The National Screening Programmes in Ireland.
There are a number of national screening programmes in Ireland for cancer. The purpose of a screening programme for cancer is to detect the presence of cancer at its earliest stage. The early stages of cancer may be in the subclinical stage. The aim of these screening programmes is to reduce the number of people dying from cancer by detecting the cancer early, where there is a greater number of treatment options available. The types of cancer screening programmes available are targeted against the most common cancers in Ireland which are breast, cervical, bowel, prostate, skin and lung cancer. The success of these programmes have shown that the number of people dying from these types of cancers have reduced.
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In January 2007, the minister for health and children established the National Screening Service (NSS). In the previous year, a strategy for cancer control in Ireland was launched, which advocates a cancer control policy programme that is comprehensive. The national screening programme came after this strategy. The following years the strategy was used to analyze all aspects of cancer management from the prevention, screening, detection of it to the treatment and management of it. The most common types of cancer in Ireland are of the skin, breast, prostate, bowel and lung. The Irish government has set up a NSS for these particular types of cancer in order to reduce the amount of people dying from these types of cancer (National Screening Service, 2019).
Many shapes and sizes cancer can come in and how the body is affected by it varies greatly. A group of illnesses all having certain common characteristics is what the term cancer describes. What is included in these characteristics is an overgrowth of cells that develops into a tumour. More than 200 different types of cancer there is, with a specific name, treatment and the possibility of being cured. Medical problems are caused by tumours in two ways. It can cause problems directly by pressing on and damaging organs nearby or indirectly by breaking off and entering other faraway organs and tissues (Irish Cancer Society, 2019).
Multiplication of cells is normal. Just one single cell humans start off life as in the ovum, where sperm fertilizes it and then begins to multiply, producing additional cells. The cells grow and mature to become cells of nerves, muscles, blood or connective tissue. These different types of cells group together to form organs. Each organ is composed of lots of various cell types and each individual cell has certain function in that organ, the cells work together to make the organ function effectively. Every so often the cells die off or wear off and replaced by new cells. This is a highly complexed and tightly regulated process. With regards to cancer, for some reason, the production of new cells becomes faulty. When a cancer cells grows, instead of replacing the damaged or cells that are lost, the cells multiply out of control, taking over the organ. In some instances, the cells grow and form a mass called a tumour. This can cause blockage of ducts or presses on other organs, stopping them from functioning correctly (Irish Cancer Society, 2019).
Tumours can be benign or malignant. Tumours that are benign can lead to issues in the organ where they are located, but don’t spread. These types of tumours can be surgically removed or treated using drugs and or radiation to shrink the tumour, which normally cures the problem. Tumours that can spread are malignant tumours. Sometimes cells from the original site can spread. This can happen in three ways. By extension, by the lymphatic system or by the bloodstream. The cells can spread to many other sites and organs in the body. Many parts of the body can be affected by multiple growths, causing organs to fail. This is known as secondary cancer or metastasis. The most likely places where malignant growths appear are parts of the body that have a rich blood or lymph supply. This includes the liver, lungs, lymph nodes and bone marrow (Irish Cancer Society, 2019).
The types of cancer that exist are sarcoma, carcinoma, myeloma, leukaemia and lymphoma. Malignant tumours are carcinomas that arise from cells lining the surfaces of the body. Malignant tumours are sarcomas that arise out of cells in the supporting structures of the body. Myeloma, leukaemia and lymphoma are all malignancies that come from blood cells. Haematological cancers these cancers are also known as (Irish Cancer Society, 2019).
The NSS has many roles. It carries out a national screening service for early diagnosis and primary treatment of certain cancer. It advises about the benefits of other cancer screening programmes that could be carried out where it can demonstrate a population health benefit. It advises from time to time the minister for health and children on health technologies such as vaccines for cervical cancer. It implements measures to promote awareness and participation especially at disadvantaged population groups, in its programmes.
The NSS maximizes its expertise across all programmes and to improve their efficiency where it has developed a single governance model. The screening programme is a population-based programme that operates on an active call and recall system where the programme selects groups of the population for screening at certain times and recalls them when their next screen is due (National Screening Service, 2019).
The cancer screening programmes, the NSS has in place in Ireland are: CervicalCheck, BreastCheck, BowelScreen and Diabetic RetinaScreen (National Screening Service, 2019).
The national breast screening programme, BreastCheck, is a breast screening service funded by the government that provides free breast x-rays (mammograms) to eligible women. By the end of 2021, BreastCheck is being extended to all eligible women aged 50 to 69. It aims to provide a screening service that is effective to the highest possible quality, so that the earliest possible stage of breast cancer can be detected in the maximum number of breast cancers. Eligible women are invited for screening by personal invitation by BreastCheck every two years. On an area by area basis the programme screens. A multi-disciplinary team is involved in BreastCheck from radiographers, specialist clinicians to breast care nurses. What the service provides is screening mammography, diagnosis and primary treatment. In 2008, BreastCheck became the first NSS provider worldwide to offer a fully digital mammography service (BreastCheck, 2019).
The most commonly diagnosed cancer in women in Ireland is breast cancer. Each year on average over 2,800 women are diagnosed with breast cancer in Ireland. Breast cancer is very treatable if detected early. BreastCheck aims to detect breast cancers at the earliest possible stage. A detected cancer at this point is usually easier to treat and there are greater treatment options available. Not all breast cancers are detected using the mammogram, however, international experience demonstrates that breast screening programmes significantly reduce deaths from breast cancer. Women who are screened and diagnosed with breast cancer is less than one percent. The aim here is to offer these women the best treatment available in order to deliver the best possible outcome. The programme has provided since its inception is more than 1.5 million mammograms to over 500,000 women and detected over 9,800 cancers (BreastCheck, 2019).
CervicalCheck, the national cervical screening programme was first made available on the 1st September 2008 to 1.1 million eligible women aged between 25 and 60. Every three years free smear tests are offered to women aged 25 to 44. Following no abnormality detected in two consecutive smear test results. Women aged between 45 to 60 every five years are screened. Women can make an appointment with CerivcalCheck registered smeartaker (practice nurse or doctor) of their choice to have a free smear test at a convenient time and date. At present CervicalCheck has over 4,150 registered smeartakers (nurses, GPs and medical practitioners) in more than 1,400 different locations. As part of CervicalCheck, the NSS is responsible for the governance and management of colposcopy services. A multidisciplinary team delivers the colposcopy services and the facilities for diagnosing, treatmen and follow up for those with an abnormal result from their smear test (CervicalCheck, 2019).
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About 300 women in Ireland are diagnosed with cervical cancer each year. The Human Papillomavirus (HPV) causes most cervical cancers, which is transmitted through sexual intercourse. This cancer is largely preventable as there is a vaccine that protects against this virus. A cancer arising from the cervix is cervical cancer. An abnormal growth of cells that has the ability to spread to other areas if the body is what causes cervical cancer. Cervical cancer generally develops over 10 to 20 years from precancerous changes. Diagnosis is generally screening of the cervix followed by biopsy. Vaccines are available that protect against from 2 to 7 strains of HPV (CervicalCheck, 2019).
BowelScreen is the national bowel screening programme. BowelScreen offers to men and women aged 60 to 69 free bowel screening using a home test kit called the faecal immunochemical test (FIT). The programme is being implemented on a phase basis in order to develop the capacity to cater for the full 55 to 74 aged population. It is starting with men and women aged 60 to 69. Over time the programme will be expanded until the full 55 to 74 age group is reached. Every two years the screening will be offered. Men and women who are eligible and wish to be part of the screening programme are sent a test kit. The kit is simple and easy to use which has step by step instructions for use at home. In a specialist freepost envelope, the test is returned to a laboratory contracted by the NSS for analysis. Within four weeks the results are provided. A normal test result is expected that most people will receive and will be given another kit in two years if they are still eligible. Where blood is found in a small number of cases in the test sample, a colonoscopy will be performed as part of the BowelScreen programme. In a hospital setting the colonoscopy will take place (BowelScreen, 2019).
The second most commonly diagnosed cancer in Ireland is colorectal cancer with approximately 2,400 cases per year and is the second most fatal cancer. With the aging population in Ireland by 2020 it is estimated that there will be an increase in colorectal cancer of 79 percent in men and 56 percent in women. The screening of colorectal cancer aims to detect both cancerous and pre-cancerous conditions and overtime will reduce mortality from the disease (BowelScreen, 2019).
Diabetic RetinaScreen, is the national diabetic retinal screening programme and has been recently introduced by the National Cancer Screening Service (NCSS). This screening programme provides free diabetic retinopathy screening to all diabetic patients aged 12 years and or greater. A common complication of diabetes is diabetic retinopathy which affects the small blood vessels in the lining at the back of the eye. The retina is what this lining is called. The retina changes what a person sees into messages that travel along the sight nerve to the brain. What is necessary for good eyesight is a healthy retina. The blood vessels in the retina can leak or become blocked and damage the sight as a result of diabetic retinopathy (Diabeticretinascreen, 2019).
A risk of developing diabetic retinopathy is anybody with type 1 or type 2 diabetes. A list of people with diagnosed diabetes is what the diabetic RetinaScreen has. National health schemes are where this information came from such as the drugs payment scheme, medical card scheme, or long-term illness scheme. Family doctors can also register people with diabetes with the programme. Specialised digital photography the diabetic RetinaScreen uses to look for changes that could affect the sight. Diabetic retinopathy before any changes to the sight, can be detected with regular eye screening. Diabetic retinopathy that is untreated is the most common cause of sight loss in people of working age. Treatment is effective when caught early at reducing or preventing damage to the sight (Diabeticretinascreen, 2019).
Another screening programme is the Rapid Access Prostate clinics. These specialized clinics were established along with the national cancer control programme to offer an efficient and fast service to men who require additional tests performed to detect for prostate cancer and are situated in 8 designated centres for cancer in Ireland. Here a urologist and a prostate specialized nurse assess the patient (HSE, 2019).
The prostate is a small gland located at the base of the bladder and in front of the rectum. The urethra runs through the prostate. The prostate makes a protein called prostate specific antigen (PSA). The PSA protein converts semen into liquid. This protein can sometimes enter the bloodstream. When a doctor is assessing a patient’s prostate, they sometimes measure a patient’s blood PSA levels as well. If the blood PSA levels are raised this can be an indication of prostate cancer. However, it can be an indication of a condition that is less serious. The prostate gland can become bigger with age and press on the urethra, sometimes causing problems with urination. Prostate cancer occurs when normal cells of the prostate gland change and grow into a mass of called termed a tumour. These cancer cells can affect how the prostate functions. It is a slow growing cancer as the prostate cancer cells may not grow or grow very slowly during a person’s lifetime. Lots of men do not develop issues or symptoms from prostate cancer. Sometimes prostate cancer grows very quickly and require treatment to stop it from metastasizing. This type of cancer often develops in men aged in their fifties and upwards. On rare occasions it presents in the late forties. The risk increases with age in developing prostate cancer (Forde et al., 2011).
In order for a screening programme to be sucessful, the participation of people who are eligible in these programmes is key. The NSS has designated screening promotion teams who have offices in various parts all over Ireland. The screening promotion team’s main function is to promote awareness and provide information to people who are eligible for the four different screening programmes currently available in Ireland. The aim of their work is to allow the people who are eligible and especially those who are hard to reach to part take in the screening programmes. This is only achieved by building and putting in place an effective screening promotion strategy. All eligible people have the right not to participate. The role of promotion is to increase awareness and the benefits of the programmes (National Screening Service, 2019).
The goal of national cancer screening programmes is to reduce the number of people dying from cancer by detecting it in its earliest stage where there are more treatment options available and a better chance of survival. The national screening programmes mentioned that are available in Ireland are targeted to lower the mortality rate against these cancers which are the most common cancers in Ireland. These programmes have been shown to be successful due to the number of people dying from these particular type of cancers have reduced. However, the success of these programmes is based on making people aware of these programmes and what benefits they provides as well as targeting the specific population that are eligible for the different screening programmes.
- BowelScreen (2019). BowelScreen – The National Bowel Screening Programme of Ireland. [online] Bowelscreen.ie. Available at: https://www.bowelscreen.ie/ [Accessed 8 Jan. 2019].
- BreastCheck (2019). BreastCheck – The National Breast Screening Programme. [online] Breastcheck.ie. Available at: https://www.breastcheck.ie/ [Accessed 8 Jan. 2019].
- CervicalCheck (2019). CervicalCheck. [online] Cervicalcheck.ie. Available at: https://www.cervicalcheck.ie/about-cervicalcheck/cervicalcheck.84.html [Accessed 8 Jan. 2019].
- Diabeticretinascreen (2019). Diabetic retinopathy screening, Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme, Ireland. [online] Diabeticretinascreen.ie. Available at: https://www.diabeticretinascreen.ie/ [Accessed 8 Jan. 2019].
- Forde, J., O’Connor, K., Casey, L., O’Brien, M., Bowen, S., Casey, R., Ahmed, I., McDermott, T., Grainger, R. and Lynch, T. (2011). A rapid access diagnostic clinic for prostate cancer: the experience after one year. Irish Journal of Medical Science, 180(2), pp.505-508.
- Irish Cancer Society (2019). What is cancer?. [online] Cancer.ie. Available at: https://www.cancer.ie/cancer-information/what-is-cancer#sthash.SWYM4seF.dpbs [Accessed 8 Jan. 2019].
- HSE (2019). Rapid Access Prostate Clinic – HSE.ie. [online] HSE.ie. Available at: https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/ulh/hospitals/uhl/hospdept/deptmed/medicaloncology/rapidaccess/raprostate.html [Accessed 8 Jan. 2019].
- National Screening Service (2019). National Screening Service. [online] Screeningservice.ie. Available at: https://www.screeningservice.ie/ [Accessed 8 Jan. 2019].
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