Women with breast cancer who are treated in special centres are 15 per cent more likely to be alive after five years.
This is the message from a subgroup of the National Cancer Forum (NCF) set up to review services for symptomatic breast disease. The group is concerned with the well-being of women who find breast lumps, rather that the separate national screening programme for breast cancer.
With one of the worst breast-cancer survival rates in Europe, the State needs to take urgent corrective action. There is strong evidence that specialised units with a higher throughput achieve much better patient outcomes.
Research published in the British Medical Journal last month by Dr R.G. Banks and colleagues at the Institute of Cancer Research in London shows that improvements in chemotherapy and other factors, specifically structural changes in the NHS, have contributed to a 15 per cent reduction in breast-cancer deaths.
The NCF sub-group report says a viable unit needs to treat 100 cases of breast cancer per year. Patients in such units are more likely to receive chemotherapy and radiotherapy in addition to surgery.
Radiologists working in smaller units may take up to 30 years to achieve the level of experience available in larger, more centralised units. Access to pathology services, too, remains unequal in the provision of care to breast-cancer patients.
The report recommends that specialist breast units based on a population of 250,000 to 300,000 be set up. This will mean the closure of seven out of the 20 centres currently providing symptomatic breast cancer services in the State. (See panel for health-board breakdown).
Closing hospital services has never been an easy decision. However, the Minister for Health and Children has said the health of women must take precedence over political considerations in deciding where breast-cancer services should be located.
"In the public debate that has ensued so far, the emphasis has been on location. We have to listen to the experts, and the key must be the patients," Mr Martin said.
Much local resistance has been based on confusion between the role of breast-cancer treatment centres and breast-cancer screening services. Communities are naturally concerned about longer travelling time, hospital stays away from their locality and difficulties with access.
In fact, where screening services are concerned, they are likely to see improved local access through the use of mobile mammography screening units.
However, where a woman goes to her GP with a breast lump that is possibly a cancer, she will in future go directly to a regional breast-cancer treatment centre. While this may be more inconvenient, it is expected that 90 per cent of patients will have a biopsy performed and the results given to them at the end of a day's investigation.
Those who receive the unwelcome news of a cancer diagnosis will have to be subsequently admitted for inpatient treatment to the specialised centre. They will meet their surgeon, oncologist, radiotherapist and other multidisciplinary team members as part of setting an individual care plan. Also, the report envisages surgeons from the woman's local hospital being involved in her care, by way of a sessional commitment to the new unit. This will go some way to ensuring continuity of care for breast-cancer patients.
Dr Niall O Higgins, professor of surgery at UCD and chairman of the sub-group, said: "This is a proposal for a service of specialised breast units around the country, the purpose of which is to reduce mortality from breast cancer significantly. We cannot afford to continue the way we are."
He said he was sympathetic to the transport difficulties that may arise for patients and that these needed to be solved in an imaginative way as part of the proposed changes.
The NCF sub-group is meeting individual health boards to discuss their recommendations, although the final decision rests with the individual health authorities themselves.