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Saturday 25 January 2020

Advances in cancer care came too late

Delayed introduction of new treatments for breast cancer has cost the lives of countless women, writes John Crown

WHILE the recent news that mortality from breast and other cancers fell in Ireland during the period 2002 to 2006 is extremely welcome, it should also prompt remembrance for all those women who have died unnecessarily from this disease in our country.

Breast cancer mortality is falling throughout the western world. The actual death rate began to fall in the USA in the 1990s, mainly attributable to widespread screening of healthy middle-aged women with mammograms (breast X-rays) to detect early cancers. These women can usually be cured by an operation to remove the growth (in most cases, sparing the breast).

The knowledge that mammography improved the chances of survival has been known since the 1960s.

The second factor in prolonging the life of a patient was the discovery of additional treatments such as radiotherapy and anti-cancer drugs following operations.

This obviously meant that patients now had to be seen by teams of specialists (multi-disciplinary care) and not just by the surgeon who performed the operation. Those hospitals that provided this multidisciplinary care, regardless of size, achieved excellent survival rates (Sligo, now sadly closed to breast cancer patients, was a good example).

It was the unnecessarily delayed introduction of these two advances -- breast X-rays and multi-disciplinary care -- that cost so many Irish women their lives. They died because many men and a few women who had the power and the resources to change things for the better decided not to exercise this power.

While medical vested interests, which allowed interdisciplinary turf wars to impede progress, deserve some blame, the principal culprits were the politicians and the permanent civil service.

It was they who designed a system where general surgeons in rural hospitals were single-handedly supposed to provide comprehensive care to all types of cancer, while simultaneously being expert in the treatment of conditions as diverse as stomach ulcers and traffic injuries.

The same politicians and bureaucrats denied there was a problem, and attempted to intimidate whistle-blowers.

The recent improvements owe nothing to the health policies of the current Leinster House junta, or to the Health Information and Quality Authority (Hiqa) which did not exist during this time.

They also illustrate the fundamental fallacies inherent in the current HSE policies, which is that centralisation and Hiqa policing is all that is needed to improve standards.

We had the centralisation of radiotherapy services in this country for years, but care was far from excellent due to resource constraints. No, all the policing and centralising in the world won't work if the basic services are not in place.

If any politician can claim credit for the improvement, it is Michael Noonan, who in his first speech on his first day as minister for health in 1994 admitted that there were hospitals in the country that he would not let a cancer-stricken relative attend, and who set about the process of increasing the number of cancer specialists.

Professor John Crown is a consultant oncologist

Sunday Independent

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