Cancer care - Canada may hold key to perfection

INTERVIEWED yesterday Professor Tom Keane, interim director of the Cancer Control Programme, emphasised that the recent controversies over cancer services have led to a crisis of confidence that must be tackled.

When it comes to cancer mortality rates, we are well behind many other countries. But it is important that people should not be given unrealistic expectations,because this will make the rebuilding of confidence all the more difficult.

No system of cancer diagnosis is perfect. “Diagnosis even in the best centres in the world is problematic,” Prof Keane emphasised. It is not possible to get it right 100% of the time, but the best international standards do reach 95%, which is well above recent results in some of our hospitals.

Our new cancer strategy is modelled on the system in British Columbia, Canada. Prof Keane emphasised that the difference between that system and our own was the lack of proper oversight. We should have had more specialist consultants verifying and re-examining each other’s findings in order to minimise mistakes.

In British Columbia one pathologist’s findings are rechecked by eight or nine other specialist pathologists, and they have found that in about 20% of the cases the initial diagnosis or recommendation for treatment will be altered on serious reconsideration.

To achieve the best results, it is necessary to recognise this by having experienced pathologists checking and rechecking the work of each other in designated centres of excellence. Once cancer patients have been diagnosed and had their initial treatment at such centres, Prof Keane explained that all care could then be delivered in local hospitals.