Wednesday, 17 February 2010
Cancer Awareness: Statements
Áine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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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.
I welcome the opportunity to speak on cancer awareness, given that today has been designated national no smoking day. It is particularly appropriate that we are having the discussion on our cancer services today and I shall focus on those areas concerning which I have questions for the Department as regards its policies and how it intends to develop them in key areas.
The Minister of State outlined the great progress that has been made in this area, and I acknowledge that. I acknowledge the move, for example, to the specialist breast cancer services. Despite some hiccups in the course of that transformation, it is extremely important that people are treated in specialist centres and this has been shown, undoubtedly, to have a clear advantage for the patient. It does not mean there are no issues as regards transferring from one service to another. Recently I came across a woman who had transferred from Tallaght Hospital to St. Vincent's and there are difficulties with such transfers. We have to take patients' needs very seriously to ensure the transfer from one service to another is achieved with all possible support for the patient. This is particularly important when the patient is in the middle of his or her treatment, when great care and support is needed during the transition.
I shall focus first on the area of smoking. It is very clear that this is an enormous problem in Ireland, given that smoking is a causative factor in 30% of cancers. Some progress has been made, undoubtedly, but I am extremely concerned that cancer society experts believe the Government has still not faced up to the need for a well-funded countrywide and co-ordinated "stop smoking" service. How to give up smoking is the big problem for individuals, as well as finding out what supports are available. It is clear from statistics internationally that if well-funded support services are in place for the 5% of the population approximately that need them, there will be a corresponding decrease in smoking. It is very worrying to read about the high levels we still have, equivalent to 29% of people living in Ireland. Obviously, there is a correlation between the effectiveness of the "stop smoking" initiatives and the amount of expenditure on them. We are all looking for value for money and I am aware money cannot be handed out lightly these days.
However, one needs to look at the returns for such expenditure. Some 30,000 people will be diagnosed with cancer in Ireland this year and new cancer cases are expected to reach more than 43,000 by 2020. One can see, therefore, that prevention is extremely important. We must encourage people not to start smoking, but if we can reach those who do, then the savings will be enormous both in cash and in health terms. It is a matter of some concern that at the height of the discussion about the ban on smoking in 2004, Quitline got 19,000 calls, while in 2009 it received just 5,765 calls. We need to examine the national approach to the co-ordination of such services. If we are serious about prevention and getting the message to smokers that they can quit, although needing help, then plans should be put in place to ensure this happens.
The second policy area I should like to address is the breast cancer mammogram service. That is now a countrywide initiative, but it is outrageous that it has taken ten years. I hope this will not be a precedent for how long it will take to roll out other countrywide screening programmes for various cancers. Too many people died while we were waiting for that service to roll out, and I do not accept the excuses that were made.
Further issues need to be addressed in this regard. We need to extend the age group that can avail of the service, as there is a false sense of security among women of 65 and over because the service ends at that point, since we know that breast cancer incidence increases with age. The programme should be extended to 70. In terms of younger women, I understand the evidence is still being studied as regards whether the service should be made available to those aged 45, as in other countries.
As regards lung cancer, it is very disturbing that the outcomes are so poor in Ireland. It is extremely disturbing that by the time many patients are diagnosed with lung cancer, it is too late to treat them. There are enormous issues as regards awareness of symptoms and getting to the doctor early. It is disturbing, too, to note that more women are now going to die from lung cancer than breast cancer, since more and more have taken up smoking. There are major challenges in that area in terms of reaching young women in particular. The same applies to young men in terms of cancer prevention, the need to be aware of the services that are available, getting to GPs early and dealing with the issues.
Undoubtedly, there has been progress, but the challenges are enormous. I should like to see more focus on health promotion, because it is clear there are enormous lifestyle issues connected to the incidence of various cancers, although not all, and this needs to be addressed in Ireland. These vary from smoking, which is well-proven, to obesity and lack of exercise. Most people are aware that some of the incidences reflect a combination of lifestyle factors that have precipitated the development of particular forms of cancer. These are factors which must be taken very seriously.
I also want to raise the whole area of sunbeds. The Minister promised legislation in relation to this, and very disturbing information is emerging as regards the use of sunbeds. I want to put some of this on the record and ask the Minister of State when the legislation will be introduced to deal with this. The very least we should be doing is banning the use of sunbeds for children under a certain age, whether 16 or 18, and I am sure the Minister is examining that. However, should we not be considering whether these products are so dangerous that they should be banned completely? This is certainly open to question, given the information emerging internationally in relation to them. Young women in particular, rather than young men, are very much at risk as regards the use of sunbeds. They were regarded for a long time as being quite innocent, but it has emerged that they are not as innocent as they might look. The International Agency for Research on Cancer, IARC, has stated they are as carcinogenic as cigarettes. It is problematic when people see them as quite innocent when they are not. We need, therefore, an information campaign on the dangers of sunbeds. In its international study of sunbeds, the IARC also found lax operating procedures in tanning salons. Regulation through legislation is much needed in this area as it is far too dangerous to leave untouched.
Concerning statistics have emerged about waiting times for colonoscopies. Susie Long was not able to access a colonoscopy when she needed it and subsequently it led to her death. When her case was debated, we were promised no one in urgent need of the procedure would have to wait more than four weeks. The number of patients, however, now waiting more than six months for the procedure across all hospitals has increased by 34%. At Tallaght hospital, for example, it has doubled from 90 to 177. I accept people's awareness has increased and more people are being referred for colonoscopies. Will the Minister of State clarify how these services will be further developed? When will the colonoscopy screening programme be fully rolled out? When will it be extended from the 60 to 69 age group to the 55 to 74 age group? Will the services be provided in the eight regional centres or on a more widespread basis?
I appreciate more moneys are being spent on cancer services. This was necessary, however, given the toll it takes in Ireland. Will the vaccine for cervical cancer be available from September or will it be rolled out in April to benefit current school goers?
To start on the note Senator Fitzgerald finished on, I would like to acknowledge the great work done by the Irish Cancer Society, Europa Donna and the Marie Keating Foundation. I smiled when I heard Senator Fitzgerald deliver her presentation, as it appears we all access the same websites to get our information. Each of these organisations have been very helpful, particularly the Irish Cancer Society. I commend them on the great efforts they put into cancer awareness.
Today is national non-smoking day. There is a school group of young students from Meath in the Visitors' Gallery. One of them I believe is a little girl, Annie Madden, whose dad I know. I would have hoped they could have stayed long enough to hear of the terrible things that can happen when ones smokes.
It is important for little boys and girls their ages never to start smoking. I am delighted the group has sat down again to hear what we have to say about this.
This morning when I accessed one anti-smoking website, I noted a packet of 20 cigarettes costs €8.40 and I thought who can afford to buy a pack every day. A 20-a-day smoker who stops will save €58.80 a week, €250 a month, the equivalent of a monthly food budget, and over €3,000 a year, allowing one to take off to sunnier climes. Having €3,000 in one's pocket to book a nice holiday on such a nice but cold morning should be more than an incentive to give up smoking.
This does not include the wonderful health benefits from stopping smoking. It will help in making breathing easier, reducing high blood pressure, the risk of sudden death from a heart attack or stroke and enhancing taste and smell. One would also begin to enjoy a better quality of life due to more energy and being able to participate fully in physical exercise.
Senator Fitzgerald gave out about the time taken to roll out the BreastCheck screening programme. The former Senator, Kathleen O'Meara, who is in the Visitors' Gallery, will remember how we roared and screamed in the Chamber about BreastCheck in the last Seanad. I always said that Rome was not built in a day and that BreastCheck would not be rolled out in a day. Is it not great it is now in place? We should commend and applaud this. Several hundred women have benefited from it with earlier detection of breast cancer.
This morning I was delighted when a member of the Irish Cancer Society told me it commended the Government on bringing through no-smoking legislation. While it is great not to have smoking in the workplace, pubs and restaurants, we cannot sit back. Money needs to be put into more awareness campaigns. Driving between Dublin and Sligo, the motorist will notice the large Paul Allen advertising billboards which could be used to display the quitting smoking helplines, those numbers that are like little mantras. A driver trying to give up smoking would be encouraged to dial one of those numbers, all the easier with hands-free sets in cars now. We have to strike while the iron is hot. I commend the Minister of State, the Department of Health and Children and the Government on no-smoking legislation but they must keep going on it.
Screening for breast and cervical cancers is in place while bowel cancer screening is imminent. On this morning's Order of Business there were calls for more prostate cancer screening. There are no two medical minds of the same view as to the road we should travel regarding such a screening programme. The way to go is to continue with research.
Sunbeds are the largest disaster that ever came into any country. Some 30 years ago, as a young married woman, I opened a small business in my home which had a sunbed. I used it without any regulation and the only item I needed was a loan from the bank for it. When I think about it now, I shudder in my little boots as to what I was exposing myself and others. There should be an all-out ban on children under 16 years using sunbeds. Once we introduce such a measure we should then consider a total ban. There is no regulation at present. The effects these machines may have on a person are equally if not more negative than the effects of smoking between 20 and 40 cigarettes per day. I cringe and I am sickened to the core when I think of mothers dressing their little girls for Holy Communion or Confirmation and who introduce them to sunbeds. I suggest those mothers should go and buy fake tan instead. I have two young daughters and their sheets are destroyed because of fake tan but at least I can wash them and I do not have to go to the accident and emergency ward.
I am pleased to note the progress in early detection in respect of lung cancer. There are rapid access venues and clinics opening now. I am pleased to note the developments in respect of specialist units and I understand the transition is going well and that there are no major problems. The more we can debate the matter in this way, the better for the whole area of cancer treatment.
I thank Senator Feeney for sharing time because otherwise I would not have had time to contribute. I will be brief. Like Senator Feeney, when the young children came into the Gallery some minutes ago I was struck by how many of them will end up smoking and what would make them smoke. I cannot understand anyone of my generation who smokes because we are very aware of the health issues around smoking. More research must be done and I trust this will take place. We must find out what makes children smoke. Unless we find out and then target resources to combat those reasons we will not make progress.
Senators Fitzgerald and Feeney commented on the use of sunbeds. Vanity is a great deterrent and if people were aware what sunbeds could do to their skin they might not be inclined to use them. Visual images of the harm that can be done should be available. I recall the topic was raised in a discussion last year about cancer. When will we see the introduction of graphic images of the physical harm caused by smoking on packets of cigarettes such that it might deter people? It baffles me why people continue to smoke when they know how bad it is for their health. Will the Minister of State indicate if there is an intention to carry out research into what motivates people, especially young people, to smoke? When one sees all the lovely young children in the Gallery one wonders what would tempt them into such a detrimental practice or habit, which is very hard to break once started. We must work on prevention.
This is a transformative time in Ireland in the area of cancer. Much of the change has been unpopular but I applaud the Department, the Minister and the Ministers of State working in this area because it has been very difficult to transform Irish cancer care services and the Government has not always received support in this area. The Department and the Minister have been focussed on the outcomes. In her contribution, the Minister of State suggested the outcomes are most important and that they are improving all the time, a point Senator Fitzgerald acknowledged. That something is unpopular is no reason to deviate from the plan and I commend the work of Professor Keane in this area. It will be some years hence before we see the outcome and the changes in peoples lives. We must stick to the plan. It is incumbent on all of us to remember that people will benefit and outcomes will be improved if we consolidate services and stick with the plan. Everyone seeks the assurance that they are being treated in the best available facility.
I seek an answer to a question. Will the Minister of State clarify that no matter whether one is a public or private patient, one is treated equally when it comes to cancer care? This should be very clear but there is a sense of ambiguity and a suggestion that if one pays privately for health care one may be fast-tracked. Will the Minister of State outline the case categorically?
I join in that welcome. Ms O'Meara is a distinguished former colleague and has represented the Irish Cancer Society. I express my admiration for the work done by this organisation. I also welcome the Minister of State, Deputy Áine Brady, and I seek the permission of the House to share time with Senator Rónán Mullen.
This is a serious situation and the facts are stark. This year, some 30,000 people will be diagnosed with cancer. This may be partly due to better diagnostic techniques but by 2020, it is estimated some 43,000 will be diagnosed, a very large number of people. We are all aware of this because we all know friends and close acquaintances who have been affected. In political life we have been shocked and saddened by the onset of cancer in Deputy Brian Lenihan and we all wish him well and a complete recovery from this very difficult form of cancer. It is something that affects everyone in society and it is very widespread.
Previously in the House, we have dealt with the tobacco industry, its dishonesty and the way it lobbied over smuggling, whereas we know perfectly well and, I am glad to say, we have put on the record of the House that the major tobacco companies have all been implicated and convicted of smuggling in the United States.
I will concentrate on lung cancer and sunbeds. More people die from lung cancer in Ireland than breast, prostate and colon cancer combined, a very shocking statistic. There is also a cultural shift. Men used to be more significantly affected but now women are catching up and the gap in closing. We must treat this as a human problem generally speaking. I am not terribly in favour of dividing and prioritising on the basis of gender, particularly with regard to screening. I welcome the roll-out of the breast screening programme. I am also glad that men's cancer, especially prostate cancer, is now being taken seriously, along with colorectal cancer which affects both men and women.
One difficulty is that we have a very bad record in terms of the treatment of cancer in this country. We are one of the worst in Europe in terms of lung cancer. Perhaps this is because it is not caught in time. Given this worrying figure, we must re-prioritise things so that the Government assists in rapid access to diagnostic sources, clinics and treatment, especially for lung cancer.
I refer to the Quitline, a matter that has been mentioned by other Members. There is a very clear payback for investing in Quitline. Our neighbouring country, the United Kingdom, almost doubled its spending on quit line services and there was a very significant drop, from 27% to 24% in the rate of smoking. It may only be a change of 3% but it represents a very significant effect in terms of the numbers. At the same time, our investment dropped and our rate of smoking went up from 27% to 29%, which indicates we must invest heavily in this area. In 2004, the quit lines received almost 20,000 calls. In 2009, this had dropped to 5,750 calls, a massive drop resulting from a lack of investment. We know the quit line works and we should continue the service.
On this lovely sunny day on which we may be seeing the beginning of spring at last, I wish to be positive. There were three lovely, wonderful and beautiful young women on television one day recently, all of whom had cancer and one of whom had cancer three times. They were happy, positive, able to recover and living, which is marvellous. We should destroy the terror, mystique and horror of cancer and we can do so in positive ways. The Irish Cancer Society has done so and has shown the economic impact of giving up smoking which, in these difficult economic times, is a significant indicator.
I used to be put off somewhat by the view that if one stopped smoking it would be ten years before one's lungs recovered, if ever. In fact, after 20 minutes one's blood pressure and pulse return to normal, which is instant; after 24 hours the risk of heart attack begins to fall; after 48 hours the sense of taste and smell greatly improve; after 72 hours breathing becomes easier and energy levels increase; and after one year the risk of heart disease and lung cancer begin to fall significantly.
However, we must do more. We deal with legislation in these Houses and we passed the Public Health (Tobacco) (Amendment) Act in 2009, which introduced the enabling legislation for pictorial warnings. We know these measures work. I remember a not so gory advertisement that asked if one would like to kiss an ashtray. While I would not, I probably have done so in my time. Pictorial warnings register with one in that they are unpleasant and communicate in an anti-social way. However, we do not have a timeline for the implementation of the enabling legislation. Will the Minister of State indicate whether the Government is serious about having a guideline on this?
Sunbeds are not just used by women. I do not believe women are any more vain than men. I used to be in a gym for many years and there was no control over the sunbeds. There was no malicious intent on the part of the staff but they did not really know what they were offering, which is worrying. Some of these machines emit levels of ultraviolet radiation and other forms of radiation that are otherwise only deemed acceptable in medical treatment. The people who offer sunbed services are not qualified and have no idea about the levels of radiation being emitted. This is partly, but not entirely, responsible for the significant rise in malignant melanoma, skin cancer. There were 660 new cases of malignant melanoma in 2007 and this number will increase. There was a 75% increase in the risk of cutaneous melanoma when people began tanning regularly in sunbeds before the age of 30 years.
I ask that this matter be prioritised. I have asked about the pictorial advertisements and investment in the health side. My third question also relates to prioritisation. Are we to prioritise the legislation? Although the Bill is being drafted, a process which is taking a hell of a long time, it is disappointing that we are told it will not be ready before mid 2011. This is not good enough because we know the position. The information to which I refer is generally known throughout the Houses and must be known in the Department of Health and Children. While I recognise there is pressure on all Departments, I ask for specific information on the three aforementioned areas. It is a matter of prioritisation and we know taking action will do good.
The image of the Quitline service came into mind particularly because I was listening to the very good broadcast in the lead-up to Daffodil Day. I remember taking part in several events that were great fun. There were photographs of beautiful young women and beautiful young me in the middle sporting daffodils. The point being made is that there is not enough advertising. People will use the Quitline service but it needs to be advertised. People do not know the number, which is 1850 201 203. We need to invest in this service.
Ba mhaith liom fáilte a chur roimh an Aire agus roimh ár n-aíonna ó Chumann Ailse na hÉireann. Ba mhaith liom tréaslú leo as an dea-obair a dhéanann siad gan staonadh do leas an phobail. Is léir go bhfuil ardmheas orthu agus ar an obair a dhéanann siad i measc an phobail. Is léir freisin go bhfuil na polaiteoirí anseo ag braith orthu le muid a choimeád ar an eolas maidir lena bhfuil le rá againn faoin ábhar seo agus muid ag iarraidh dul i ngleic le fadhb na hailse sa tír seo. In congratulating the Irish Cancer Society and other groups on the good work they do, I acknowledge we are very dependent on them for keeping the issue of cancer in the public eye and keeping politicians briefed on the issues they need to be underlining.
Today, as we all know, is not only Ash Wednesday but also national no smoking day, the day on which we should be speaking about cancer. The cancer statistics that have been rehearsed up to now are depressing. Twenty-nine per cent of the population smokes. We discussed at budget time the impact of adding an extra €1 to the price of cigarettes and heard the rebuttals, which focused on smuggling and such practices. Despite our best efforts, the absolute focus needed from the Government to nail the problem of smoking is not evident.
It is particularly depressing to see younger people falling for the habit of smoking. This raises all sorts of questions about the quality of our culture and family life. It has always been the case that younger people wanted to try things out but we have never been more educated or conscious of the dangers. It is remarkable, therefore, to see recurring issues of human folly, such as young people falling for smoking, perhaps under the bad influence of family and peers and, to make matters worse, to see parents taking their children to sunbeds in advance of their Confirmation or Holy Communion.
I heard Senator Feeney's little plug for the fake tan industry but I would like to believe we could be even more ambitious and have a culture that is less superficial and tries to promote the idea that true beauty does not depend on the colour of one's skin or what one is wearing on it.
A serious issue arises as to how law and culture intersect. It is absolutely right to talk about the Public Health (Tobacco) (Amendment) Act. The enabling legislation for pictorial warnings was introduced but the Department does not appear to have a timeline for the development of the regulations or the implementation of any of the guidelines. I would support any such measures. They work to an extent but it is a bit like putting up the price of cigarettes in that, on their own, inhibiting measures do not work unless there is the necessary cultural transformation.
ASH Ireland referred to the need to ban smoking in cars. I am not sure how I feel about that. While I support legislation up to a point, I believe there is a danger that we would try to achieve with law what can only really be achieved by changing the culture. Bearing in mind the privacy of family life – perhaps the family home extends into the family car – I would like to believe parents would not be smoking and that there would be very clear cultural messaging that good parenting involves trying not to smoke in the presence of one's children and trying not to do anything that would encourage children to take up the habit or imitate their parents in this regard.
Cancer is one of the leading causes of death in Ireland and worldwide. In Ireland, it is responsible for 25% of deaths. Taking about cancer, sometimes referred to as "the big C", brings on anxiety and incredible dread, yet it is a very survivable disease. The debate we are having is very welcome because it gives us an opportunity to send a message of optimism to people. Over 80% of cancers are curable and over 30% are preventable. For this to be the case, behavioural changes and responses are required on our part. This is where cancer awareness plays a key role.
Awareness is the first step in bringing about attitudinal and behavioural change. Over recent years, an enormous number of education and information campaigns have been spearheaded by voluntary groups, such as the Irish Cancer Society, and Government bodies, such as the Department of Health and Children and the HSE. In the education, awareness and information that has been attempted to be put out lies the road to two critical steps: prevention and early detection. While not wanting to repeat what colleagues have said, when we look at what we know and at the evidence, we see that if we want to prevent cancer, there are a number of proactive and positive steps we can take. We can stop smoking, we can not smoke at all, we can improve our nutrition and we can improve our physical exercise. Smoking is attributable to 30% of all cancers and to 95% of lung cancers. Those statistics speak for themselves as to why, if we want to prevent cancer, we should either not start to smoke in the first instance or, if we are smokers, we should cease as quickly as possible.
On the campaigns we run with an aim to bringing about attitude and behavioural change, which changes are necessary if we really want to prevent the cancers, I often think of the effectiveness of environmental campaigns run with children. It is imperative that we start early. It is not only about educating the adults within our society. We must educate children. In meeting residents and constituents, often I am struck by them stating that the real trigger in bringing about attitude and behavioural change on their part when it came to recycling was the pressure they were put under when their children came home from school and insisted they segregate their waste because they were working towards their green flag. There is a really important lesson in that for us when we seek to bring about attitude and behavioural change on the part of all of our citizens.
Without wanting to repeat what colleagues have said about early detection, knowing the symptoms, recognising them and going for screening is very important, but that means we need to provide education and awareness in that regard. An interesting study by the Irish Cancer Society looking at bowel cancer and to which I will merely refer showed how little information on the symptoms was available.
Today is national no smoking day. Smoking must be one of the greatest menaces to stalk our health services. One should keep in mind that giving up smoking is not only about cancer prevention but also about a range of other diseases, from breathing disorders to blood pressure, heart disease, artery disease and stomach ulcers. Cancer affects not only the person who has it but all of his or her family. Excellent suggestions have been made to the Minister of State and I would urge her to consider them.
I commend the Irish Cancer Society, especially my ex-colleague who is one of the key persons in spearheading how to deal with cancer by way of an awareness campaign in terms of leaflets and reaching out to schools, hospitals and doctors. Everyone in society has a role to play, but the Irish Cancer Society has created that role for all of us to make that happen. More than ever, the big C, as it is known, is a big dread in society. However, it should not be so because it can be prevented. It is all about preventative medicine and how we create a proper diet and de-stress people in society. These are areas in which we all have a role in terms of prevention.
Today is national no smoking day, and smoking is a significant factor contributing to cancer. We need to hold daffodil day and pink ribbon day and to issue leaflets. We need to keep stating that it need not be the dread of society. We will talk this down. Cancer can be cured. There are examples of people with different types of cancer and we know of significant success stories. We seem to dwell on those who are not successful, but they are a small percentage.
With the Irish Cancer Society, all Members, along with those in schools, hospitals and other walks of life, should promote a prevention campaign not to be afraid of cancer. Health is the most important issue for our nation. We all have a role. I commend those participating in this awareness campaign and the Irish Cancer Society on promoting it.
I welcome the Minister of State, Deputy Áine Brady. I also welcome a former colleague, former Senator Kathleen O'Meara, and the team from the Irish Cancer Society who are present. I thank them for the work they do in raising awareness and thank them as well for the statistics brief they provided. As those have been well flagged already, I will not repeat them.
In my former work as a midwife in the maternity services, it was always obvious to me at delivery time that a mother was a smoker. There was a great difference in the state of the placenta after delivery and we would never need to ask the women. One could tell by the state of placenta because it would be gritty and infarcted whereas a normal healthy placenta would be no such thing. These babies suffer disadvantage from the very beginning of their lives because they do not achieve their expected birth weight targets and may have difficulties with feeding. The message about smoking in pregnancy needs to be reiterated. Anything a woman does while she is pregnant will have an impact on the baby she happens to be growing in her body. There is no reason to have a disconnect in that regard.
On my research, while we all were looking at the same websites, I want to focus in particular on an aspect of men's health because prostate cancer is extremely common, colorectal cancer, while it does not only affect men, affects them in many cases, and there is also testicular cancer. I looked at the website of Mr. Des Bishop, who was a good advocate for getting information out there. As a sufferer of testicular cancer, he was a good role model. He was a visitor to the Houses because of his ability to learn Irish and speak it so eloquently, and he is a good guy. People like him would do a great deal for putting the positive side of diagnosis and how to treat particular aspects of cancer.
On how obesity links into cancer and to ill-health, my colleague, Senator McFadden, and I are involved in the "Operation Transformation" television programme. The 14 Oireachtas Members between us have lost 11 stone plus in the five weeks, but it was mostly those on the other side of the House who were heavy.
The boys, yes. We very much welcome that the restaurant here is now preparing the menus decided by the "Operation Transformation" team and Dr. Eva Orsmond. This is something Mr. Don Rice and his team have taken on board and that option will continue in the restaurant.
Yesterday we had the honour of having four of the five leaders who are undergoing the programme on television at present here as our guests. They were delighted that this option was available here and they also stated that there were restaurants around Dublin which were also interested in having the reduced fat and lower calorie options available to people. There is an interest in having programmes such as this to raise awareness.
Another aspect of my work involves visiting schools with the sexual health programme. I speak about cervical screening and about the HPV vaccine, which is coming on stream for young women later this year and which I very much welcome.
To get the attention of young people, and the Irish Cancer Society might take this on board, we must put up one-liners on social networking sites such as Google Buzz, Bebo and Facebook with links to facts they may need to know. We certainly must be innovative in how we get young people to engage with health awareness and cancer prevention. Testicular cancer, in particular, mainly affects young men between the ages of 15 and 35 years. Young people must take proper care, be able to check themselves out and get comfortable with that process. There should be links on such pages where young people might get even one piece of information. In my experience it is often the one-liner or throwaway remark that will make a difference in people's lives.
Many people are not aware of the dangers of doing something or of signs and symptoms because what is normal for a person who is going through puberty? No two people are the same. Another aspect of my life is running junior discotheques. It is very difficult when one meets a young girl of 12 years of age who is wearing make-up and high heels and dressed for a social outing to tell the difference between her and a 17 year old. During puberty, when the body is undergoing massive changes, normal can be a movable feast for many young people. They do not know what is normal. Rather than have people concerned about body changes, they should know what is normal for them, and the only way to achieve that is to give them information in a way they can understand and recognise. We need to move forward in planning how to get that information to young people and perhaps get greater take-up of it and more prevention as a result.
Today is national no smoking day. Cigarettes now have far more addictive properties than they had previously. It is one of the means of trapping people into smoking. It is no longer simply a matter of somebody being able to have a cigarette when they are out socialising and not smoking otherwise. The addictive properties make people continue to smoke. I also support the call for legislation to monitor the use of sunbeds. The idea that people are exposing young children to sunbeds must be examined.
I thank the Minister for her attendance and appreciate the opportunity to contribute to the debate on this important subject. I hope there will be positive moves on it. I also thank the Irish Cancer Society and the other speakers for their contributions to the debate.
I welcome the Minister. This is one of the most important debates the House has had, as cancer affects so many families in our society. I welcome visitors to the Chamber on national no smoking day. As an avid non-smoker, I would encourage measures to prevent smoking. In terms of environmental health, it is crucial that we consider as many measures as possible to enhance people's lifestyles and to minimise diseases such as cancer and the many other things caused by smoking.
Cancer is a scourge. There has been a rapid increase in its incidence in Ireland. The number of people who die from cancer is increasing. Indeed, it is projected by the national cancer registry that there will be approximately 30,000 cases of cancer diagnosed in 2010 and that the figure will be 43,000 in 2020. That is an increase of 70% over the next decade. We cannot afford to sit back and allow that to happen. We must examine as many measures as possible to deal with it. Many people have spoken about education, which will be an important part of that process.
I refer to the KiKK study which was produced by the radiological protection agency in Germany. It provides some startling facts. The study examined clusters of cancer incidence within a 5 km radius of nuclear power plants. It found that in children up to four years of age there was a 60% increase in the incidence of tumours within the 5 km radius of nuclear power plants compared to the national average. In the case of childhood leukaemia, there was a 118% increase around such plants. It is not conclusively proven that nuclear power plants are the cause of the cancers. There could be other factors. Unfortunately, there is a great deal we do not know about cancer; there is much we must still discover. However, there appears to be clear evidence that there is a likelihood that environmental factors play a key role in causing cancer.
We must ask why it is the case that in the less technological age of the past far fewer people died of cancer. Indeed, cancer incidence is rapidly increasing; it is now the second main cause of death in this country. It will be the main cause before long. That is the trajectory we are on and we must deal with it.
What must this country do? Having looked at the study from Germany, it was startling to discover the lack of research in this country. It is very difficult to get figures on any aspects of cancer. We need far more statistical research into particular areas and industries around which there may be clusters of cancer. We need information and to examine what is causing cancer in Ireland. Research is crucial. There is a clear link between cigarettes and cancer but it took many years to find it and, indeed, it was not accepted. At one time it was said that cigarettes were good for people. They were considered cool, wonderful and so forth. It is now widely accepted, and there have been many legal cases which demonstrate, that cigarettes cause cancer and are very harmful. However, it took many years for that to be accepted.
We must examine the various different types of radiation. There is clear evidence that radiation has effects. In the case of the mobile telephone industry we must examine what might be the cancer effects. I am not making any assertions about that industry but there is clear evidence, for example, that the non-ionising radiation from mobile telephones heats up people's heads. That might or might not cause the various increases in tumours; we do not know. However, we should adhere to the precautionary principle, look at what is coming down the line and not make the same mistake that was made with cigarettes. It is clear that cigarettes are dangerous, and there appears to be a growing body of evidence that children under the age of 16 years should be careful about the amount of time they spend using mobile telephones. There are many different aspects to cancer research but we must be clear about the environmental aspects of cancer.
I will conclude by referring to a number of different services. Services for treating cancer in Ireland are rapidly improving but I urge that we examine the Finnish model as well. I attended a World Health Organisation conference in Finland a number of years ago. The Finns have a very good health model and have moved far more into prevention. A total of 30% of cancers are preventable.
Finally, the pilot daffodil centre in Galway has worked out very well. Those centres should be established throughout the country. The recent investment of €7.5 million by the Minister for Health and Children in the clinical research facility in University College Hospital in Galway is very welcome. In addition, the centres of excellence and the work of the Government in that regard are very important.
Gabhaim buíochas leis an Seanadóir Ó Brolcháin faoi a chuid ama a roinnt liom. It has been said many times that cancer has no boundaries and today in the Seanad we see that it does not respect political boundaries. We all agree that work on cancer must continue in terms of promoting awareness and delivering best practice services to people who have unfortunately contracted different forms of cancer. Today's statements follow the launch of daffodil day, when the Irish Cancer Society announced its expansion of cancer information services. I commend the society and welcome the initiative of setting up daffodil centres in a range of hospitals nationwide, including designated care services. Mr. John McCormack, CEO of the Irish Cancer Society, has said the largest gap in the delivery of cancer information is from the point of diagnosis within the hospital to providing a link with the support centres and groups in the community, thus enabling a continuous system of care and patient progress. It is important to recognise the society's achievements and the work it is doing.
I refer to Sligo General Hospital which provided cancer services until late last year when they were moved to a centre in Galway. I raise a minor but very important point, namely, the two commitments entered into by the Government to patients as a result of the withdrawal of services. The Minister for Health and Children, Deputy Mary Harney, promised campaigners and patients that a bus service would be made available to patients to enable them to travel for treatment. That service never materialised. As a consequence, patients are using the old bus service which is unsuitable for transporting people who are sick. A promise was made which has since been reneged on that follow-up services would be provided in Sligo but they are being provided in the BreastCheck clinic which is unsuitable for recovering patients. Will the Minister of State ensure the Government will live up to the commitments given to cancer sufferers and campaigners?
I thank the Minister of State for her indulgence.
I raise the issue of screening for women under 50 years of age. While I accept research tells us the disease affects older people, I have serious concerns about women under 50 years of age. This morning Dr. Juliet McAleese and Professor Arnold Hill debated the issue succinctly on "Today with Pat Kenny". I raised it yesterday on the Adjournment and was told that the debate was ongoing. I do not accept that there is not a major need for cancer screening for those under 50 years of age. It is an issue which has affected me in my personal life. A number of my friends and acquaintances, members of my family and constituents in their 40s have been diagnosed with cancer. It is an outrage that one must show symptoms or be in an at-risk category before one can be screened. It is not right that one cannot have a mammogram without being referred by a doctor.
It took ten years to roll out BreastCheck, a fantastic service. The service was only made available in Waterford last year. Why can we not extend it to women in their 40s? In providing a walk-in BreastCheck service for one hour in a particular area, women could make an appointment and undergo a routine check. If one is worried about breast cancer, one should be able to be screened without having to go through the rigmarole of having to pay a general practitioner to get a letter of referral. Screening is becoming a money-making racket. If we can do anything, we should extend breast cancer screening to women under 50 years of age.
The statistics are frightening. In 2007, 455 of the 600 women under 50 years of age diagnosed with breast cancer were in their 40s. I have experience of this in my close circle. I worked in a doctor's surgery and the number of women in their 40s who presented with breast cancer was staggering. I looked at a website and the information available for young women with breast cancer was trite. Women are in the prime of their lives in their 40s. They are rearing their children and looking after their aged parents. They are very important, socially and economically, to society. As we have said time and again, early detection is the only way we will be able to increase survival rates for women with breast cancer.
Áine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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I thank Senators for their positive contributions and many suggestions which I will take on board. This debate about cancer awareness on National No Smoking Day is timely. Lung cancer is the leading cause of cancer deaths in Ireland. Therefore, giving up smoking is one of the most, if not the most, important actions people can take to protect their health and reduce their risk of developing cancer and other serious illnesses. This debate presents an opportunity to reiterate that message.
Cancer awareness means being aware of what we can do to reduce our risk of developing cancer. It also means being aware of the signs and symptoms of cancer and seeking medical advice promptly. As many have said, prevention and early detection are central to the fight against cancer. In this regard, various charities play a very important role in society. They do this by raising awareness through various high profile campaigns such as the ongoing Marie Keating Foundation's breast cancer awareness campaign or the Irish Cancer Society's recent lung cancer awareness campaign. Such organisations play a pivotal role in providing up-to-date and accurate information and advice. These charities, with others such as Europa Donna, are to be commended for their efforts.
Cancer is a great burden on Irish and European society. Most people, at some stage in their lives, will be affected by it as a result of the diagnosis of a friend or family member with cancer or because they will become one of the 23,000 people diagnosed with invasive cancer each year in Ireland. However, there are many positives in cancer care. It is important to note that cancer has become a disease which people can expect to survive. The Minister for Health and Children, Deputy Mary Harney, has made it a priority to work towards the continuing improvement of cancer services. In recent years she has allocated considerable resources to cancer services and screening. With regard to services for those diagnosed with cancer, more than €56 million in development moneys has been provided for cancer programmes since 2007 to enhance and reorganise cancer services. The fact that an additional €20 million has been provided for cancer control measures this year, despite the difficult economic position, demonstrates the priority the Government accords to cancer services. The funding will be used for the development of a number of services, including those dealing with rectal cancer and brain tumours, and the further development of lung and prostate cancer services.
With regard to screening, BreastCheck and CervicalCheck are now national programmes. I strongly urge those eligible to avail of screening and respond to the invitations issued. The Minister also announced in January that work would commence on the introduction of two important screening and preventive programmes, namely, the HPV vaccination programme and the new colorectal cancer screening programme. Both programmes have been shown, through a health technology assessment by HIQA, to be cost effective and the decision to move ahead with them this year represents very good news.
I take the opportunity to remind people that screening programmes are aimed at those who do not have symptoms. Anyone who is concerned about his or her health should attend a GP who will refer him or her on, as appropriate. As has been said, it is important not to delay as early detection can significantly improve outcomes.
Senator Fitzgerald referred to waiting times. Those waiting for a colonoscopy are mainly non-urgent cases. In almost all cases urgent cases are being seen within four weeks. Last year the Minister introduced a target of 100% of urgent cases being seen within four weeks. Colorectal screening will be provided in ten to 12 centres around the country.
Senator O'Malley questioned the treatment of cancer in cancer care centres. Diagnosis is made by a multidisciplinary team and treatment provided based on clinical need. A major aim of the cancer programme was to provide an equitable system of diagnosis and care, regardless of where a person lived.
Many Senators referred to the use of sunbeds. The Minister intends to introduce legislation to ban the use of sunbeds by young people under 18 years of age. I urge her to prioritise such legislation.
The issue of placing pictorial adverts on cigarette packets was mentioned. This is provided for under the Tobacco Control Act. The regulations are being drafted with the assistance of the Attorney General.
Senator Ó Brolcháin referred to the National Cancer Registry which plays a key role in the examination of data and research. Its director, Dr. Harry Comber, is chairman of the scientific committee of the International Agency for Research on Cancer.
Some €170,000 in lottery funding was provided for the Sligo bus service in late 2008.
Regarding the HPV vaccination programme, in mid-January the Minister for Health and Children announced her decision to commence vaccination of girls in first year. Additional funding has been made available to the HSE to allow the programme under which 30,000 girls will receive three doses of the vaccine each year to be delivered as announced. The HSE is working closely with the Department of Health and Children to finalise the plan and the necessary arrangements which must be put in place to allow the programme to commence before the summer. Staff in the HSE who will carry out the HPV vaccination programme are completing the swine flu vaccination programme and also vaccinating additional school-age children with the MMR vaccine. This latter requirement arises because swine flu vaccination necessitated a delay in the MMR vaccination programme in certain areas and from the fact that in recent weeks there has been a significant rise in the number of measles cases, especially among the Traveller population. Each of these vaccination requirements is being considered. There is significant potential in the delivery of the vaccine, namely, in the prospect of it being delivered by nurses and at the same time as other vaccines provided for children in the school setting. Both developments will offset the impact on resources required for the programme and any possible impact on other services provided by these staff. These specific aspects form part of the details being finalised by the HSE. Yesterday the Department of Health and Children received a document from the HSE outlining a number of options for implementation of the HPV vaccination programme. An agreed plan, based on the commitments given by the Minister, will be finalised shortly.
Senator McFadden made a point about lowering the age group for mammography screening. There is limited evidence for the efficacy of screening women aged 40 to 49 years in reducing mortality from breast cancer.
It is fair to say services for the detection and treatment of cancer have never been better. As stated, up to one third of cancers may be preventable. It is true that healthy lifestyles do not guarantee continuing good health but, especially on National No Smoking Day, it is important to bear in mind that a significant impact on the incidence of cancer could be made by individuals making a change in personal lifestyle that would reduce their risk of developing cancer.