The Cancer Legacy of the Belfast Good Friday Agreement
The Belfast Good Friday Agreement has had a lasting impact on cancer research and cancer care on the island of Ireland says Professor Mark Lawler.
L to R: Prof William Gallagher (University College Dublin); Ms Eibhlín Mulroe (Cancer Trials Ireland); Prof Mark Lawler (Queen’s University Belfast); An Tánaiste Micheál Martin TD; Mr Robin Swann MLA; Prof Aedin Culhane (University of Limerick); Prof Risteárd Ó Laoide
This year marks the 25th Anniversary of the Belfast Good Friday Agreement, which led to peace in Northern Ireland. But as well as its undoubted impact on peace and reconciliation, the Belfast Good Friday Agreement also had a lasting impact on cancer research and cancer care on the island of Ireland. In the 1990s, cancer services in Northern Ireland were fragmented, with a wide variation in treatment provision, breast cancer being a prime example. Northern Ireland had the poorest outcomes in the United Kingdom for nearly all cancers. The situation in the Republic of Ireland was not much better, with nearly 40 centres treating breast cancer, again reflecting a deficit in specialised cancer care. Research activity was also at a very low level in each jurisdiction, both for fundamental cancer research and clinical cancer research.
One individual recognised that the Belfast Good Friday Agreement had the potential to change the narrative of sub-optimal cancer research and care on the island of Ireland. Prof Patrick (Paddy) Johnston had been based at the National Cancer Institute (NCI) in Bethesda, USA and had just returned to Queen’s University Belfast in Northern Ireland to develop a comprehensive cancer research and care programme. He saw a unique opportunity to significantly shift the dial, by creating what at the time was a unique initiative, brokered between the governments of Ireland, Northern Ireland and the United States (US). Pursuant to the Good Friday Agreement and Paddy’s efforts, a Memorandum of Understanding was signed in November 1999 at Government Buildings in Stormont, Northern Ireland between the Departments of Health in Ireland and Northern Ireland and the US National Cancer Institute. I was fortunate enough to be there in 1999 and witness history being made. Looking back, I remember the excitement and sense of a once-in-a-lifetime opportunity for Ireland and Northern Ireland that pervaded the corridors of Stormont as the Consortium agreement was signed by Ireland, Northern Ireland and the US.
This MOU gave rise to the Ireland – Northern – National Cancer Institute Cancer Consortium and reflected an unparalleled opportunity to develop linkages between cancer researchers, physicians and allied healthcare professionals in Ireland, Northern Ireland and the US, in order to help deliver world class research and better care for cancer patients on the island of Ireland. The core aim of the Consortium, captured in the MOU was
“to reduce cancer incidence and mortality on the island of Ireland through cross-border and transatlantic collaborations in cancer research and education.”
So did the Consortium achieve its lofty objectives? If we take for example breast cancer, enhanced screening and a reorganisation of breast cancer services yielded a decrease in breast cancer mortality in Northern Ireland by 29.6% by 2006 compared to 1995, while by 2013, survival for breast cancer at 81.9% was the highest in the UK. An overall analysis of the impact of the Consortium that we performed indicated that collaborative cancer research had doubled between scientists in Ireland and Northern Ireland and also with researchers in premier US cancer research institutions. There had also been a significant increase in the quality of the cancer research that was being produced and being published in the very highest impact scientific and medical journals. These data prompted NCI’s former Clinical Director Dr Bill Dahut to opine that
“Ireland and Northern Ireland together are now firmly embedded on the global cancer research map.”
From a training and capacity building perspective, more than 550 clinicians, allied health care professionals and scientists received top quality training at the NCI over the period and returned to bolster cancer research and cancer care on the island of Ireland. Critically, in the context of enhancing clinical cancer research and clinical care, over 30,000 patients have been enrolled in cancer clinical trials in the last two and a half decades, saving thousands of lives and enhancing quality of life. The Consortium has been transformative for cancer research and cancer care on the island of Ireland. Recently, we hosted a joint QUB-NCI Symposium at the NCI in Bethesda, showcasing a joint QUB-NCI Doctoral Training Programme in Precision Cancer Medicine, where the quality of the students, jointly supervised by QUB and NCI mentors, highlights the potential for the Consortium going forward.
It’s not just on the island of Ireland where we are making our mark, but also in the wider US and European context, made all the more urgent by the recent disastrous impact of COVID on cancer services and cancer patients. Crucially, we have shown through a just-published Lancet Oncology European Cancer Groundshot Commission (the most comprehensive analysis of cancer research activity in Europe ever performed) that cancer patients treated in research-active hospitals have much better outcomes than those who are not, emphasising the absolute need to deliver the very latest advances in cancer research directly to our patients. The European Cancer Groundshot, which resonates strongly with the US Cancer Moonshot, also reimagines cancer research and its implementation for optimal clinical care. From an Ireland – Northern Ireland – NCI perspective, the joint discovery research and its translation that we are espousing, allied to collaborative cancer clinical trials between Ireland, Northern Ireland and the US is compelling. Cancer knows no borders, neither should we.
But we should not rest on our laurels, Recently, through the International Cancer Benchmarking Project (which I chair) we developed a score card linking cancer policy to cancer outcomes for seven different cancers (colon, lung, oesophageal, ovarian, pancreatic, rectal and stomach) in ten countries or jurisdictions across the world – Denmark, England, Ireland, New South Wales (in Australia), New Zealand, Northern Ireland, Norway, Ontario (in Canada), Scotland and Wales. We published the results in the premier cancer journal Lancet Oncology. The main result of the research was that consistent cancer policy leads to better outcomes for patients, as judged by improved five year survival.
Ireland has done well in this regard, with our data indicating they are in the top half in relation to cancer policy and its impact on outcomes. For Northern Ireland, the results are a salutary lesson of what happens when we take our foot off the pedal. We languish at the bottom of this particular league table. The reason – we have only implemented one new cancer strategy in the past 20 years. We do have a new cancer strategy, but it has not been resourced or implemented. As Chair of ICBP, a cancer researcher at Queen’s University Belfast and leading a number of significant pan-European cancer initiatives, I am particularly disappointed in drawing attention to our latest research and the poor performance of Northern Ireland. I’ve highlighted above how much Northern Ireland had improved and what we have achieved – we need to return to that Yes We Can attitude. Lack of political leadership in more recent times, a policy vacuum and absence of dedicated investment have taken their toll on cancer services, research and innovation and regrettably cancer patients in Northern Ireland.
As part of the Agreement 25 Conference at Queen’s University Belfast to recognise the 25th Anniversary of the Belfast Good Friday Agreement, we hosted a Cancer Showcase event entitled “Cancer Knows No Borders” where we highlighted the substantial impact that the Good Friday Agreement has had on cancer research and cancer care on this island and highlighting not only the health benefits that have been delivered, but also the economic dividend that the Ireland – Northern Ireland – US partnership has and can continue to bring to this island.
We also looked forward to what can be achieved in the next 25 years and called out the need for the Northern Ireland Cancer Strategy to be resourced and implemented as a matter of urgency. We have an unrivalled opportunity here. Working together and in close cooperation with our prestigious US partner, we would be unbeatable, delivering unparalleled benefits, both for our citizens and for our societies. To paraphrase my dear departed friend Paddy Johnston:
“Dream no little dreams, for they stir not the hearts of men nor women”.
We need to be bold, we need to be ambitious, and most of all, we need to work together. We need to compete, not against each other, but against cancer … our common enemy.
About the Author
Prof Mark Lawler is Associate Pro-Vice-Chancellor, Professor of Digital Health and Chair in Translational Cancer Genomics at Queen’s University Belfast. He has been prominent in advocating for an all island approach to cancer research and cancer care and is Co-Lead of the All Island Cancer Research Institute (AICRI), which brings together cancer researchers across the island of Ireland. In 2021, he was the recipient of the Irish Association for Cancer Research (IACR) outstanding contribution to cancer research and medicine award, for his pioneering work on cancer research and care on the island of Ireland. He hosted the Cancer Showcase Event “Cancer Knows No Borders” which took on Tuesday 18th April 2023 as part of the Agreement 25 Conference at Queen’s.