Catherine Ardagh (Fianna Fail)
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In this Commencement matter, I call on the Minister for Health to provide an update on the pilot lung cancer screening programme and to indicate when a full programme will be rolled out nationally.

Lung cancer is one of the biggest killers in Ireland, accounting for 22% of cancer deaths in males and 20% of such deaths in females. There are 2,500 new cases of lung cancer diagnosed every year and 1,800 deaths annually. Unfortunately, approximately 70% of lung cancers are currently detected at quite an advanced stage, with most at stage 3 or 4 at the time of diagnosis. Late presentation of lung cancer limits the treatment possibilities. However, the good news is that there are really good treatments available when lung cancer is diagnosed at a very early stage. The other good news is that Ireland is very good at targeting the causes of lung cancer. We have made great strides in terms of banning tobacco and are making great strides with regard to vaping. We are really leading in that area across Europe. However, what is missing is screening. Evidence shows that lung cancer screening detects lung cancers at an early stage and we have the drugs to successfully fight early-stage lung cancer.

There are pilot programmes ongoing in Ireland and the United Kingdom and the data indicate that lung cancer screening programmes are effective. In Ireland we have three screening programmes for cervical, bowel and breast cancer. Those screening programmes are very important because they catch many cancers at an early stage. While there may be certain issues or problems with the current screening programmes, that should not prevent us from rolling out a lung cancer screening programme.

I wish to highlight an important issue with regard to lung cancer in Ireland. We often hear that cancer does not discriminate but in Ireland cancer does discriminate. Cancer in this country disproportionately affects those living in marginalised areas because they do not have adequate access to a GP in order to get an early diagnosis.Nearly 50% of lung cancer patients are getting diagnosed at a late stage in emergency departments, especially those from disadvantaged areas. Access is a huge problem. I am calling for a national lung cancer screening programme that will take away any inequality because it will be available to all of the public and everyone will get a chance to have their lungs screened and have access hopefully to the many amazing treatments that are out there. We need early detection and a screening programme and we need equality of access to medical care.

Jack Chambers (Dublin West, Fianna Fail)
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I thank Senator Ardagh for bringing this important issue to the House. I am taking this on behalf of the Minister for Health, Deputy Donnelly. As a Government, we are fully committed to supporting our population screening programmes, which are a valuable part of our health service. Lung cancer screening is receiving increasing attention and the international evidence in this area continues to build. An updated European Council recommendation on cancer screening was published in December 2022 and it recommends the gradual introduction of screening for new cancers. Ireland will be actively engaged at European level to take forward the updated recommendation on cancer screening, informed by the evidence and advice emerging from the wider international work in this area. Ireland has always strongly advocated for the implementation of smoking cessation policy in tandem with the introduction of screening for lung cancer. Ireland also welcomes the emphasis on equity and on the importance of ensuring participants in cancer screening programmes are as informed and empowered as possible.

I am aware that lung cancer is the leading cause of cancer death in both men and women in Ireland. However, five-year survival rates for lung cancer in Ireland have increased greatly from 9% to over 24%. Treatment for cancer is centred on eight designated cancer centres, with rapid access clinics providing diagnostic services for lung tumours. It is important to emphasise that our policy priority continues to be a focus on primary prevention. We know that nine out of ten lung cancers are caused by tobacco consumption, so we continue to do what we can to drive down our smoking rates. There are several initiatives in place in Ireland in relation to smoking cessation. These are recognised as an important element of a comprehensive tobacco control strategy. Among many other initiatives, the Department of Health is progressing legislation that requires the licensing of every retailer of tobacco products in Ireland. It bans the sale of cigarettes from self-service vending machines and at locations intended for children and events organised for children. A range of measures have been introduced to further reduce the use of tobacco and nicotine-inhaling products such as e-cigarettes, particularly among young people. We have also undertaken a range of measures to help people quit smoking such as the QUIT campaign that uses real life stories. Cost is regularly highlighted as a barrier to accessing or adhering to nicotine replacement therapy. Therefore, the removal of VAT on all nicotine replacement therapy was a longstanding recommendation in the Tobacco-Free Ireland policy. In addition, we have year on year increased the price of cigarettes.

With regard to lung cancer screening, I understand that researchers in the Royal College of Surgeons Ireland, RCSI, and Beaumont Hospital are currently preparing to run a pilot of lung cancer screening in Ireland, with funding from the Irish Cancer Society and the European Union. The pilot will provide valuable information on the feasibility of implementing lung cancer screening in the Irish context, including the best methods to identify the target population of high-risk smokers and ex-smokers. As the Senator may be aware, decisions on whether to introduce new screening programmes, are made on the advice of the national screening advisory committee, NSAC. All population cancer screening programmes are associated with both benefits and harms, and lung cancer screening is no different. It is important we have rigorous processes in place to ensure our screening programmes are effective, quality-assured and operating to safe standards. The NSAC will consider the updated European Council recommendation on cancer screening and advise the Minister and the Department of Health on the evidence as it applies to Ireland. In light of all this, I trust the public can be assured of the Minister’s ongoing commitment to further expansion of population-based screening in Ireland.

Catherine Ardagh (Fianna Fail)
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I would just like to follow up on that. European, Dutch and Belgian trials confirmed that very low dose CT screening in people at high risk of developing lung cancer demonstrated a reduction in mortality rate of 26%. This is factual scientific evidence. The European Respiratory Society has urged countries across Europe to implement lung cancer screening programmes without delay. The technology in this area is advanced. As legislators and policymakers, we are always going to be a little behind the technology and the medicine but it is time for us to listen and to implement a lung cancer screening programme without delay because there is a rapid increase in the incidence of lung cancer in Ireland.We must ensure that we maintain best international standards and that, as legislators, we have the best medicine in place for our citizens.

Jack Chambers (Dublin West, Fianna Fail)
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I thank Senator Ardagh. I reiterate that the national screening advisory committee will consider the updated European Council recommendation on cancer screening and advise the Minister for Health and his Department on this evidence. We are committed to the further expansion of screening in Ireland in accordance with internationally accepted criteria and best practice. I assure the Senator that Ireland will be actively engaged with the significant ongoing collaborative work at a European level to take forward the updated recommendation on cancer screening, including work on lung cancer screening. The Senator referenced some trials in Belgium and the Netherlands. That is why we have a structure to take the evidence. In addition to screening and diagnostics, we must ensure there is a focus on primary prevention around cessation of smoking. Radon control was also implemented as it has an impact on lung cancer specifically. It is important that is not forgotten as a cause. It is important to remind everyone that screening is for healthy people without symptoms. If someone becomes aware of symptoms or has concerns or worries, they should contact their GP who will arrange appropriate follow-up care.