Enda Kenny (Mayo, Fine Gael) | Oireachtas source

I, like millions of others, read the story of the actress Angelina Jolie and her decision to have a mastectomy, as well as her statement to her children that their mammy would always be the same. She made her decision based on the risk of death, as her mother had died of ovarian cancer. This is of particular interest to a cohort of women in this country and around the world.

The demand for counselling and testing for diagnosis of hereditary genetic mutations in the BRCA1 and BRCA2 genes for patients diagnosed with breast or ovarian cancer who have a strong family history of similar cancers occurring in relatives younger than 50 years has increased. The NCCP has established a hereditary cancer programme in collaboration with the National Centre for Medical Genetics at Crumlin Hospital to improve access to assessment and genetic testing for those patients whose cancer may have a hereditary component. There are outpatient clinics with genetic cancer expertise at St. James's Hospital and the Mater hospital, with a similar service planned for Cork University Hospital shortly. That programme is primarily focused on patients who have hereditary breast, ovarian or bowel cancer. A working group has been established to agree appropriate structures and best practice in the identification and management of those with hereditary cancer mutations.

Deputy Martin is correct that at the request of the HSE, HIQA recently completed a health technology assessment of surveillance of women aged less than 50 who are at elevated risk of breast cancer. The Deputy will be aware that the programme for Government contains a commitment to extend the breast cancer screening programme to those aged between 65 and 70. HIQA examined the potential of a standardised surveillance programme as well as the resources required to support such a programme. The report found that surveillance for these women can reduce the number of deaths when compared to a situation where there is no surveillance programme in place, which seems to be quite logical. Women at high risk tend to have far more aggressive tumours, so early detection in these cases is absolutely critical. For those women who have been identified as being carriers of certain genetic mutations, HIQA concluded that surveillance from ages 30 to 49 using annual MRI tests would be cost-effective, and for those aged between 40 and 49, the addition of an annual mammogram should be considered. In another small cohort of women who have a high probability of developing breast cancer before 30 - that is, those who are carriers of a mutated TP53 gene - annual MRI surveillance from age 20 to 49 is the optimal strategy recommended by HIQA.

For women with a high familial risk but no identified genetic mutations and for those at moderate risk the HIQA report found that surveillance is not cost-effective compared to offering no surveillance.

However, HIQA concluded that if the goal is to maximise health gains using existing resources and taking account of current international best practice then annual surveillance using mammograms for those aged 40 to 49 years is better than the current arrangements. For persons who have a high risk or who have a family history in these kinds of cases the reported waiting list is not as long. In cases where there is no history doctors have recommended that a test is not absolutely necessary. The HSE national cancer control programme and the report specifically identify the at-risk categories and the strategy and structure for that is being put in place now by the working group. I hope it will save lives.

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