PUBLISHED IN 2006, the National Cancer Forum’s Strategy for Cancer Control in Ireland set out a vision which promised to reduce our cancer incidence, morbidity and death rate relative to other EU countries by 2016. Halfway through the 10-year lifespan of this strategy, how has the landscape changed for the 27,000 people who are diagnosed with the disease in the Republic every year?
There have been many positive developments: damaging breast cancer scandals that led to widespread public concern about the quality of cancer services have been put behind us. Women are now treated in eight specialist cancer centres operating to best practice guidelines. As a result of this multidisciplinary model of care, patients with breast cancer can expect a 15 to 20 per cent greater chance of surviving. Screening for cancer of the cervix is now available countrywide, with a screening programme for colorectal cancer for older men and women due to be introduced next year. And a free vaccination programme against cervical cancer for 12- to 13-year-old girls is up and running.
According to Dr Susan O’Reilly, director of the National Cancer Control Programme (NCCP), there is a 5-6 per cent improvement in survival rates to be gained for a range of cancers other than breast. With the network of cancer centres in place, attention is being directed at rationalising the care pathways for these cancers. The treatment of lung cancer, the malignancy with the poorest prognosis, is now offered in four of the eight centres, although rapid access assessment clinics are located in all eight. There is an urgent need to improve the miserable statistic of just 12 per cent of people surviving five years after diagnosis.
Prostate cancer, the screening for which some recent studies have shown does not reduce its mortality, will be treated in six of the eight cancer centres, with rapid-access diagnostic clinics available through the network.
The second commonest cancer in both men and women is bowel cancer. Ireland has the highest mortality rate for bowel cancer in western Europe due, in part, to the majority of cases being diagnosed at a relatively late stage. While the forthcoming screening programme will help earlier diagnosis, there is a need to improve our treatment performance. It is proposed to confine the more challenging surgical treatment of cancer of the rectum (the last 15cm of the large bowel) to the eight specialist centres by the end of this year. Somewhat surprisingly, however, the management of cancer of the colon is to remain in 15 of the State’s acute hospitals. In this regard, the NCCP must ensure the same rigorous standards and multidisciplinary care models are applied to the seven hospitals which will treat colon cancer patients but which are not part of the spine of cancer hospitals underpinning our national cancer strategy.
More broadly, controlling cancer in the Republic is a long-term project. And although real progress has been made, much work remains if we are to match the performance of other EU states.