There is an urgent need to improve services for breast cancer patients across the State, the president of the Royal College of Surgeons in Ireland has said.
Prof Niall O'Higgins told a weekend conference that, six years on from the publication of a report on the development of services for symptomatic breast disease in the Republic, some treatment centres were developing well but others were not.
"There exists a lack of co-operation and co-ordination which is so essential to eliminate the inequalities of access to high-quality, modern standards of care which undoubtedly remain," he said.
"To an extent, therefore, availability of such care is like a lottery depending on geographical location. The service remains patchy. There is an urgent need to improve and refine services all over the country. We must do better soon."
Progress on implementing the 2000 report had been disappointingly slow, he said, due to "local politics, medical politics, administrative difficulties, lack of co-ordination".
Prof O'Higgins reiterated that results were better for patients treated in larger centres, where a larger number of patients are cared for and where all the specialists work together in a co-ordinated team.
"This integrated teamwork is not just a desirable ambition, it is essential for improvements in survival. What might have been considered adequate care a decade ago is no longer acceptable because evidence now indicates a 25 to 30 per cent survival improvement for women treated in high-quality centres. This improvement is not associated with an individual doctor or specialist. It is the system of care which makes the difference.
"It is not possible to have such systems of excellence in every hospital. Apart from the expense involved, it would never be possible to provide sufficient throughput of clinical activity to maintain skills. It is therefore essential that breast cancer treatment be provided in a small number of designated sites and that these hospitals be provided with all the staff and facilities needed to supply such care."
The Government's new national cancer strategy, based on these principles, is due to be published shortly. An action plan for its implementation is now being devised. Guidelines are also being drawn up for ways to regularly audit the performance of centres providing breast cancer services.
These will mean there will no longer be room "for self-congratulation that 'our unit is doing well' without evidence", Prof O'Higgins said.
Meanwhile, he said, it was unfortunate the same quality service was not available to women with breast cancer symptoms as those with none.
"Unfortunately, the same high quality that exists for screening does not fully extend to the symptomatic service and we have to admit this. There is something unjust about a system that rightly provides an excellent service for women who have no symptoms and a patchy, suboptimal service for women with breast symptoms, all of whom are anxious and distressed."
It was time, he stressed, to move to appoint a specific co-ordinator or director to implement the changes required.
Prof O'Higgins was speaking at a conference on breast cancer in Dublin on Saturday, organised by Europa Donna Ireland.
Prof Alberto Costa, director of the European School of Oncology in Milan, told delegates that nobody could treat breast cancer by him or herself any longer. There were now so many types of breast cancer that a whole-team approach, including input from a pathologist, was now required.
Every year about 2,000 Irish women are diagnosed with breast cancer and about 650 of them die.