ANALYSIS:IT'S JUST over a year ago since Susie Long first came to public attention when she highlighted how her seven-month wait for a vital colonoscopy in the public health service meant her bowel cancer wasn't picked up until it was too late.
By the time she was eventually called for her colonoscopy - an internal bowel examination - her cancer had spread. She died last October.
Taoiseach Bertie Ahern told the Dáil that "very regrettably, the system did not live up to its standards" in her case.
Minister for Health Mary Harney said what happened was "intolerable" and the State's new interim director of cancer control Prof Tom Keane described the case as "totally unacceptable".
However, 12 months on, figures obtained from hospitals across the country by The Irish Times and published today indicate patients referred by their GPs for colonoscopies can still be waiting a year or more to be seen.
Hospitals stress that referral letters from GPs are read by consultants and prioritised accordingly. Patients classed as "urgent", they say, are seen quickly and that only "routine" referrals can have to wait for long periods.
However, the reality is that the long waiting times for routine referrals could be putting more patients' lives at risk.
Among these routine referrals would be people who have a history of bowel cancer in their family and who want the test for reassurance - the so-called "worried well". Also among them though could be patients with early stage bowel cancer who, as a result of the length they have to spend waiting, may not have their cancer diagnosed on time.
Early diagnosis is very important in cancer cases.
Thousands of patients are referred for colonoscopies every year. Many are referred by their GPs for the procedure because changes in bowel habit, such as having regular or constant diarrhoea or even persistent constipation, patients passing blood and suffering from weight loss, abdominal pain and anaemia.
Patients admitted to hospital may also find their consultant requesting a colonoscopy.
However, it is public patients in the community waiting for the test, who are likely to be waiting longest. It may well be when they are seen they have nothing to worry about or that their problem resolves itself while they are waiting, but for some, the risks of waiting are obvious.
As Dr Martin Daly, a GP in the west, puts it, a person who has to wait 18 months for a colonoscopy may wait "innocently and silently on the sidelines without the knowledge of their GP while an early cancer develops".
He says that without a national bowel screening programme, there needs to be a very low threshold for rapid access to diagnostic colonoscopy.
The establishment of a national colorectal screening programme, recommended in the most recent national cancer control strategy in 2006, is currently being examined but there are no indications yet when such a programme might be rolled out.
"I think the HSE should set a target waiting time for any person referred for a diagnostic colonoscopy and it should be no longer than six weeks," Dr Daly notes.
Prof Niall O'Higgins, former president of the Royal College of Surgeons, believes every hospital has to reduce the length of time patients have to wait for investigations, both because of the anxiety factor associated with waiting for patients as well as the fact that a patient's condition might deteriorate while they wait.
He adds that it is extremely important that all doctors referring patients for colonoscopies should fill out an agreed form which would indicate the urgency of the patient's condition. "There should be a uniform form," he says.
The introduction of such a standardised form, in addition to targeted waiting times, sound like reasonable and achievable goals which can and should be met.
The HSE should set a target waiting time for any person referred for a diagnostic colonoscopy and it should be no longer than six weeks.