‘Countless’ lives saved from cancer due to Belfast Agreement

Belfast Agreement led to greater cross-Border collaboration on cancer and more research opportunities in US

It has been estimated the Belfast Agreement has saved almost 2,500 lives that would have been lost to violence had the historic peace deal in Northern Ireland not been signed 25 years ago.

However, the accord has been a lifesaver in other, less remarked-upon ways, notably in how it has resulted in improved cancer services and research on both sides of the Border.

The Republic and Northern Ireland have transformed their cancer care in the quarter century since the agreement, with some of the credit due to increased collaboration between the two jurisdictions, and with cutting-edge US research institutes.

“Northern Ireland was not a good place to be if you had cancer in the 1990s, Prof Mark Lawler, a cancer researcher at Queen’s University Belfast, recalls,” and the situation in the Republic was not much better”.


Cancer services were fragmented and there was a wide variation in the provision of treatment. Two-thirds of surgeons in the North were performing fewer than 10 operations a year, leading to low skill levels. In the Republic, there were nearly 40 centres treating breast cancer and, consequently, little specialist provision. Research was at low levels on either side of the Border.

Within a year of the agreement, a memorandum of understanding was signed in Stormont between the departments of health in the Republic and the North and the US National Cancer Institute.

Prof Lawler, a Dubliner working in the North, was there for the signing, and remembers the “excitement and sense of once-in-a-lifetime opportunity” pervading the corridors of Stormont as the agreement was sealed.

He credits Prof Paddy Johnston, who had just returned to Queen’s from the National Cancer Institute, for having the foresight to seize the opportunity that opened up after the Belfast Agreement. “He saw in the Good Friday agreement a unique opportunity to significantly shift the dial, by creating what at the time was a unique initiative, brokered between the governments of Ireland, Northern Ireland and the US,” Lawler recalls. Sadly, Johnston died at the age of 58, six years ago.

In the years that followed, cancer services were consolidated, research efforts multiplied and a flow of Irish scientists travelled to the US to pick up incomparable experience.

In the North, breast cancer mortality fell 30 per cent. By 2013, its five-year survival rate of 82 per cent was the best in the UK. Lawler points to a “significant improvement” in oesophageal cancer survival rates.

Cancer research collaborations doubled, he says, “and the quality was much better”.

Some 550 Irish doctors trained at the National Cancer Institute and returned home with new skills to bolster research and care.

Cancer trials, which were “fairly rudimentary” in the 1990s, according to Lawler, expanded massively – 30,000 Irish patients have been enrolled on them in the last 25 years.

“All of this work has saved thousands of lives and greatly improved the quality of life of people with cancer,” he says.

But would cancer services have improved anyway? “I don’t think it would have happened on the scale it did. The impact was five times greater than if we had done nothing,” Lawler responds.

“Some things might have happened, but the clinical trials infrastructure would not have developed as rapidly.”

Today, services in the Republic outperform those in the North, which has “taken its foot off the pedal”, he says.

The impact of the Belfast Agreement on cancer services will be discussed in one strand of a major international conference on the agreement in Queen’s on Tuesday.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times