Áine Brady (Kildare North, Fianna Fail)

I particularly welcome the opportunity to address the Seanad on the topic of cancer awareness today, national no smoking day. Cancer is a leading cause of mortality, with approximately 8,000 people dying of the disease each year. Awareness of the early signs and symptoms of cancer and what we can do to prevent it is, therefore, hugely important.

Lung cancer is the leading cause of cancer deaths, killing around 1,600 people each year. It is followed by colorectal cancer which is responsible for around 1,000 deaths per annum; breast cancer, with around 670 deaths, and prostate cancer which kills around 540 men annually. However, cancer is increasingly viewed as a condition which people can expect to survive. According to the latest available figures, survival rates in Ireland for almost all types of cancer have improved. This is a trend that must continue in order that the 23,000 or so Irish people diagnosed with invasive cancer each year have the best possible outcomes, on a par with our European neighbours.

The National Cancer Registry predicts that the incidence of cancer is set to increase steadily in the coming years. This is due mainly to the increasingly older age profile of the population. Cancer predominantly affects older people, with approximately 60% of cases diagnosed in people aged 65 years and over. However, in speaking about cancer awareness particularly we need to remember that cancer can develop at any stage in life. Cancer awareness is often used to refer to awareness of the possible signs and symptoms of cancer. This is very important. In speaking about cancer awareness we also need to be aware of what steps we can take to reduce our risk of getting cancer. It is estimated that around 30% of cancers may be preventable. Cancer-preventing behaviours should be practised by everyone. For those cancers that do occur, early detection is a key factor in achieving the best possible outcome.

Prevention and early detection are emphasised in the European Commission's European code against cancer. The code is a simple list of recommendations that reinforces two clear messages. First, certain cancers may be avoided and health, in general, can be improved by adopting a healthier lifestyle. Second, cancers may be cured, or the prospects of cure greatly increased, if they are detected early. That is why we all should be aware, first, of the risk factors and, second, the possible early signs and symptoms. Obviously, prevention and early detection must also be key aspects of public health policy. As many people will be aware, cancer control is a priority for the Government and significant resources have been made available for cancer screening and the development of cancer services under the national cancer control programme. Regarding services for those diagnosed with cancer, more than €56 million in development money has been provided to the cancer programme since 2007 to enhance and reorganise cancer services, €20 million of it this year. In that time, we have had the complete reorganisation of breast cancer services and major progress has been made on other site-specific cancers, including lung and prostate, two of the most common cancers.

Cancer screening clearly has a major role in early detection and, for some cancers, in prevention. The National Cancer Screening Service, which this year will be integrated into the national cancer control programme, has responsibility for the delivery of the BreastCheck and CervicalCheck programmes and this year is undertaking preparatory work for the introduction of a colorectal screening programme. Considerable resources have been made available for these screening programmes. This year, more than €64 million has been allocated to the NCSS which continues to make significant progress in the implementation of Government policy in this area.

Last year, the NCSS completed the national roll-out of BreastCheck. Now, anywhere in Ireland, women aged 50 to 64 have access to free mammograms every two years. By 2008, BreastCheck had screened more than 275,000 women and detected more than 3,500 breast cancers. Last year, approximately 120,000 more women were screened and this year we expect the figure to be higher again. However, it is important to stress that any woman who has concerns that she may have possible symptoms of breast cancer should contact her general practitioner who will refer her to the symptomatic breast service in her area as appropriate.

In 2008, CervicalCheck was established nationwide. The programme provides free smear tests every three years to women aged 25 to 44 years of age and every five years for women aged 45 to 60. In 2009 approximately 280,000 women were screened. For the first full year of operation up until September 2009, CervicalCheck operated on an open access system. This was done to accommodate the initial expected interest in the programme. Eligible women were able to obtain their free smear test without the necessity of an invitation letter.

In September 2009, CervicalCheck moved to a call-recall system in line with best international practice. It ensures an effective and efficient approach to cervical screening is maintained and the target uptake of 80% is achieved. In particular, the call-recall system allows CervicalCheck to target women in low uptake cohorts for participation in screening. In addition to the call-recall system, there is a fast-track opt-in facility for any woman aged 25 to 60 who has not had a smear test in three years or more. Such women can opt in on-line, by phone or by post. There are additional exemptions to invitation-only screening, including women over the age of 60 who have never had a smear test and women regardless of age undergoing colposcopy treatment follow-up.

Approximately 250 to 300 new cases of cervical cancer are diagnosed each year and there are 70 to 100 deaths. The incidence is relatively low compared with other cancers. However, cervical screening when combined with a HPV vaccination programme has the potential to reduce significantly over time the incidence of cervical cancer and the number of deaths caused by it. Therefore, last month the Minister, Deputy Harney, announced the introduction of an HPV vaccination programme to begin later this year. I remind those eligible women and girls to be aware that cervical cancer can be prevented and I urge them to participate in these programmes.

The Minister for Health and Children also announced in January the beginning of preparatory work for the roll-out of a colorectal cancer screening programme. Colorectal cancer kills approximately 1,000 Irish people each year and it is the second most commonly diagnosed cancer in Ireland. The introduction of colorectal screening is a critical development for both men and women. The programme will commence in 2012 for men and women aged between 60 and 69, irrespective of where they live. The programme will be extended to all those aged 55 to 74 years of age as logistics and resources allow. Like cervical screening, colorectal screening brings benefits in terms of prevention, through the removal of pre-cancerous growths, and early detection. I urge all those eligible to participate in this programme when it commences.

Approximately 30% of all cancers can be prevented and addressing lifestyle risk factors is obviously very important in cancer prevention. The European Commission's European Code against Cancer outlines some of these, including diet, physical activity and tobacco use which accounts for almost one third of cancer deaths. As today is national no smoking day, I take this opportunity to reiterate the message that smoking causes cancer. I cannot urge people strongly enough to be aware of the dangers of smoking and to use the resources that are available to help them give up. The website, www.giveupsmoking.ie, and the national smokers' Quitline at 1850201203 are there to offer advice and support.

While any advances have been made with regard to smoking and smoking control in Ireland in recent years, including a ban on advertising and the workplace smoking ban, much remains to be done. Worryingly, while the incidence of lung cancer among men is falling, the incidence among women is rising and we expect that in the next couple of years, lung cancer will be responsible for more deaths among women than breast cancer. We must also remember that more than three quarters of all smokers in Ireland started to smoke before they reached the age of 18. The Minister, Deputy Harney, has already put in place a number of measures to prevent young people smoking, including banning the sale of packs of less than 20 cigarettes, a ban on all in-store and point-of-sale advertising of tobacco products and a ban on the display of tobacco products in retail premises.

The NCCP community oncology programme is also involved in smoking cessation, and is working with HSE primary care teams and health promotion personnel to pilot smoking cessation training in selected primary care teams. The fact remains that people still smoke although everyone is or should be aware that smoking causes cancer. Awareness must be translated into action. I urge people to take action for themselves on smoking and to use the supports available to help them give up. Smoking is not the only aspect of lifestyle to be aware of. Diet and physical activity are also significant elements in cancer prevention and control. National physical activity guidelines were developed in 2009 which set out appropriate levels of physical activity for all ages and abilities among the population.

Not all cancers can be prevented and where a cancer is present, early detection significantly improves outcomes and survival rates. The national cancer control programme has stated that comparison with other jurisdictions shows that advanced stage of disease at presentation is more common in Ireland. I mentioned earlier initiatives on lung and prostate cancer. The NCCP identified in particular that access to diagnosis for both of these cancers was problematic and decided that this must be enhanced. This is being done through the establishment of rapid access diagnostic clinics for both of these cancers in each of the eight centres. To date, five rapid access lung clinics and four rapid access prostate clinics have been established so that patients can be fast-tracked for access to early diagnosis and multidisciplinary decision making as appropriate. The fact that prostate and lung cancer are among the most frequently diagnosed cancers in Ireland makes this initiative very important. I reiterate the importance of early detection and the need for anyone who may be experiencing worrying signs or symptoms not to wait but to attend his or her GP for advice.

GPs have a crucial role to play as the first point of contact for patients who may have possible symptoms of cancer or may be at risk. In this regard, the cancer programme is working with GPs and with the Irish College of General Practitioners to develop capacity and knowledge among health professionals in the community to promote best practice in cancer control. Aspects of this work include a focus on GP cancer education and the development of standardised GP referral guidelines for the common cancers, including the introduction of electronic referral.

We cannot speak here today of cancer awareness without speaking of the enormous contribution made by the Irish Cancer Society, the Marie Keating Foundation, Europa Donna and other organisations in raising awareness. Senators may recall the Irish Cancer Society's bowel cancer awareness month last year, which was particularly useful in raising awareness of the symptoms of colorectal cancer and I want to acknowledge very strongly the society's generous contribution towards the preparatory costs of setting up the screening programme which I mentioned earlier.

Europa Donna, with financial assistance from the Department, has recently produced a very informative and helpful leaflet on breast cancer. The Marie Keating Foundation travels to communities and workplaces to provide information and education to schools, communities and workplaces. I commend these organisations and others like them for the tremendous efforts they make in the fight against cancer.

I have outlined many of the areas on which the Government and the cancer programme are focusing in order to enhance prevention and early detection of cancer. That is the focus in terms of public health policy. We as individuals must also play a part in relation to cancer prevention and early detection. That means seeking to adopt healthier behaviours, such as stopping smoking, eating healthily and taking more exercise. It means participating in screening programmes where these are provided. It means being aware of our own health and visiting the doctor promptly if we notice a sign or symptom that may cause concern.

I should like to end on a positive note because there is much that is positive. Cancer services have improved significantly in Ireland in recent years and the work of the national cancer control programme is having a significant impact on the organisation and delivery of services. Hundreds of thousands of people are already being screened for common cancers each year and more is being done in this area. Most importantly, survival is improving.