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Left on the shelf: Ireland's cancer victims



LOCAL politics is hampering the survival chances of women with breast cancer and as many as 130 lives lost to the disease every year could be saved, according to one of the country's most respected doctors.

Professor Niall O'Higgins wrote a report seven years ago, commissioned by the Minister for Health, which recommended the establishment of specialist breast cancer centres around the country.

It was adopted as official government policy but its recommendations have still not been implemented. A second ministerial-commissioned report written by O'Higgins on standards of breast disease care was published shortly before the general election last May and again approved by the government, but a scheduled July commencement of its implementation has come and gone without a whisper of action.

The proposal to provide multidisciplinary centres of comprehensive cancer care serving populations of 300,000 to 350,000 . . . necessitating the closure of some existing services . . . has provoked pockets of local protests, sparking political grassroots concerns. But such change would allow women referred by their GPs to be seen within two weeks.

Meanwhile, about 650 women die of breast cancer in Ireland each year, 15% more than the EU average. Last week, the Department of Health suspended breast cancer services at the privately-run Barringtons Hospital in Limerick pending the outcome of a review of the treatment of ten patients, including one woman who has died.

The news was followed on Friday with an announcement by the HSE that it had placed a consultant radiologist at the Midland Regional Hospital in Portlaoise on administrative leave during a review of the consultant's work in the radiology breast service.

Saying that he could not comment on the individual patient cases recently revealed or those under review, former president of the College of Surgeons O'Higgins believes that if his reports were enacted, errors in breast cancer testing would be significantly reduced. The Irish Cancer Society has echoed that belief by calling for the implementation "without delay" of O'Higgins' May report, entitled 'National Quality Assurance Standard for Symptomatic Breast Disease Service'. The Cancer Society reiterated that patients have the best chance of survival by being treated in specialist centres.

"If the O'Higgins Report had been implemented, none of this would have happened, " claims medical oncologist Professor John Crown of St Vincent's Hospital, Dublin. "This government has had 15 years, more or less, to sort this out and look at what we have."

International evidence A large body of international evidence shows that properly resourced designated centres are the most effective way of treating breast cancer. A key proposal in the O'Higgins Report is that specialist cancer centres hold at least one triple-assessment clinic per week for newly referred patients. It would involve a physical examination, a breast x-ray and a fine needle aspiration.

"We are convinced that mortality can be reduced by 20% for women and errors would be brought down to a bare minimum, " says O'Higgins. "In my opinion, it is unacceptable that the recommendations have not been implemented. I have been involved in cancer care since 1960 and I feel it on my conscience to make these proposals. I fear that politics, or local politics, have come into play here. The talk has been about taking services away from local areas.

We have a high rate of breast cancer and breast cancer mortality in this country. We had better get a move on and set up these centres because the international evidence is overwhelming that they can give women a better chance of survival.

This is a matter of survival or not for many women. Every woman and every person deserves a better arrangement than is the case.

If a country is not at war and it is a well-to-do society, I find it unconscionable that this has not been done."

The Irish Cancer Society received "quadruple the normal number of calls for a Friday" on its helpline (phone 1800 30 90 40) after last Thursday's news of the suspension of service at Barringtons. A spokeswoman for the Society said that "the vast, vast majority of callers were from women in the Limerick region who had attended Barringtons for a mammogram."

The review at Barringtons follows the disclosure that a 51-yearold woman from Co Tipperary had twice been given the all-clear and gone untreated for breast cancer for 18 months after being referred to the hospital. She had first attended Barringtons in September 2005 and had a mammogram.

A lump was removed the next day and sent to be tested at University College Hospital Galway. The result was negative. The woman returned to Barringtons in June 2006 after discovering a second lump in her breast. Again she received a negative result. She went to Barringtons for the third time earlier this year, underwent a biopsy and her tissue sample was sent to Cork. Three days later, she was told she had cancer and she underwent a mastectomy.

Her doctor, Professor Rajnish Gupta, regional director of cancer services for the HSE, said at a press conference a month ago: "If this kind of situation is allowed to continue involving patients with possible or proven cancer I certainly, for one, would find it difficult to continue in this health service."

Wrong diagnosis Before the general election, it emerged that another Co Tipperary woman, Rebecca O'Malley, was diagnosed with cancer at the MidWestern Regional Hospital in Limerick 14 months after being given the all-clear. Her test had been done at Cork University Hospital.

Janette Byrne of Patients Together has called on hospitals to come clean when they get patients' tests wrong. "They should put their hands up, " she says. "We're not stupid. They should keep us in the loop. Withholding the truth creates mistrust around the whole area of care.

"Everybody in this country knows that patient care is being compromised every day and the patient is voiceless. We have the government and spin doctors trying to suppress our stories, to keep the lid on it and make us all shut up."

Referring to the BreastCheck screening service for women aged between 50 and 65, O'Higgins remarked: "It is a cruel irony that we have a great system for women who think there is nothing wrong with them and a mediocre system for women worried there is something seriously wrong with them."

BreastCheck is not yet operational in the west or south of the country but the plan is to expand the service in those areas before the end of the year. In 2005 80,000 women in the north and east were invited to be screened at dedicated units.

Almost 60,000 responded to the invitation and, of those, 1,867 were called back for assessment. Cancer was detected at an early stage in 318 of those women.

Campaigners in the west and south have repeatedly called for the immediate expansion of BreastCheck throughout the country and criticised the delay, saying that lives were being lost unnecessarily.

It was announced last week that a community initiative is to build a cancer treatment centre in Letterkenny, Co Donegal where many breast cancer patients have chosen radical mastectomy surgery to avoid arduous bus journeys to Dublin for radiotherapy treatment.

"Women in the north-west are more likely to have mastectomies because of the lack of radiotherapy. It's what I call mutilation-bygeography, " says Crown.




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