Professor Risteárd Ó Laoide:

Gabhaim míle buíochas leis an gcomhchoiste as an gcuireadh anseo inniu. I thank the joint committee for the invitation to meet it to discuss the BreastCheck screening programme and improving outcomes for breast cancer with the national cancer control programme. Thank you, Chairman, for introducing our witnesses, so I will not repeat that. I should point out that Mr. Martin O'Sullivan is joining us from Cork University Hospital and has to return to a theatre list at approximately 12.30 p.m. If there are issues relating to family history, I would be grateful if they could be directed to him prior to that time.

In this statement I will provide an overview of breast cancer in Ireland and outline the various approaches to improving services and outcomes along the entire breast cancer pathway, including screening.

I offer my thanks to everyone working in cancer services, including in hospitals, screening services and community services across the country, who have continued to provide quality care to their patients, particularly during the pandemic crises and the recent cyberattack. I also thank those involved in the charitable and voluntary sector who support people dealing with cancer. Our partnership approach with these organisations, as well as with our colleagues in the HSE, the Department of Health, the National Cancer Registry and a broad range of stakeholders across research, education and service delivery, strengthens our collective ability to face the challenges presented by cancer in Ireland today.

Breast cancer remains the most common cause of invasive cancer in women in Ireland. Approximately 3,500 new cases of breast cancer are diagnosed each year and the National Cancer Registry predicts this will rise to 4,650 by 2045. One in seven women in Ireland will be diagnosed with breast cancer in her lifetime. For each of these women, their diagnosis brings a worrying and uncertain time for them and their families. The incidence rate of breast cancer has increased over time, by approximately 2% per year between 1994 and 2008, partly due to improved levels of detection, but has levelled off since then. Crucially, however, mortality rates from breast cancer have shown a consistent downward trend, decreasing by some 2% each year from 1994 to 2016, supported by earlier diagnosis and improvements in treatment.

Breast cancer was the first of the cancer services to be centralised when the NCCP was established. The multidisciplinary care pathways implemented since then, supported by national clinical guidelines, screening, electronic referrals, rapid access clinics and cutting-edge research into cancer treatment, have significantly improved the level of care provided to women in Ireland. The cancer services have had clear policy direction through the three national cancer strategies initiated in 1996, 2006 and 2017. We are currently midway through the timeframe for the third strategy. Funding of €20 million in 2021 is helping to address historical deficits in the cancer service and the implementation of the cancer strategy. I acknowledge a separate amount of €12 million that has been allocated under the pandemic plan to address the impacts on cancer services of Covid-19 and the cyberattack.

It is estimated that approximately one quarter of breast cancers may be preventable through modifiable risk factors and environmental factors. The first line of defence against most disease, including cancer, is prevention through a healthy lifestyle, that is, not smoking, maintaining a healthy weight, limiting alcohol consumption and being active. Breast cancer awareness is an important tool in early detection of cancer and we welcome the focus breast cancer awareness month provides in this regard. Breast screening is one of a number of key strategies used in this country to improve breast cancer survival. Screening provides an opportunity to detect breast cancer at an early stage, thereby decreasing mortality and stage of disease at diagnosis. The benefits of early detection through population screening must be balanced, however, against potential harms of screening and ultimate affordability. Screening, therefore, targets those people most at risk of disease, based on best scientific evidence and international experience. BreastCheck invites well people for screening and is thus a non-urgent service. Each year, approximately one third of all breast cancers diagnosed in Ireland are detected through BreastCheck.

A pathway is being developed for the assessment and management of patients with a family risk of breast cancer, including recommendations for surveillance. This pathway reflects HIQA recommendations and best current international evidence. The NCCP and the national screening service are working together to explore a surveillance process for this patient cohort.

The majority of breast cancers are diagnosed through symptomatic breast disease clinics. Each year in Ireland, some 42,000 women are referred to such clinics by their GP and approximately half of them are triaged as urgent referrals. Between 2,500 and 3,000 of the women referred to the clinics will receive a subsequent diagnosis of breast cancer. The rate of cancer diagnosis among women triaged as urgent is 10% and is less than 1% for those triaged as non-urgent.

Most women with breast cancer will receive treatment in the form of surgery, radiotherapy, systemic anti-cancer therapy or a combination of those methodologies. Approximately 85% of women diagnosed with breast cancer have surgery and more than 70% receive radiotherapy. The role of systemic anti-cancer therapy has grown rapidly over the past ten years. Nine new systemic therapy treatments for breast cancer have been funded since 2012, with others now under consideration. Advances in genetic testing and molecular testing have driven more targeted treatment for patients. In addition, clinical trials translate research discoveries and knowledge into novel ways of treating patients. People with a diagnosis of breast cancer account for almost a quarter, or 23%, of people living with and beyond cancer in Ireland. The cancer strategy's particular focus on quality of life has led to targeted investment in psycho-oncology services and other supports.

Today, as a result of historical capacity issues, the Covid-19 crisis and the cyberattack, breast cancer services are facing many challenges. The past 18 months have been a particularly difficult time for people living with cancer and it goes without saying that the pandemic has had a significant impact on our ability to provide cancer services. It is important to note, however, that symptomatic breast disease clinics continued to operate throughout the period of the pandemic. Furthermore, the symptomatic breast service was significantly bolstered during this time through resources from temporarily paused screening services being diverted into symptomatic services. This ensured that urgent, at-risk patients were seen, diagnosed and treated quickly. The cyberattack had a particularly devastating effect on the continuity of cancer services and was a very difficult time for patients, their families and those providing their care.

Through the continued efforts of cancer service teams, innovative approaches have kept services operating through these challenges, including by way of extra evening and weekend clinics, extended working days, refitting of mobile screening units, pioneering changes to radiotherapy fractionation, virtual clinics, insourcing and outsourcing, and rapid development of clinical guidelines to support safe care. Míle buíochas as ucht bhur n-aird is bhur bhfoighne.