Camillus Glynn (Fianna Fail)

I welcome the Minister of State, Deputy Tim O'Malley, to the House. I compliment him and the Tánaiste and Minister for Health and Children, Deputy Harney, on the strides that have been made in the area of cancer control. Certainly, I am not for one moment saying that we are enjoying a utopia but many significant steps forward have been taken in addressing this serious matter.

I thank Deputy Tim O'Malley, in his capacity as Minister of State with special responsibility for the psychiatric services, for his hospitable and proactive response to me and a number of organisations which sought his assistance recently.

Turning to A Strategy for Cancer Control in Ireland, cancer is the one word in the English language that strikes so much fear and desperation into the hearts and minds of people that there is a reticence among most people to refer to it as cancer and they refer to it in terms of "the bug", "the boy", "the lad" or whatever. They have this innate fear of saying the word "cancer". No doubt the incidence of cancer has been noted as having increased over the past number of years but there has been a decrease in the recent past which must be recognised and appreciated.

At the outset, it is important to remember that everybody has a responsibility for his or her own health. In terms of what we are doing to control cancer, we must remember that in the main we are providing reactive services rather than proactive services and this debate is so important because it addresses control and diagnosis.

The proposal to limit the number of centres might strike a note of disharmony in the minds of those who have such a facility close to them but it has been proven that the more procedures carried out at a centre, the more efficient is the service. If fewer procedures are carried out at a centre, the results are not what we would wish.

A number of positive steps have been taken on cancer control. I have been a member of the Oireachtas Joint Committee on Health and Children since 1997 and when representatives of tobacco companies appeared at committee hearings, they denied all the way to hell and back that tobacco was injurious to a person's health. However, the world and his wife knew it was and even if the reality jumped up and bit them on the nose, they would still make the same claim.

The onus is on everybody, but especially men, to be responsible for their own health. Women are more inclined to have themselves checked out. When we buy a car, we make sure it is serviced regularly but men are not as inclined as women to consult their general practitioner or consultant. In many cases, when men seek a medical opinion, it is at the prompting of a female.

I worked in psychiatric services and many psychiatric patients smoked. I often walked through the door on to a long-stay ward to be met by a fog of smoke but that has diminished in recent years, which is welcome. Environmental tobacco smoke is a carcinogen. I commend the initiative of the Government and the former Minister for Health and Children, Deputy Martin, who led the way in banning smoking in the workplace. Senator Browne correctly referred to the number of young women who smoke and the general consensus is they smoke to control their weight. However, they could adopt healthier options.

The issues of cervical cancer and BreastCheck are frequently raised and the target date for the complete roll-out of BreastCheck is 2007 but more must be done. The HSE and the Government must be proactive rather than reactive. Reference was made to the PSA test but it is only an indicator of prostate cancer and does not provide a conclusive result. According to medical opinion, a prostate cancer screening programme would not be useful but that is difficult to understand.

We are what we eat and we should pursue a healthy lifestyle by avoiding processed and fast food and addressing obesity. For example, a major tumour was removed from the brain of a 15 year old constituent of mine recently. The poor boy is completely inactive, as he does not have the use of his limbs and that is another example of what cancer can do, even to the very young.

We are all responsible for our own health. Most of us have a general practitioner and at least one visit a year for a check up is not out of the question. We service our cars; why do we not service our own bodies to make sure they are healthy and we are doing everything we should?

Cancer is an affliction that impacts on large numbers of people, irrespective of background and status. Naturally it frightens many people. Accordingly, it is essential that the State takes an active part in providing the resources for prevention, diagnosis and treatment. As the strategy highlights, much progress has been made in cancer treatment in recent years and there is much cause for optimism that medical advances mean major strides forward in prevention and cure are possible in the coming decades. Such advances will have serious implications for resourcing our health care system but if they have financial implications, so what? What price health? Current services will not meet the substantial demand for treatment, cure and care. Meeting demand will require a significant Government commitment to cancer services in the years ahead. This will also mean decisions being made soon on investment, planning and organisation. The goal must be to deliver a universal, quality-based and timely service in line with the best available internationally.

The strategy recommends a wide-ranging cancer control policy programme. It also places a major emphasis on measurement of need and on addressing inequalities. The strategy also focuses substantially on reform and reorganisation of the way cancer services are delivered to ensure future services are consistent and of a high quality. The strategy notes there is evidence of considerable variation in cancer survival rates between regions and also significant fragmentation of services for cancer patients. The strategy recommends that all cancer care be provided through a national system of four managed cancer control networks. Each network must serve a population of approximately 1 million people providing primary, hospital, palliative, psycho-oncology and supportive care. Patients should be fully integrated between each of these elements within each network. Each network should have a formal structure of clinical leadership. The emphasis of the network should be on integrated connection and partnership rather than on segregation and self-sufficiency, distribution of resources rather than on centralisation and on maximising the benefits for all patients.

The strategy states primary care is fundamental in the co-ordination of the wide variety of services patients may use. It is a key partner in the delivery of effective secondary care services. The strategy calls for cancer centres, each serving a minimum population of 500,000, to be designated by the HSE as soon as possible. Ireland will require about eight such centres. The cancer centres within each network should be looked on as equal partners to ensure adequate case volume and expertise, and a number of centres should provide a higher level of care for those cancers that need larger volumes than would present in a single centre.

The strategy contains a number of key messages. Approximately 60% of cancer patients die from the disease within five years of diagnosis. Although it must be recognised that the incidence is falling, it is important to note that the aging of the population will lead to large increases in the number of people who will develop cancer. There has been a transformation in the range and capacity of cancer services as a result of the 1996 national cancer strategy, as well as the work of the first National Cancer Forum.

This is an important matter because as I stated at the outset, the word strikes fear in people's hearts and minds to such an extent that they are unable to bear mentioning it. Hence, the condition has been bestowed with many nicknames and terms. While this may be self-delusional, it indicates clearly the great fear of cancer and of developing the condition among the public and all Members.