Sir, - Death rates in Ireland from breast cancer are unacceptably high and compare unfavourably with other countries.
The Department of Health and Children has adopted a two-pronged approach to the problem - a screening programme and a treatment programme. The screening programme involves examination of apparently healthy women by mammography in an attempt to save lives by finding cancers when they are small and curable. The treatment programme is for women with identified breast disease.
Phase one of the National Breast Screening Programme (BreastCheck) began earlier this year. It is hoped that it will soon be extended throughout the State.
Concerning the treatment programme, it is now known from international studies that patients with breast cancer have a much better change of long-term survival when they are cared for in large specialist centres that treat, at a minimum, 100 new breast cancers a year. Treatment of large numbers of patients results in maintenance of high levels of staff knowledge, skill and teamwork, all of which are required for best outcome. Evidence also exists that women are prepared to travel further to a centre if they know that, by so doing, their chances of survival are increased. Such centres need a population base of 250,000 to 300,000 people. No matter how dedicated an individual doctor may be, it is simply not possible to provide optimum care consistently in small units.
Some communities may find such change difficult - as indeed it is. The tremendous voluntary work done by individuals and numerous groups all over Ireland to improve services for women with breast diseases is acknowledged gratefully. The huge voluntary contribution which people have made, and continue to make, is truly inspiring. We acknowledge that some people and groups may feel angered by the recent report concerning specialist breast units. Although everyone would wish that people be served in their local communities, we cannot ignore the overwhelming international evidence indicating that our wives, mothers, sisters or daughters with breast cancer are considerably more likely to have long-term cure if treated in centres dealing with large numbers of patients.
As we increase our efforts to overcome this dreadful disease, let local and larger communities go forward in partnership to provide the best, most effective and safest treatment for patients with breast cancer. - Yours, etc.,
Niall O'Higgins, Professor of Surgery, UCD, Chairman, National Breast Cancer Advisory Group, St Vincent's Hospital, Dublin 4.