Cancer Treatment Services: Statements
Dr. Henry: I welcome the Minister of State. This is an important issue because cancer and cardiovascular disease are the most common cause of death in the country. I am indebted to the National Cancer Registry which published, in March, the Cancer in Ireland Report 1994 to 1998. I commend all those who compiled it because it is a comprehensive and useful document.
The statistics contained in the report are, at times, cheering, but they are also a matter of concern. They point out that the survival rates, at five years, for non-melanoma skin cancer and even melanoma are quite high. In the case of non-melanoma cancers, every case should be cured and, mercifully, that appears to be the case. The good thing is that the lesion can be detected on the skin and the patient can bring it to the attention of their doctor at an early stage. Melanomas cause more of a problem, because they can spread rapidly early on. I was interested to see that in five years the survival rate in women was 85%, while that in men was 68%.
There are many aspects of the report that I would like a sociologist to examine. Was that difference in the survival rate due to the fact that men with skin lesions waited longer than women to have them seen to? Do we need to educate men about the essential fact of seeing a doctor as soon as they detect a skin lesion, particularly in view of the fact so many of these cases occur in people working out-of-doors and in the west? As we know, sunlight is a major contributor towards non-melanoma and melanoma skin cancer. We must consider the areas of the report to which I refer and examine whether further education is needed.
Lung cancer is one of the worst scourges. I support the Minister for Health and Children, Deputy Martin, in his desire to completely ban smoking in pubs and restaurants because of the awful risks to members of the public. On the Order of Business this morning, Senator Michael McCarthy raised the issue of a man who was stabbed to death in a New York pub because he objected to the fact that another inhabitant of the pub was smoking. The risk that Senator McCarthy, if he is a smoker, might die of lung cancer is far greater than that of his being stabbed to death in a pub - bad and all though the behaviour of people may be in such establishments, even those in Dublin.
I am concerned that the incidence of lung cancer among young women is decreasing to any great extent. This is an area that we need to tackle. A recent article in the New England Journal of Medicine stated that smoking is worse than sunlight in terms of the skin-ageing process. One can always identify heavy smokers, even if they gave up the habit many years before, when they come to visit one. It is known that the collagen within the skin thins dramatically in people who are smokers. We must emphasise this fact in the case of young women. When they are 18 years of age, they never think they will reach 50 years of age and that they will not want to look like a saddlebag for a camel when they do so.
It is on areas such as this that we need to focus in order to try to encourage people to stop smoking. We could be facing a situation where there will be an epidemic of lung cancer in women in their 40s and 50s. I also read an article which stated that in Tower Hamlets in London, for the first time ever a year or two ago, lung cancer beat breast cancer as the most common form of cancer in women. This is the first health board area in England where this has happened. I do not think it has happened in Ireland. Everything we can do about cancer and its prevention must be done.
The Minister for Health and Children should be applauded in his efforts to prohibit smoking. In Canada, where the prohibition on public smoking is in vogue in almost all the cities I visited, people had a good time in the pubs without smoking. They informed me that the bar trade had initially cut down slightly, but that the table trade, where people were eating, had gone up and this made up for it. I did not meet one member of staff in either Ottawa or Halifax who was not glad that the ban had been introduced. I hope the Minister for Health and Children persists with his intentions in respect of this area.
There are very good details given in the report about the influence of sex, age and stage of diagnosis on the likely outcome. Women appear to do better than men, in most instances, regarding survival rates. I am concerned about the situation regarding men with symptoms who may be less likely than women to go to doctors at an early stage. General practitioners will state that men are inclined to let things go that bit further than women before making a visit to the doctor. Bladder cancer is an exception. I do not know if women would not notice blood in the urine, which is the main sign of cancer, or do they put up with cystitis more readily than men might. All these issues need more investigation to ensure that people go early to their doctor.
People who are younger are likely to do better than older people in cancer treatments. We must take into account that older people may die from other conditions in the five year survival period. From the report, it appears that older people were not necessarily as aggressively treated with specific anti-cancer therapy as younger people. A 70 year old woman with breast cancer is as entitled to radiotherapy or chemotherapy as is a 50 year old woman. I realise that in cases where particular cancers have spread, people may decide that the treatment is too dreadful. A friend of mine who was undergoing chemotherapy recently, told me she could only describe it as horrific. It is not like that for every patient. However, everyone is entitled to decide what treatment they will undergo. Older people may, perhaps, be less likely to agree to aggressive treatment, but they must be offered it and we must ensure that ageism is not practised in respect of cancer treatment.
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There is unfortunately a distinct problem regarding geographic spread as to where one is likely to receive treatment. In the west, for example, while people with breast cancer are undergoing more radical surgery, they are not receiving radiotherapy when it might be extremely important for the condition. That is a problem of distance from a radiotherapy unit. While we cannot have a radiotherapy unit at every corner, we need to have a better spread.
Stage of diagnosis was one of the most important points made in the report, with particular reference to the five year survival rate of those who had progressed to stage 4, where the cancer had spread to distant organs, for example, bone, the brain, liver or lung. Their survival rate was much lower than those diagnosed when the initial cancer was at a very early stage.
The type of cancer is important because cancer of the ovary unfortunately is inclined to be diagnosed quite late because people do not have symptoms until quite late and sometimes the symptoms are rather obscure. For example, I have frequently known cancer of the ovary to present as a deep vein thrombosis in the leg. While it accounts for only 3% of cancers in women, it accounts for 6% of deaths within five years.
We also know that there is a genetic basis in the case of both breast and ovarian cancer. It is not that common but we do have to try to pick out those groups most at risk of breast or bone cancer and the families in which they occur are entitled to screening. I have spoken several times in this House about the fact that the national centre for medical genetics in Our Lady's Hospital, Crumlin, which screens for breast cancer is squeezed for money. I do not know if it has run out of money but it undertook a pilot project which was incredibly successful following which it received another €80,000 to continue for a little longer and the last I heard was that it was going to have to let three of its technical staff go. If that happens, it means it simply will not be able to screen the blood samples taken from patients like this, which is really very bad, particularly in view of the fact that we now also know that the cancers which have a genetic predisposition require different treatment from those which do not and we certainly want patients to have the optimal treatment. Ovarian cancer presents a big problem regarding late diagnosis, as does cancer of the pancreas when, once again, late diagnosis leads to a much higher mortality rate. For example, in both men and women cancer of the pancreas accounts for only 2% of cancers but 5% of deaths.
Let me move on to breast screening. It is extraordinarily important that we provide for screening all over the country. I know the Minister for Health and Children has promised this but what does that mean? He has no money. It is the Minister for Finance who has to promise that there will be breast screening.
Senator Glynn talked about a prostate specific antigen and screening for prostate cancer which, combined with a clinical examination, does appear to be worthwhile. I must praise those involved within the construction industry who initiated a free screening programme for their members. This was useful, even in trying to get men to take a better interest in their own health. Such screening programmes are costly and have to be shown to be cost effective. I do not know if the incidence of prostate cancer or breast cancer is greater but, again, we have to look at environmental factors because both cancers occur in fatty tissue and there are constant worries about pesticides, herbicides and so on. In a country such as this we really must have ongoing research in these areas.
We cannot rely on the research of others. Why is breast cancer more common in the Po Valley than in the south of Italy, say in Sicily? There is a big difference in diet. In the Po Valley it is mainly dairy based whereas in Sicily it is based on olive oil. Could this have to do, for example, with the spreading over decades of various organophosphates, organochlorides and so on, which are taken up through the grass, eaten by cows and then consumed by us? We have got to be involved in research in these areas.
In another way delay in diagnosis is a problem which we and, particularly, the Minister of State and his Department have to address. There is a terrible delay in general practitioners getting appointments in hospitals with specialists in various disciplines. This is a very serious problem. Some hospitals, however, have managed to give priority slots, for example, in the case of symptomatic breast cancer. I think six Dublin hospitals now do this whereby every Thursday one has exactly what one would want. Patients are referred, seen during the preceding days and get immediate appointments. There are ten slots available. General practitioners are only to refer symptomatic cases and I gather are very good about doing this. The team meets on the Thursday and looks at mammograms, X-rays, blood test results, clinical reports and so forth. The surgeon, oncologist, radiotherapist and so forth then decide the best line of treatment for the person concerned. This is what we want. All round the country this will have to be tackled.
I know there are problems with the medical profession. I looked at the findings of another survey recently which indicated that some doctors were undertaking serious cancer surgery in only ten cases a year, a huge proportion which, perhaps 60%, involved breast and colono-rectal cancers, another very important problem. There are also problems, however, with local politicians who say women in their area should not have to travel that but if they have to travel 20 miles down the road to receive better treatment, surely to heavens they must be persuaded to do so. We cannot have the Taoiseach going to Castlebar and announcing that all will be well there, that they will get their own unit if there are not enough cases being dealt with. This is a very important matter.
When one hears of elective surgery being put off, as happens every day in our hospitals, frequently they are cancer cases. There are further delays due to problems with acute beds being blocked. Something has to be done about freeing these beds in order that patients will not be contacted by telephone in the morning and told their operations for breast cancer, stomach cancer, colono-rectal cancer are off because every day matters. It is totally unfair on them that this is happening. This is the area where we, as legislators, are important and have to ensure there are no delays. We have to educate patients to go rapidly to their general practitioners and the centre of excellent primary health care in general. First, however, we have to ensure they will get a rapid appointment with a suitable specialist and, when an operation is considered essential, will be brought into hospital without further delay and will receive the cancer specific treatment they need as rapidly as possible. I frequently meet people who have had either radiotherapy or chemotherapy put off for weeks because there was no bed available for them in the hospital.
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