yearly intervals within the primary health care setting. It took until October 2000 to get phase 1 in the Limerick area up and running. In 2003 a statistical review carried out by the Irish cervical screening programme found that coverage of the target population was 70%, well within striking distance of the international screening target of 80%.

If invitations for screening were sent to Irish women they would accept and visit their general practitioner. Further examination of the programme in 2004 showed that it worked well. In view of this will the Minister of State explain why, well into 2006, we are still talking about rolling it out nationally? In her speech on the launch of the report on women and cancer on 7 February 2006 the Tánaiste and Minister for Health and Children stated:

I consider that the programme would be best rolled out in the primary care setting, subject to affordable and acceptable arrangements being agreed. A review of the contractual arrangements for the provision by general practitioners of publically funded primary care services is being conducted at present under the auspices of the Labour Relations Commission and I have asked that the general practitioner elements of a national cervical screening programme be tabled at these discussions. Any remuneration arrangements agreed must be capable of delivering a high uptake among women. Payments must be primarily based on reaching acceptable targets.

The Minister of State should note that this mainly addresses the issue of how much it would cost, not how many Irish women's lives would be saved.

The survival rate for women diagnosed with cervical cancer throughout Europe is approximately 95% but Ireland is near the bottom of the league table, just above Scotland and only just better than Slovakia, Estonia and Poland, which have only recently become members of the European Union. Even then our survival rate exceeds that of Slovakia by only 4% and that of Poland by 12%, two very poor countries. The five-year survival rate has risen from 61% in the mid 1990s to 69% by 2001 but in other countries the rise has been far higher. The Women and Cancer report states "differences between countries in provision uptake and effectiveness of cervical screening are almost certainly responsible for some of the variation in survival". There is no provision for cervical screening for most Irish women, though we know from the pilot scheme that the uptake was high, at 70%.

Approximately 70 Irish women die each year from a condition for which a curative result would have been possible. The average age at death is 56 years. One could postulate that 40 or more women lose their lives each year in this country due to lack of screening. Families lose mothers in their 40s and 50s. This is not shroud-raising but represents the facts and without a sense of urgency this will continue.

At present we rely on opportunistic screening, where women attending a maternity hospital may be offered screening or may ask their GP. With the decline of fertility of women in this country and the lower age of reproduction, many women do not attend maternity hospitals in their late 20s or early 30s, nor will they attend as frequently as in the past because families are smaller. As for the option of visiting a GP, I was contacted recently by a nurse with whom I worked and who would by no means consider herself impoverished. She said that the payment of €65 for cervical screening by a GP or practice nurse would be a lot of money. She had checked the prices in her district and other GPs were charging €50 but that is still a lot of money for some people.

The Minister of State will be well aware that medical cards, whether general or doctor-only, are not covered, although I could not get a quick answer from the Medical Council about this issue. We know that women from the poorest socio-economic levels are those who are most likely to develop cervical cancer, which is outrageous. We are still discussing the matter despite the discussion originating in 1992.

Survival rates are good given early detection but in Ireland they are below the EU average. Between 1,700 and 1,800 women are diagnosed with breast cancer each year and 650 die from the condition. Since 1990, improvements in survival rates are evident but they are not in line with the better survival rates of other EU countries or the United States of America. We are at the back with the eastern European countries. To cite the Women and Cancer report, when screening for breast cancer, using mammography is effective in reducing mortality rates from breast cancer in the population. It detects breast tumours early and early detection allows for early treatment, which improves chances of survival.

A good screening programme has been in place in different parts of the country since 1999 but how do women in parts of the country where no breast screening is available feel when they hear advertisements urging them to keep their mammography appointments to ensure they have a good chance of early detection, diagnosis and treatment and a better chance of survival?