Professor Fidelma Flanagan:

We paused the programme because the risk of having breast cancer in the general population is less than the risk of women who have a palpable lump or symptom. When there are limitations in resources, which we had when we had to close the programme, we diverted what we had to the symptomatic service and bolstered that service. As we said, we continued to deliver a symptomatic service right through the pandemic. Women who had a symptom and who were at a higher risk of breast cancer were able to attend those services.

Putting a figure on this, if we screen 1,000 women, we expect to pick up seven patients with breast cancer. If we assess, in our symptomatic services, 1,000 women, we will pick up 100 women with breast cancer. We had to provide the service in those areas where we knew the women would have a higher chance of having breast cancer. When we closed the programme, we diverted to the symptomatic service, and many of us, including me, as a radiologist, were diverted to the front line. Many of the radiographers and radiologists were diverted to the front line. We were all linked with host hospitals and dealing with the pandemic on the front line. It was absolutely appropriate that we stopped screening to divert to the symptomatic and front-line services.

While we were doing that, at BreastCheck we were adapting the service so we could hit the ground running once we got the green light to go again. We took off very cautiously and there were two recovery periods. The first had to be stopped because of the second wave of Covid-19 at Christmas and in my unit, more than two thirds of the people contracted Covid-19. Some people are still out with long Covid. It was a direct impact on the programme.

As I have said, this is a very intimate process, involving close contact with a high-risk population. When we started again, we were able to deliver screening. As I said earlier, we are right back to where we were before Covid-19. We are very proud of the people in the symptomatic services and in BreastCheck who under very difficult, stressful and challenging times could get us back here.

There is the question of what we did specifically to maximise the number of people coming for appointments. We rearranged our scheduling and introduced text messaging. We adapted mobile units so we could safely accommodate patients as they came in. We have also got the resources and funding for three more mobile units so when we go into a location we can move out quickly and try to get around.

There is no doubt the task is challenging and it will probably take at least three years to get around this round of screening. We know that. Nevertheless, our priority is to get back on track in screening. We encourage women to come along if they are asked. The opportunity for early detection is still there. People can still turn up for their mammogram and the opportunity to detect early breast cancer is still there. Women should turn up for their appointments and we have maximised the efficiencies we can bring about in the programme. All we want now is for people to turn up and we can get back on track.

We are still living in a pandemic and have restrictions. Even with the Covid-19 waves we see today, the future is going to be challenging. We are up to the task and have learned much. We follow public health guidelines. We will do the best we can.