Cancer rates and disadvantaged areas


Sir, – Your editorial of December 4th about cancer becoming the commonest cause of death mentions health inequalities in passing.

You fail to observe that death rates for some of the commonest cancers are twice as high in areas of most disadvantage compared with the most affluent.

The causes of this may be multifactorial, but what is certain is that access to the health service in such areas in a significant contributor to the lack of prevention and early detection of cancer.

Much higher numbers of people in areas of disadvantage get multiple illnesses (including cancer) at a younger age, often complicated by psychosocial problems. Yet resources are distributed according to population numbers and not need, resulting in huge shortfalls in services where they are needed most.

While general practice is in crisis all over the country, nowhere is this more evident than in disadvantaged areas where it is almost impossible to recruit, because of the particular challenges combined with lack of adequate support both in practice and the wider primary care team.

GPs are ideally trained and placed for prevention and early detection of cancer which are so critical to reducing death rates. However in these areas, where there are not nearly enough GPs or support staff, they are completely overwhelmed with the larger number of younger, sicker patients with acute health and social problems, which are so demanding that there is no time to address issues of prevention or early detection. Uptake of cervical smears is much lower in our areas – if we are under pressure to treat an acute problem like a chest infection, while addressing serious mental health problems, a chronic illness like diabetes, and deal with an acute crisis like imminent homelessness, it’s not possible to persuade either doctor or patient that her smear takes priority.

With a packed waiting room outside, neither is there time to consider that she might need a chest X-ray for her cough, or spend time discussing smoking.

This gap for GPs between what they are doing and what they could be doing is hard to tolerate.

It is extraordinary that a mechanism such as the Deis schools system in the Department of Education has never been used in the health service to direct resources where they are needed most. Meanwhile, your likelihood of dying younger will continue to be determined by where you live. – Yours, etc,



Dublin 15.