The breast clinic at St James's Hospital is one of the best organised in the Republic. Yet it has achieved this status,"in spite of, not because of our National Cancer strategy", according to sources at the hospital.
As can be seen from the accompanying table, it routinely records the kind of performance data which is now mandatory in all units in Britain. This has been done for the best professional reasons but regrettably without any prompting from the Government.
The clinic offers genuine rapid access for a patient with a worrying breast lump. Her GP faxes a proforma to the breast cancer office in St James's. This information is evaluated by a breast care nurse in conjunction with a specialist breast surgeon and the patient is offered an appointment within two weeks.
When she arrives for her appointment, the specialist nurse talks the patient through what lies ahead.
The assessment of a suspicious lump involves three separate approaches: an examination by a consultant surgeon; a mammogram [specalised x-ray of the breast] which is reported on by a radiologist on the spot; and if appropriate, the aspiration of fluid from the lump by a specialist pathologist, who then examines the cells under a microscope to see if they show any changes suggestive of cancer.
Eighty per cent of patients receive a same-day diagnosis. This is particularly reassuring for the majority of women who will be told the problem is benign. But even for the unlucky 12-15 per cent who have cancer, they are immediately counselled by the nurse and the surgeon.
Before they leave, they have an appointment for surgery which takes place within days of the diagnosis, according to consultant breast surgeon Mr Terry Boyle.
All cases seen in the Triple Assessment Breast Clinic are discussed at a weekly multidisciplinary conference. Patients with a malignancy are discussed a second time after their surgery, when all the pathological information is available. This means each case is reviewed from both a diagnostic and a treatment point of view.
The patient will be seen at the oncology clinic one week after discharge from hospital. As well as discussing chemotherapy with the consultant oncologist, she will have the opportunity to meet a consultant radiotherapist, who holds his clinic at the same time. Usually chemotherapy lasts for three to six months, followed by radiotherapy in St Luke's Hospital in certain cases.
Dr John Kennedy, consultant oncologist at St James's, says that "everyone goes through the same consultant-delivered evaluation regardless of whether they are a public or a private patient". He says that the St James's service is even more co-ordinated than the one in the world-famous Johns Hopkins Hospital in the US, where he worked previously.
However, he has one major concern. The O'Higgins report into breast-cancer services, which recommended regionalisation of breast cancer treatment so as to reduce deaths by 20 per cent, has not yet been implemented. It means services in many other centres around the country remain unco-ordinated.