The news that a second woman has been the victim of a cancer misdiagnosis raises questions about the quality of our health service. In particular, it is a reminder that the current fragmentation of breast cancer services in the State requires urgent correction. Breast cancer is the most common fatal cancer in women and its incidence is increasing.
Figures from the National Cancer Registry show that, on average, some 2,700 women on the island of Ireland are diagnosed each year. But mortality from the disease here is 15 per cent higher than the EU average.
Reducing death rates depends on two key factors: having a comprehensive breast screening programme to identify women with asymptomatic disease; and for those women who develop a breast lump or other symptoms suggestive of breast cancer, the provision of a high quality treatment programme.
Patients with breast cancer are much more likely to survive if they are treated in specialised centres operating to international best practice guidelines. Such centres were first proposed for the Republic in 2000. Last May - some seven years later - the National Quality Assurance Group for Symptomatic Breast Disease Services again made important recommendations. Acknowledging that the continuing inequalities in access to good treatment and variations in outcomes were of "deep concern", the report outlined quality indicators for breast disease services. Among these are the need for individual consultant surgeons to treat a minimum of 50 and a maximum of 150 new patients with breast cancer each year. Breast pathology reports must contain a minimum set of data, with consultant pathologists who analyse breast tissue required to take part in a quality assurance programme.
But perhaps the group's most important recommendation is that all women who develop a breast lump should undergo a triple assessment at a specialist centre. Staffed by at least two consultant breast surgeons, two specialist radiologists and at least two experts in breast pathology, such centres have been set up in some areas and provide routine patient assessment by a multidisciplinary team working to a set of quality assurance standards. While no system can guarantee perfection, international expertise has proven that this approach minimises the risk of misdiagnosis. However, the woman whose case came to light this week was not treated at a specialist breast cancer centre but was cared for by an ad-hoc mix of the public and private health sectors.
It is imperative that the Health Service Executive (HSE) selects all the locations for specialist breast centres in the Republic without further delay and that it ensures that all women who present with symptomatic breast disease are automatically assessed in these designated facilities. And the private hospital sector cannot be allowed operate in isolation from the rest of the health system. The Minister for Health must give the Health Information and Quality Authority (HIQA) the power to license and regulate private hospitals in the State.