Mary Henry (Independent)

I welcome the participation by the Minister of State in this debate on the national strategy for cancer control. Figures for the National Treatment Purchase Fund were released the other day, which revealed that the top ten procedures were those involving cataracts, procedure scopes, tonsillectomies, varicose veins, joint replacements, cardiac surgery, cardiology, skin lesions, hernias, grommets and cholecystectomies and gall bladders. However, the two procedures which might involve cancer, procedure scopes and skin lesions, involve considerable delays before treatment, with potential effects for patients. We should be careful to ensure that any patient suspected of having cancer is referred much earlier than is the case at present. Delays arise, for example, in referrals for appointments with specialists, diagnostic procedures, operations and chemotherapy. All these delays increase the chance of a poor outcome.

Everyone was incensed about the report from Europe which indicated that we are 25th out of 26 countries on an index of consumer satisfaction with health services. Senator Quinn said on yesterday's Order of Business that we should try to learn from this report rather than pretend it is of no significance. I am concerned about the report's findings that our neonatal figures are not as good as countries with which they should be comparable and that we have poorer medical outcomes in many areas.

The appointment of additional consultants is to be welcomed because there had been a shortage of oncologists and specialists in cancer surgery. However, we should realise that teams must be appointed. The team approach to cancer treatment is now considered extremely important because, while a surgeon with great expertise in colorectal surgery may be appointed, if he or she is not complemented by a chemotherapeutic expert, patients' chances of survival may not be increased as much as expected. The appointment of such experts will be of great help to a service which has already made great strides over the past ten years.

The Tánaiste is right to point out how good it is that, since 1996, mortality from cancer has decreased by 15% in the under 65 age group but she is also correct that more work is needed. As a result of our fragmented cancer services, the survival rate in Ireland in respect of many common cancers is significantly different from other European countries. The comments of some Senators about having cancer services in every corner of the country made me somewhat anxious. It is not possible to provide that level of service nor will we achieve the best results through such a policy.

The Sloan-Kettering centre in New York is not one of the major cancer treatment centres in the world because it treats 50 cases of this or that but because it treats thousands of cases and has developed an expertise which gets the best results. We will have to do the same. I sympathise with Senator Callanan's remarks about people who suffer from a lack emotional support because they are far from their relatives. However, I would prefer to spend the money to move the relatives to be with the patients at centres which can provide the best treatment. Too many centres treat 50 cases a year when they need to treat 500 if they are to develop any sort of expertise. I appeal to Members on all sides of the House to remember that we are trying to deal with survival rates rather than parochial interests.

The state of radiotherapy services is disappointing. The Hollywood report is now four years old, yet we have not yet decided where to locate radiotherapy centres. While I have little expertise in radiotherapy, others with even less expertise have called for linear reactors in various parts of this country, which will not allow us to ensure the best treatment for patients. We have to listen to the advice of the people with the most expertise.

The Minister of State's proposal with regard to a cancer care network is welcome. Chemotherapy could be easily carried out in regional hospitals, thereby avoiding a great deal of travel. Such a network should be developed as speedily as possible.

With regard to cancer prevention, while genetic factors are relevant, such as the incidence of breast or colorectal cancers in families, there is strong evidence that environmental factors are important to the development of cancer. Clearly, the population of this country will experience an increased incidence of cancer because we are all living longer and our control over cellular development and degeneration apparently decreases as we get older. That is why some of our cells turn haywire and produce cancer cells. However, we can do something about environmental factors.

The smoking ban was extremely effective and only 25% of the population now smokes. That must be one of the best rates in Europe. Not having smoked since I was 11, I can feel particularly smug about this issue. Evidence on passive smoking increasingly supports the decision by the then Minister for Health and Children, Deputy Martin, to introduce a ban under health and safety legislation. The Tánaiste announced that she would take a fiscal approach to this issue. It would be helpful if tobacco was taken out of the consumer price index. Can we take this step on our own or must we find agreement with the rest of the EU to do so? We might have more sympathy now on the matter, given that a number of countries have followed our example.

I was astonished at how easily a ban was introduced in Italy, where people appeared to have to give up overnight. Apparently, there was virtually no discussion about the issue in the Italian Parliament and people were told they would not be allowed to smoke by the end of the month. Scotland has also introduced a smoking ban and efforts are currently ongoing in the rest of the United Kingdom in that regard. If tobacco was taken out of the consumer price index, it could then be heavily taxed. Those involved in trying to limit the consumption of tobacco and alcohol agree that price and availability make a difference. If we could remove tobacco from the consumer price index and increase taxes on it, we would all pay less income tax. It would be better than the current situation, where smokers pay for the rest of us. It would also be good for their health.

I am pleased that legislation on sunbeds was introduced but I wonder why the minimum age is 16. It might be better to have it at 18, the age at which childhood ends. Warnings should be displayed because people do not realise how it affects skin. It makes people look like old saddlebags. The Minister should be applauded for trying to prevent this.

The speed of the implementation of the BreastCheck screening programme is very disappointing. I understand that cost is not the only reason and that we have a shortage of radiographers, histopathologists and specialists to examine X-rays. We have had a considerable amount of time to produce more radiographers. Many of the people involved in BreastCheck had not been working for some years but felt they had a moral duty to return and train for specialist work. We are short of radiographers and rather than take them from other countries we should train them here.

The level of screening for cervical cancer is woeful and it is in this area that the Government is found wanting. It is entirely preventable if cases are detected early. The scheme has been in place in Limerick since 2000. It is known internationally that this screening is quite easy and the pathology of the disease is even easier to carry out than before. A sense of urgency is needed. Some 80 women per year are dying and they would not die if there was screening. The average age of those who die is 56, leaving husbands or partners and young children. This issue is most serious.

Several Senators referred to screening for men. The problem for screening for prostate cancer is that the international jury is still out on its effectiveness. One can have cancer of the prostate without elevated levels of androgen and one can have elevated levels of it without prostate cancer. When one is screening for a condition, it must be common. Cancer of the prostate is a common condition and, perhaps for environmental reasons, it is increasing. The results of screenings are not good enough at present. I am most anxious about men receiving the wrong information and advice, having unnecessary biopsies and being told they are healthy when they may not be.

Screening for colorectal cancer is very successful and only requires a piece of paper. The person can use it for three days running and if blood is present it can be analysed and a scope can be arranged. Haemochromatosis is more common in men and can lead to cancer of the liver. Screening for this and colorectal cancer should be encouraged because accurate results can be obtained. In the case of haemochromotosis a patient can be bled and in the case of colorectal cancer the colon and rectum can be examined. The results are good for those who have early diagnosis.

I am delighted to see that more money is being allocated to cancer research. It is important that all hospitals give patients access to new drugs. I was shocked by what happened in the Mater Hospital some months ago when some women in a trial were denied access to new drugs for the treatment of breast cancer because the sponsor of the trial advised participants to abstain from sex or to use contraception. This denial of access should not happen. However, I am pleased that we do not deny people access to drugs because of price. In England the so-called postcode lottery determines whether one will receive the best new drugs. I commend the Minister of State on the fact that this practice does not happen in Ireland.

I am pleased Senator Scanlon mentioned the hospice movement. It is important that, if treatment has not been successful, the best palliative care is available. A patient recently referred to the Blackrock Hospice, stating that the food is very good. It is wonderful that someone could be savouring food even when undergoing palliative care. I commend the speech of the Minister of State and hope he takes note of what I have said.