Máire Hoctor (Tipperary North, Fianna Fail)

I welcome the opportunity to address the Seanad on the topic of bowel cancer awareness. In Ireland there is a relatively high incidence of this type of cancer, also known as colorectal cancer. It is the second most commonly diagnosed cancer in this country. This is why initiatives such as the Irish Cancer Society's bowel cancer awareness month are so important. Early diagnosis is a significant factor in improving outcomes for all types of cancer and this initiative will help to make people more aware of the signs of colorectal cancer and encourage them to take action where needed.

The Government published a national strategy for cancer control in 2006. This sets out the blueprint for the addressing the burden of cancer. Under the strategy there are four main areas to cancer control: prevention, early detection, treatment and after care. In response to the strategy, the Health Service Executive established a national cancer control programme in 2007. Under Professor Tom Keane, the interim director of the programme, the HSE is reconfiguring the present fragmented cancer care system by the establishment of eight designated cancer specialist centres. Progress under the programme must be on an incremental basis and the initial focus has been on the development of breast cancer services in the eight centres, together with addressing the gaps in treatment for other major cancers. At present approximately 27,000 people are diagnosed with cancer each year. The number of newly diagnosed cancers is increasing by 6% to 7% annually and unless a major reversal of trends occurs in the near future the number is likely to double in the next 20 years.

Approximately 2,200 cases of colorectal cancer are diagnosed in Ireland each year and more than 900 people die from the disease. According to projections from the National Cancer Registry, the numbers are set to increase significantly. By 2030, the number of new cases diagnosed is projected to rise by 110% in men and by 83% in women. The rise in this type of cancer is mainly due to demographic factors,essentially an increasing and ageing population. Incidence generally increases with age, with more than four fifths of cases occurring in those over the age of 55. However, survival rates have been increasing slowly over time. Over the five-year periods between 1994-1999 and 2000-2004, relative survival from colorectal cancer, at five years after diagnosis, increased from 46% to 51%. The increase for men was from 45% to 49% and for women from 47% to 53%. We wish to see relative survival rates improve further.

In the context of the national colorectal cancer screening programme, the optimum approach to population screening has not been fully defined, but as with all screening programmes, it must be acceptable, sensitive, specific and cost effective. It is against this background that the Minister, Deputy Harney, requested the board of the national cancer screening service to advise her on the introduction of a population-based colorectal screening programme, including who should be screened, at what intervals screening should take place, the type of screening test that should be used and so on.

In this context, the Health Information and Quality Authority, HIQA, has been asked to conduct a health technology assessment on a colorectal screening programme to examine the cost effectiveness and resource implications of a population-based colorectal cancer screening programme in Ireland. The Minister has received an expert report from the screening service. I understand the health technology assessment is also complete and the Minister expects to receive this shortly. At that stage, she will be in a position to consider further the introduction of a colorectal screening programme and the resources that would be necessary for this.

A population-based screening programme would be aimed at prevention and early diagnosis for people who do not have symptoms but who nevertheless may be at risk. Separately, however, it is important to ensure we can provide speedy diagnosis for symptomatic patients as well as timely and appropriate treatment for those who do receive a diagnosis of colorectal cancer. There has been a great deal of media coverage in recent times on waiting times for colonoscopy services. Colonoscopy is not the only diagnostic tool available for patients with symptoms that may indicate colorectal cancer but it is one of the most important.

While most patients referred for colonoscopy will not have a diagnosis of cancer, timely access to colonoscopy is necessary to ensure appropriate treatment for those who receive a diagnosis of colorectal cancer as well as those whose symptoms relate to another condition. For this reason, all hospitals have been instructed to refer anyone waiting more than three months for a colonoscopy to the National Treatment Purchase Fund. In addition, a target of four weeks from date of referral for urgent colonoscopies has been set and the Minister has asked the HSE to report to her under the service planning process on its compliance with this target. Overall, therefore, there has been a significant reduction in waiting lists for colonoscopies and the HSE is continuing to work towards the target of four weeks for urgent referrals.

There is a strong link between improved cancer outcomes and high levels of hospital activity for those diagnosed with colorectal cancer. In this regard, the national cancer control programme continues to make progress in the implementation of the cancer control strategy and the centralisation of all cancer services over time into the eight designated cancer services. Despite the difficult economic circumstances, the Government was able to allocate significant additional funds and posts this year to further develop services for the diagnosis and treatment of cancer.

On colorectal cancer specifically, the NCCP has focused initially on rectal cancer surgery. This is a technically demanding surgical procedure and there is widespread agreement that it must be performed by surgeons who specialise in this area. At the request of the national cancer control programme the National Cancer Registry in collaboration with the Royal College of Surgeons of Ireland has recently completed the first national audit of rectal cancer surgery. The audit showed that in 2007, a large number of hospitals were performing small numbers of rectal cancer surgeries. The programme has accepted a recommendation from the Irish Society of Coloproctology that the number of hospitals performing rectal cancer surgery should be reduced, with the ultimate goal of reducing this number to the eight designated cancer centres as surgical capacity is created. A directive to reflect those recommendations will issue shortly.

The national cancer control programme has not as yet taken a policy position on a timetable for the centralisation of colon cancer surgery. Inevitably, there will be a requirement to reduce the number of hospitals performing colon cancer surgery. The programme will continue to engage with the Irish Society of Coloproctology prior to adopting a policy statement. Guidelines for the management of colorectal cancer have been issued by the Association of Coloproctology of Great Britain and Ireland. Those are supported by the programme, which is currently in dialogue with the Irish Association of Coloproctology in regard to formally adopting and implementing those as national guidelines.

As we know, prevention, early diagnosis and timely and appropriate treatment are all of vital importance in the battle to improve outcomes and survival for this type of cancer, as for all cancers. Much progress has been made in recent years on all these areas. In terms of prevention and early diagnosis, for certain cancers screening is one of the ways that we can do that and a health technology assessment is due to be submitted to the Minister, Deputy Harney, shortly on a screening programme for colorectal cancer.

Two national screening programmes are already in place: BreastCheck and CervicalCheck. CervicalCheck was launched nationally in September 2008. To date, approximately 90,000 cervical smears have been performed under the programme, with approximately 40,000 of those being in March. Given that a successful cervical screening programme has the potential to reduce deaths from cervical cancer by up to 80%, it is encouraging to see this programme being availed of in such significant numbers.

BreastCheck is now available in 22 counties and by the end of this year will have been rolled out in all 26 counties and the number of women screened is increasing year on year. In 2007, a total of 66,527 women were screened, in 2008 it was 90,335 and this year the target is 140,000, with more than 27,000 women already screened this year. Validated figures on the number of cancers detected for 2007 show that in that year 396 cancers were detected by the BreastCheck programme. Where cancer is detected, appropriate treatment and follow-up is provided within the BreastCheck programme.

Improving outcomes is also a key objective of the work being done under the national cancer control programme. I have already outlined the work being done by the programme in terms of colorectal cancer. That is one element of the reorganisation of Irish cancer services. The programme is also continuing to focus this year on a number of other site-specific cancers.

Centralising breast cancer diagnosis and surgery was the first priority for the programme. There is worldwide evidence to show that centres treating higher volumes of patients have better treatment outcomes. In mid-2007, a total of 33 hospitals were providing breast cancer diagnosis and surgery, but by the end of 2008 just 12 hospitals were providing those services. The process of transferring services to the eight designated centres is almost complete. The key objectives of this initiative are to ensure that where breast cancer services are provided, they comply with the national quality assurance standards for symptomatic breast disease services and that outcome and survival rates improve.

This year the cancer programme is also focusing on lung cancer and prostate cancer in particular. Access to early diagnosis for these two cancers has been problematic and that is an area that must be addressed. In this regard, the programme has decided that earlier diagnosis and multidisciplinary decision-making must be enhanced for both of those cancers. A key initiative this year, therefore, is the establishment of rapid access diagnostic clinics in the designated cancer centres for those cancers. Based on agreed referral criteria, patients will be fast-tracked to the rapid access clinics from which they can receive a definitive diagnosis within two weeks.

This year the national cancer control programme is also focusing on the reorganisation of services for brain tumours, pancreatic cancer and reconstructive surgery for head and neck cancer. It has been agreed that there will be a single national programme for the management of brain tumours and other central nervous system tumours across the two sites of Beaumont and Cork University Hospital.

Through the HSE's national cancer control programme and in conjunction with voluntary agencies, we will continue to work towards our stated goals of better cancer prevention, detection and survival for all cancers, including colorectal cancer. Some members of the Irish Cancer Society are with us in the Visitor's Gallery today. I very much welcome its awareness campaign given the relatively high incidence of bowel cancer in Ireland and also because of the importance of awareness campaigns in terms of prevention and early diagnosis. The Irish Cancer Society has produced some excellent information materials and I am sure many people will benefit from the current campaign. I reiterate that anyone who has any concerns about colorectal cancer should consult their GP, as the earlier problems are detected the better the outcomes.