Thursday, 31 October 1991
Dáil Éireann Debate
Mrs. Fennell: The study to which I refer was undertaken by Dr. Áine Gallagher attached to the UCD Department of Public Health. Indeed, the study has not yet been published, although I am aware that it will be published. Dr. Gallagher gave details of the study in various medical publications and in the media last week.
What we read in the papers last week were very disturbing facts. Dr. Gallagher maintains there is evidence that the hit  and miss approach to cervical screen testing throughout the country has resulted in many poorer, less advantaged women not being screened at all. Those are the women most at risk. The main claim she makes — and this is the most worrying point of all — is that almost half the women tested, whose tests proved positive between 1980 and 1985 — were not contacted to ascertain whether they were aware of the results of their tests nor were called for follow-up screening.
If that is the case — and I am asking the Minister to give me information on this — this is, indeed, serious because some of these women who would not have been notified, who would not have been given the option of treatment, could have developed cervical cancer whereas a reasonably simple surgical process could have been carried out to ensure that they did not contract that disease. This cancer is controllable. It is the one disease which, if caught early enough, can be cured. This is accepted beyond doubt and in countries such as Finland and Norway it has been stamped out altogether through good, well-structured and properly funded programmes. We are far from that stage here. Irish women are still the poor relations in preventative health care. There is, for instance, no cervical screening service in the health centres in Cavan, Monaghan or Cork and Kerry.
I know the Minister in his reply will lay great stress on the fact that St. Luke's cytology department now process results in 24 hours. That is a big improvement and it is to be acknowledged but it does not go far enough. There is a critical need for realistic reform. Action must be taken on the alleged 40 per cent of cases where women were not properly notified or given follow-up treatment. The Minister might say what he intends to do in this regard. There should be greater regional promotion of a screening service. Every health centre should advise women and carry out this service, making special efforts to reach the at risk over-45 age  group. There must be a centralised register of positive tests and an efficient follow-up system should be initiated. The woman's name and last address should be noted.
Women deserve a properly-funded service. All women over the age of 35 should have three-yearly screening wherever they live. It should not be a disparate service which is patchy in rural areas and good in Dublin. They should be informed of the result, whether negative or positive, and get treatment if necessary. Lives can be saved with better organisation. We could have no deaths from cervical cancer here.
Minister for Health (Dr. O'Hanlon): I am sure every Member would share the concern of Deputy Fennell that there should be a highly efficient cervical screening service available to women. The report to which Deputy Fennell referred, which has not yet been published, refers to the period 1980-85 before I became Minister. In the years 1985 and 1986 complaints were received about the availability of testing and delays. In general it was felt that the service was poorly organised and under resourced. The delay in testing arose because of the shortage of resources in the laboratory services. Additional resources were provided for these laboratories and the backlogs were subsequently cleared. The problems concerning availability of tests were resolved. St. Luke's were able to state in a recent press release that there is a 24-hour return service on tests submitted to them.
Women, regardless of income, can arrange through their local health centre for the test to be taken or they can attend their family doctor or the local outpatient department. The service is also available in family planning centres. Testing kits are provided free of charge by St. Luke's Hospital.
In Dr. Gallagher's report which relates to the years 1980-85 the age profile of  those availing of the service was considered disproportionate in that a high number of those below the age of 25 were taking the test. The study also highlights the quality and the timing of the notification of the results to referring doctors and patients and poor history taking by referring doctors. When I came into office in 1988 I established a committee to review the whole service and the committee has produced a very constructive interim report. Its major recommendations are being considered for implementation. The main recommendations are the provision of improved training of staff, reporting time to doctors and patients not to exceed one month — which is the position — abnormal results to be followed up quickly by the referring doctor with the laboratory assistants, common classification to be adopted, continued availability of the service through different outlets and the computerisation of laboratory procedures.
Recently, in accordance with an undertaking in the Programme for Economic and Social Progress, I arranged for the reconvening of that committee chaired by the chief medical officer in my Department to look at the operational efficiency of the test notification procedures which are inter alia the subject of Dr. Gallagher's study.
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