The State's new cancer supremo, in her first interview, tells our health correspondent EITHNE DONNELLANthat patients should be aware their first shot at treatment is their best shot
MANY MAY have thought when breast cancer services were moved from 33 hospitals into eight designated cancer centres across the State between 2007 and 2009, the main work of the national cancer control programme was done. If they did they were mistaken, says our new cancer tzar Dr Susan O’Reilly.
She points out that while much progress was made by her predecessor Prof Tom Keane, much remains to be done to improve cancer outcomes in the Republic.
She believes a 10 per cent improvement can be made in breast cancer survival rates, for example, in coming years purely by applying knowledge and policies we already know work “in an organised system in sophisticated centres”. In reality, this would mean 90 per cent of breast cancer patients would be alive five years after diagnosis, similar to in British Columbia where Dr O’Reilly worked before her arrival in Ireland.
“We are beginning to see an improving trend in breast cancer survival – it’s gone up from 76 per cent to 80 per cent – five years after diagnosis. I think there’s an ability to have another 10 per cent improvement . . . I think that’s absolutely achievable over the next five years quite honestly,” she says.
There is also a 5-6 per cent improvement in survival rates to be gained for a range of other cancers by following similar policies, and Dr O’Reilly is currently putting together expert groups on five different cancer types to draw up best practice guidelines for treatment of those cancers which will then have to be applied consistently across the country.
“I think it’s important for people to get a sense that the work has only just begun on developing a sophisticated national cancer control programme and I wouldn’t want people to think that because there’s been substantive progress on surgery and some progress on radiation that the job is done. I think we’re just getting started, so this is a multi-year project that spans the whole range of cancer control,” she adds.
That whole range of cancer control includes everything from getting people to quit smoking and avoid sunbeds to centralising surgery for a range of cancers in a small number of designated centres, commencing bowel cancer screening next year, and providing more radiotherapy capacity so patients don’t have to wait months for it.
Last week, a radiotherapy service began at Dublin’s Beaumont Hospital for the first time, another will begin shortly at St James’s Hospital, and these will complement services already provided at St Luke’s Hospital, Rathgar, increasing radiotherapy capacity in the Dublin area by 50 per cent.
A capital plan to “refresh” radiotherapy services in Galway and Cork, and provide public radiotherapy facilities in Waterford and Limerick is also advancing within the Department of Health.
But in a climate where money is in short supply, and where funding for cancer services is no longer ringfenced as it was when Prof Keane took up his post in 2007, is progress likely to suffer a setback?
Dr O’Reilly says the embargo on recruitment “does pose some challenges”, but new money was provided for cancer this year as a result of a reallocation of resources within the HSE. “So we have been able to move forward. Is it as fast as I would like? Well probably not, but I think progress is being made.”
She says there’s an awful lot that they can do within current resources, but in coming years there will have to be substantial investment to cope with the enormous growth in the incidence of cancer that will be driven by our ageing population, as well as to cover the cost of new drugs. “That’s not going to be something that you can simply do by moving around existing budgets.”
Projections from the national cancer registry show the incidence of female breast cancer will more than double by 2035, while cases of prostate cancer are projected to rise by 97 per cent, cases of colorectal cancer by 97 per cent and cases of lung cancer by 70 per cent over the same period.
Before her arrival, there was much controversy over the decision to move some breast cancer services out of Sligo, and in opposition Fine Gael supported the retention of those services. Is she worried the new Government will try to row back on the changes that have occurred?
“The Government is in charge of health policy, I am in no doubt about that,” she replies diplomatically, but points out many cancer services remain in Sligo, including chemotherapy and colon cancer surgery.
The decision by the Northern Ireland health minister Michael McGimpsey in recent days to postpone investment in radiotherapy services at Altnagelvin in Derry, which would have been used by cancer patients from the northwest, is disappointing, she admits. “If indeed this doesn’t get revisited in the North, we will have to factor this into our overall planning for radiation.”
In the meantime, patients from the northwest have to travel to Galway, Dublin or Belfast for radiotherapy. But her message to cancer patients is not to worry about travel.
“The most important message for patients with cancer is your first shot is your best shot for a cure or long-term survival . . . so that is why it is so critically important that the majority of patients with cancer are seen and treated by specialists who have high-volume cancer practices in a sophisticated multidisciplinary environment.”
She looks forward to extending the HPV (cervical cancer vaccine) to more secondary school girls but doesn’t foresee the vaccine being given to boys as part of the national vaccination programme despite the fact that they transmit the human papilloma virus (HPV) to girls during sexual intercourse.
“In a perfect world if the vaccine was cheap you would vaccinate both boys and girls. Right now though, the people who are most susceptible to having a serious cancer as a result of getting the virus that could either render them infertile or potentially be fatal are women, so it’s very appropriate the focus is on vaccinating women,” she says.
“If I had a son of the right age, would I suggest that he got vaccinated and even pay for it myself . . . yes I would. I think it’s a very reasonable thing to do.”
