Why should women of Ireland be happy with the current state of cervical screening
18 April 2006
On bad days I feel it would be easier to promote the establishment of a heart transplant unit in Tullamore Hospital, particularly while it is in the constituency of the Minister of Finance, than get much needed but simple measures taken in the Health Service.
The recent publication by the National Cancer Registry and the Women's Health Council entitled Women and Cancer in Ireland 1994-2001 was not a cheerful document. The five-year survival rate for both breast cancer and cervical cancer in Ireland was below the European average. The only countries with lower survival rates were Scotland, Estonia, Poland and Slovakia - the latter three being the only former eastern European Countries mentioned. All of the other western European countries were better than us and the United States of America had a higher incidence of both cancers and a much higher - 33 percent -survival rate than us. It was suggested in the text of the report that higher survival rates were associated with screening.
Every Wednesday evening when the Seanad is sitting there is a debate called Private Members' time where a Party or a member of the Independent group chooses a topic for the debate of the evening. It is possible for an amendment to be put down by opponents or friends and this usually happens.
It was my turn to choose the topic for Private Member's time so, supported by my Independent colleagues, I put down a motion that, in view of the fact that cancer is the second most common cause of death in Irish women and that death rates were higher than in other European countries, it was regrettable that the successful cervical cancer screening programme in the Limerick area had not been extended nationwide. I also mentioned the slow pace of the roll-out of BreastCheck, the failure to set up a pilot programme for colorectal cancer screening, the paucity of clinics to see people with a genetic predisposition to certain cancers and the lack of equity of access to specialist treatment throughout the country.
The Government parties put down an amendment commending the Government for "the unprecedented investment in the development of diagnostic treatment and care services for people with cancer, particularly in the area of women's health" and acknowledged the great aspirations the Government has to improve treatment and so on.
I found this all very depressing. Why should the women of Ireland, one of the richest countries in the world the Government keeps telling us, be grateful that our five-year-survival rate is "only 4 percent below the European average" as Minister O'Malley (the unfortunate person sent in to take the debate) said in the Ministerial reply to my motion? Why should we not be in the company of Swedish, German and French women with better survival rates? Why should we aim at the lowest common denominator?
The idea of cervical screening here began in 1992. It took until 2000 to get the pilot project under way in Limerick, Clare and North Tipperary in a primary care setting and it seems to be a success. Now, I'm delighted with five-year programme regarding cervical cancer, which is to take place in the Coombe Hospital, but will it mean a slow-down in, to quote from the Government amendment, "the recent decision of the Táiniste and Minister for Health and Children to ask the HSE to propose the roll-out of the Irish Cervical Screening Programme"? Please note, "to propose the roll-out".
It is profoundly depressing that there seems to be no sense of urgency about this issue. Seventy plus women die of cervical cancer every year in this country. The average age at death is 56. A friend of mine who lived in Dublin died last year - she was in her mid-forties. If she had lived in Limerick, she would have been called for screening and might be alive today because cervical cancer has a very good cure rate if detected early.
Every year seventy families are deprived permanently of a wife, mother, sister, or daughter. Why should we continue to accept this?
Worse still, when we first started talking about screening for diseases in this country one of the obvious impediments was the lack of a National Population Register here. A National Population Register would give us accurate information on the make up of the population so that on a given day we could, for example, say how many women were celebrating their twenty-fifth birthday and where they lived, so that they could be contacted for their first cervical screening.
Senator John Minihan brought the issue of a National Population Register up in this debate. I have brought it up on and off over the years, asking for progress on setting one up. There appears to be very little action even though some sort of "progress report" was promised a year ago.
Trying to get relatively simple, often cheap, very effective initiatives especially in the Health Service is nearly impossible. I have written to the Minister asking if opportunistic screening by GPs, especially in lower socio-economic areas could be promoted, women from lower socio-economic groups having the highest rates of cervical cancer and being least likely to be able to afford the €50 to €65 that patients have told me they are charged for "private" screening.
All over the country we lack physicians in respiratory medicine, rheumatology, neurology, all disciplines which are associated with chronic disease and not "sexy" to use that dreadful adjective. Why are there no rheumatologists in Letterkenny or Sligo hospitals? Transport in that part of Ireland is notoriously bad - try the Sligo train sometime. Comhairle na nOspidéal supports the appointment of more rheumatologists around the country.
Another of my Senate colleagues, Joe McHugh bewails the plight of patients trying to get treatment in Donegal and it's not as though there aren't enough patients with arthritis there to justify a specialist team being set up. Now that we know how important it is to give patients with acute rheumatoid arthritis treatment as soon as possible why are such relatively cheap appointments not made? It leads to use of acute hospital beds when the patient is in more trouble. He points out that the incidence of multiple sclerosis in that part of the country is our highest and asks for a cross-border neurology service with Altnagelvin Hospital in Derry - why not?
All this moaning has not cheered me up and if I felt the situation would be any better this time next year I would say so. One has little power in the corridors of Leinster House. All I can do is point to the inadequacies in our health service. They are easy to find.
Senator Mary Henry, MD
