BREAST CANCER is the Republic’s second most common disease with about 2,500 cases diagnosed each year. The treatment of women with the disease in both our public and private hospitals has been the source of concern after the identification of shortcomings in the quality of symptomatic breast services. Following the cases of women such as Rebecca O’Malley, Edel Kelly and Ann Moriarty in 2007 and 2008, public trust in our cancer services diminished.
Prof Tom Keane and the national cancer control programme have worked hard to bring uniformity and quality to symptomatic breast disease services since then. Instead of 33 public hospitals assessing women with breast lumps and other symptoms suggestive of breast cancer, and treating them to variable standards, now just eight specialist units provide this service. Each must work to standards set by the National Quality Assurance Group for Symptomatic Breast Disease Services. All women who find a breast lump must undergo triple assessment within a minimum waiting period; in addition if diagnosed with breast cancer, they must be operated on within 20 working days.
A triple assessment of a breast lump means that a woman will undergo a mammogram, examination by a specialist breast surgeon and a biopsy of the lump which will be examined by a specialist breast pathologist. In addition, all health professionals involved in a woman’s care should be in a single location, enabling multidisciplinary teamwork to take place. Research has confirmed much lower death rates from breast cancer associated with this level of co-ordinated and standardised care.
The publication by the Health Information and Quality Authority (Hiqa) of a formal review of the eight specialist centres is an opportunity to assess the impact of recent changes. Overall, the report card is positive.However, some gaps remain: centres at Waterford, Cork and Limerick will require additional assessment visits in 2010 because at the time of review last autumn they were still in the early stages of development; the outsourcing of some services requires tighter control and uniformity; continuity of patient care is an issue for certain centres; and patient information must flow more consistently and be accessible to treating doctors and patients at all times.
The report shows that a national network of centres for the future treatment of all tumour types is now in place. Properly resourced, this promises to reduce both mortality and morbidity from cancer in the years ahead.