Address by Mr. Tim O’Malley T.D., Minister of State at the Department of Health and Children at the first National Irish Cervical Screening Programme Conference 18 June 2005

Good Morning Ladies and Gentlemen

I am glad to be here this morning to open the first National Cervical Screening Conference for Ireland. I would like to extend a warm welcome to all those attending, especially those from outside the jurisdiction. The numbers attending reflect the importance of the conference, the quality of the presentations and the interest of delegates. It also reflects the organisational ability of the Conference Team led by Dr. Marian O’Reilly.

The prevalence of cervical cancer in the developed world and the number of deaths, particularly in the younger age groups, from the disease present a major challenge in our efforts to reduce the impact of cancer on our society. In Ireland we have on average 180 cases of cancer of the cervix annually and about 73 deaths according to the most recent Report of the National Cancer Registry. There is general international acceptance that the most effective method of reducing the prevalence of this illness is by way of a quality assured population screening programme. Dr. Harry Comber, Director of the Registry, will speak in more detail on this theme.

Evidence is that detection of pre-cancerous cells followed by appropriate and timely treatment can prevent progression to more serious invasive cancer at a later stage. This was the rationale for establishing the Irish Cervical Screening Programme in October 2000. It was also the basis for the commissioning of an evaluation which addresses key elements of a national roll out. I wish to welcome Dr. Euphemia McGoogan back to Limerick as one of the key note speakers. She prepared the very positive and challenging evaluation report on the Programme.

One of the significant findings in Dr. McGoogan’s Report is that the age standardised incidence rates for Ireland was 9.5 per 100,000 compared to 13.9 in the United Kingdom. However, despite the differences in incidence, the mortality rate was almost the same for both jurisdictions. This indicates that Irish women are being diagnosed with cancer at a later stage. As this audience is fully aware, interventions are less successful when cancers are at an advanced stage. The experience of medical consultants treating women with cervical cancer is that relatively young women are now presenting with advanced cancer. The impact of a diagnosis of cancer on young women in particular and their families is traumatic.

This Conference today provides an opportunity to reflect on the progress made to date in relation to this Programme and the necessary preparatory work on a national roll out. Approximately 74,000 women in the 25 to 60 age group in the Mid-West region have been able to avail of free cervical screening since the programme began.

The effectiveness of a screening programme relies on a high level of take up. A key challenge for the Programme is encouraging women, especially those in high risk groups to attend. A population register and an effective call and recall system have been successfully established. Over 90% of women are included in the register and 75% of eligible women have taken up the offer of a smear test. The Programme will also target areas of low uptake.

One of the essential elements of a successful programme is that it must be acceptable to women. A programme must take into account the views of women. The Woman’s Health Council evaluated the Programme from the women’s perspective. Ms. Geraldine Luddy, Director of the Council will address the Conference later this morning on this evaluation. Suffice to say that the evaluation is generally positive and also suggested key improvements which she will address in her presentation.

An important element of this evaluation refers to the recognition that participation in such a programme is influenced by socio-economic factors which must be addressed in a national roll out. I would very much welcome some discussion at the Conference around the theme of social inclusion. Geraldine and the Council have also assisted my Department in developing its overall response to the next stages of the national programme. This input is of significant importance as we move forward with a national programme.

Understanding the reasons why women attend is necessary but we also need to understand the reasons why women do not attend. What are the barriers to participation – are they economic, social, educational or environmental? Dr. Jane Walsh will address the Conference on factors that affect attendance for a cervical smear test. Such factors must be understood and must influence how we structure and develop a participative screening programme.

More than 200,000 smear tests are generated each year in this country outside of the Programme. This volume of smear tests places considerable pressure on our laboratory system and utilises considerable resources. Experts advise me that opportunistic testing will not have an appreciable impact on reducing cervical cancer mortality. Such testing is not population based and does not attract sufficient numbers of women who should be tested. Nevertheless we must assess the impact of a population screening programme on the current high levels of opportunistic testing. Will we have two parallel programmes in place, one population based and the other opportunistic? Clearly this would result in an unnecessary duplication of resources. I am particularly interested in experience in Wales and Bristol on this issue and perhaps Doctors Denton and Fielder might refer to this in discussion later this morning.

This Conference will support the introduction of a national screening programme. I very much welcome such a conclusion. The introduction of an organised national programme is a significant undertaking that will require major resources. We also have parallel priorities in improving cancer care such as the extension of breast screening nationally and major developments in radiation oncology. It is necessary to ensure that we carefully plan the next stages of the extension. Considerable preparatory work has taken place:
•we are extending liquid based cytology preparations to all participating laboratories and the Department has invested over €1million in this development
•Certified training programmes for smeartakers are underway
•An extensive Quality Assurance programme for laboratories is in place. An external laboratory accreditation proposal in cytology and histology laboratories is currently with the Irish Health Services Accreditation Board
•A standard cytology referral form is agreed which involves women being uniquely identified on a consent basis to ensure adequate follow up.

I want to acknowledge the significant efforts of Dr. Marion O Reilly, Programme Director and her Central Programme Office here in Limerick. It is also important to recognise the significant support she has received from medical and scientific experts in hospitals and in primary care who have very willingly assisted, advised and supported the Programme. The support from the Irish College of General Practitioners and the Royal College of Surgeons in Ireland has also assisted progress.

In addition, the Department has engaged in very fruitful discussions with major professional and advocate stakeholders relevant to cervical screening. These discussions are based on Dr. McGoogan’s Report and have regard to the major elements of the national roll out. Such factors include governance structures, population based registers and quality assurance at all levels of the programme supported by modern data systems.

The Report also recommends a major redesign of our laboratory services to support a national roll out. We must also examine how best and most cost effectively to organise the programme. I can assure this audience that the Tánaiste and I are fully committed to the national roll out in line with international best practice. The Department very much appreciates the constructive contribution made by the various interest groups during this consultative process. The Department is now examining options in relation the national roll out.

In conclusion, you have a very challenging agenda which I am certain will generate a quality discussion. I look forward to being advised on the outcome of this first national conference. I am privileged to formally open this Conference.