Dáil debates

Thursday, 21 October 2021

Breast Cancer Awareness Month: Statements


2:55 pm

Photo of John LahartJohn Lahart (Dublin South West, Fianna Fail) | Oireachtas source

I thank the Ministers of State who are present today to hear these statements and comments. I am a member of the Oireachtas Committee on Health and this week, as part of Breast Cancer Awareness Month, we were fortunate enough to meet experts from the breast screening services and the national cancer control programme. They included Professor Fidelma Flanagan, Ms Fiona Murphy, chief executive of the national screening service, Professor Arnold Hill and Dr. Martin O'Sullivan. If anybody wishes to listen to that meeting of the health committee last Tuesday, it was a very fine interaction between Members of the Oireachtas and the experts. Most of the questions asked by the public representatives were answered. Not all of them were answered so I have a few I would like to follow up on with the Minister of State. The guests did commit to forward papers to the committee on some issues, and I look forward to receiving them.

There is some good news before I ask the questions. It was the Taoiseach who, in his role as Minister for Health a number of governments ago, introduced the national cancer strategy. We have that to thank for the fact that statistics demonstrate that while breast cancer incidence is expected to increase, as the committee heard and as other colleagues have mentioned here, mortality rates have been dropping consistently year-on-year by 2%. Obviously, we need to do more and would like that to be greater, but from 1994 to 2016 that trend has been downward by 2% per year. It is small but at least it is downward.

A couple of the key messages, and some of them have been referred to by other Members and were also referenced by the experts before the health committee, are the messages of prevention and awareness. Approximately 25% of breast cancers are preventable through modifiable risks. There is also the message that the three previous speakers mentioned about taking up one's appointment when one gets it. Over 20% of people not taking up their appointment is quite dramatic, notwithstanding the excellent efforts that the health specialists are making to ensure people are reminded through text messages and so forth of the fact that they have an appointment. I reiterate the message from my colleagues on all sides of the House that when women receive the text or notification with their appointment date and time, they should take it up. However, there are modifiable risk factors and environmental factors, the usual ones, that heighten the risk of a woman developing breast cancer.

The committee also discussed the age cohorts that are enabled to access the breast screening programme, because there are many questions about that among the community. Some colleagues at both Oireachtas and council levels have raised them with me. They are quite mainstream questions and they are the questions to which we did not get granular answers. I will list them explicitly. There are those who might say that every young woman should be entitled to access the BreastCheck screening programme. Very reasonable answers were given to that suggestion. There are issues to do with the age cohort of women who generally are more vulnerable. From the menopause age onwards was one of the indications given. It was also said that adopting a national universal screening programme could cause more anxiety among the female population and do more harm than intended when set against the improvements it was wants to do, the service it wants to provide and the alerts it wants to provide to people. The answers and the interaction we had with the experts on that were very meaningful and useful to the public.

We were told there are international standards and principles at play in respect of all ranges of cancer screening, not just breast cancer, and Ireland does its best to adopt and meet those international standards. Some queries were raised. We screen the 50 years to 70 years age group, but some countries do it for women under 50 years old and some do it for women under 45 years old. Almost no country in the European Union screens women under 40 years old. I understand that the European Union recommendation is that 45 years upwards would be the ideal. Hopefully, the Minister of State might be able to respond on when Ireland might hope to achieve that.

I understand the incidence of breast cancer in women under 30 is one in 200. For every 200 cases of breast cancer, only one is a woman aged under 30. However, there is anecdotal evidence indicating that may not tally. While we had the mortality rates, they were not broken down by age group. It would be very useful to have the information in tabular form for how many women, very regrettably, passed away in recent years aged from 20 to 30; 30 to 40; 40 to 50; 50 to 60; 60 to 70; and over 70. There seems to be difficulty in accessing that information. I have tabled a number of parliamentary questions on that. The people involved and advocates have found it well-nigh impossible to access that information. That information needs to be made public, not to alarm people but hopefully to reassure them.

I was very heartened by the answer I got to a parliamentary question on widening the age cohorts for breast cancer screening. I was informed that the national screening advisory committee, NSAC, is having its first annual call later this year and that will open up applications for proposals for new population-based screening programmes and modifications to existing programmes, such as a reduction in the age of those eligible for screening. According to the NSAC, applications along those lines will be welcomed from the public as well as from the HSE, health professions and other professional bodies. The Minister of State might be able to inform us as to when that will be launched. That would be very interesting given that it is a first call. It will allow those advocates, who have concerns about women of a particular age not being able to access breast screening programmes, to put forward their views and their anxieties along with their on-the-ground experience of dealing with women, particularly young women, who are diagnosed with breast cancer.

Before I ask my questions, I pay tribute to the professionals who have kept the screening programme going. Clearly, it had to close during the Covid restrictions, meaning that only three months of screening was done in 2020. As it is a very intimate procedure, that was necessary to protect both patients and front-line medics. As a result, even though they have gone full throttle this year and I think 15,000 breast screenings were completed in September alone, it is behind by 120,000 breast screening procedures. It will be 2023 before we catch up on those breast screenings. If a woman was due a breast screening procedure a year ago and it has been delayed, we are all concerned over the impact of that delay on her health and her mental health. I appreciate the major efforts being made to catch up.

The health committee also discussed the impact of the cyberattack. The diagnostics and the radiological procedure are technology based. The cyberattack had almost as big an impact on the breast screening programme as the Covid pandemic had. It was important that those issues were made public.

While I understand that the Minister of State might not be able to give answers to these today, I would like answers subsequently. Of the approximately 690 deaths annually from breast cancer, how does that break down by age group, particularly those aged 49 and younger? It seems very difficult to get that information.

Of those women eligible for the BreastCheck programme at the age of 50, what percentage need to wait to get their appointment? What is the maximum waiting time? What is the minimum waiting time? I would like tabulated information on the average time from a woman making appointment to when she is called. What is the maximum waiting time for a first breast check? For example, could a woman be waiting until she is 52 or 53 before getting called?

How is the GP education being rolled out? The high-risk screening unit at St. James's Hospital is an excellent facility. How many such clinics are operating in Ireland? We need to ensure that GPs know to refer a woman presenting with symptoms of breast cancer on for further assessment even if they present in their 20s or 30s. Anecdotal evidence would suggest that because many of these women are very young, they sometimes felt dismissed by their general practitioner when they raised concerns after following the normal kinds of personal procedures they are advised to follow of checking whether they have lumps.


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