Improvements in services should lower regional disparities in cancer survival rates highlighted in a new report, writes Theresa Judge
Breast cancer services in the western region are now as good as, if not better, than those in the Dublin area, according to the regional director of cancer services in the west, Oliver McAnena.
McAnena, a surgeon at University College Hospital Galway, was responding to the latest report from the National Cancer Registry, which expressed concern over regional variations in survival rates.
The report covers the period from 1994 to 2001 and both McAnena and the Irish Cancer Society stress that there have been major improvements in services since 2001.
However, the Irish Cancer Society has questioned why the HSE has still not advertised the post of national director of cancer control, a position it agreed to create last June.
This position was recommended in the National Cancer Control Strategy last summer, and, according to the Irish Cancer Society, is a "crucial step" in upgrading services and guaranteeing uniformity of care through the State.
"The cancer control strategy recommended proper cancer control networks, with the country divided into four regions. But unfortunately progress in its implementation has been very disappointing," says John McCormack, chief executive of the Irish Cancer Society.
McCormack says there have been "plenty of meetings and plenty of talk" since last June but adds: "The difficulty is we haven't seen action."
Coincidentally, when McCormack raised the issue on national media last week of the delay in advertising the post of national director, when responding to the new cancer registry report, the HSE then issued a press release saying it "expects shortly to begin recruitment".
When asked by The Irish Times if it could state when the post would be advertised, the HSE said it could give no specific date as yet.
A spokesman said the job description was "being finalised" and the reason it was taking some time was because the HSE was planning to recruit "a high-profile international expert".
He says delays in advertising the post are due to the preparatory work involved in the new national cancer control programme.
"This new directorate will bring together services from the community, the hospitals and health promotion. It has taken time to ensure all of this is done properly," he said.
Plans for this merger were currently being drawn up, he added, and one of the primary objectives of the cancer control programme was to ensure uniformity of services throughout the State.
McCormack stresses the importance of developing cancer services, pointing out that currently 22,000 people a year get cancer in the Republic but that this will grow to 44,000 by 2020, mainly because of the ageing population.
Mortality, however, is not expected to increase at the same rate. Some 7,800 people die from cancer each year.
Overall, the report from the National Cancer Registry Patterns of care and survival of cancer patients in Ireland 1994-2001, found improvements in overall survival rates - as compared with the period pre-1994 - for breast, colorectal and prostate cancers, while there was no significant improvement for lung cancer. These are the four cancers covered by the report.
Report author Paul Walsh, of the national cancer registry, says such improvements "are to be expected in any developed country".
He says survival rates, measured five years after diagnosis, in Ireland - 75.4 per cent for breast cancer, 69.5 per cent for prostate cancer, 49.2 per cent for colorectal cancer and just 8.6 per cent for lung cancer - were slightly below average EU rates at about the same time period.
However, Walsh adds that figures for EU averages include eastern European countries where survival rates can be much lower than the EU average and we would not compare so favourably to more richer western European nations.
Walsh says that one of the main points of the report is "the lack of consistency across the country both in treatment and in survival rates".
The report uses survival rates in the eastern region - covering the old Dublin health boards - as a reference and compares survival rates in other areas to these.
The report states: "Regional variation in survival is still apparent . . . with survival generally lowest for patients resident outside the eastern region, except for lung cancer."
It also states: "At regional scales, there is still substantial variation in the use of particular treatment modalities. These variations are largely unexplained by patient and tumour characteristics, suggesting that geographic and institutional influences on treatment may be critical."
Walsh says a number of regional variations are statistically significant - for example, the chances of a person with colorectal cancer in the southern region dying was 24 per cent higher than for a person with the disease in the Dublin area between 1994 and 2001.
For breast cancer, in the west a patient's chances of dying was 26 per cent higher than for a patient in Dublin, while the chances of dying in the midlands were 28 per cent higher than in Dublin.
Walsh also points to some large differences in terms of treatments. For example, a woman with breast cancer in the west was 62 per cent more likely to receive hormone therapy than a woman in the east and a woman in the south was more than twice as likely to get hormone therapy than women in Dublin.
He says these findings raise the question of whether women may have been getting hormone therapy when they should have been getting other treatments. The use of radiotherapy for breast cancer in the west was also much lower than in Dublin.
Walsh also says that some other preliminary analysis done by the cancer registry shows that up to 2002 "the proportion of breast cancer patients having breast conservation surgery does vary markedly".
The findings indicate that women in some regions may have been having mastectomies as opposed to breast conservation surgery in combination with radiotherapy.
McAnena, accepts that in the past, "before the arrival of radiotherapy in Galway far more people were getting mastectomies than needed to".
He insists, however, that there have been very significant improvements in cancer services in the west over recent years, particularly since a radiotherapy unit opened in March 2005.
He says there is now a breast cancer network centred in Galway with links to Sligo and Donegal and there is a multidisciplinary team in place, following international best practice.
"I don't think there is a service anywhere in the country as good as it. My only concern would be that services in the east may not be as good as in the west," McAnena says.
He says there is "no doubt that there is a physical problem in relation to Donegal" and its distance from services, but points out that a new accommodation unit with 30 rooms has been opened in Galway for patients receiving radiotherapy. This facility was paid for entirely by a charity, Cancer Care West.
McAnena says that while services have improved hugely and that he is now confident Breastcheck will be extended to all of the State by the end of this year, it is "very frustrating" that it has taken so long.
In 2003, the Government promised to extend Breastcheck nationwide by 2005, but the target now is December 2007.
McAnena says he believes more attention should be paid to cancers such as colorectal and some less common types such as intestinal. Within cancer services in Galway now, he says, the focus is on getting specialists for less common cancers.
What he would ideally like to do is establish "a comprehensive cancer unit with a separate door" from the main hospital in Galway, as this would ensure that cancer patients did not have to compete with A&E patients for beds. While surgery has rarely been cancelled because of A&E patients getting beds first, "it has happened on occasion", McAnena says.
John McCormack, from the Irish Cancer Society, stresses that in all cancers early detection is crucial and he urges anybody with concerns over "lumps or bumps, bleeding or some change in bodily habits" to go get checked out by their GP. He points out that some 20 per cent of women who get appointment letters from Breastcheck do not respond.
Women should remember that nine out of 10 breast lumps are not cancer, he says.
The Irish Cancer Society helpline number is 1800-200700 and the e-mail address is helpline@irishcancer.ie.