Liam Twomey (Wexford, Fine Gael)
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I move:

That Dáil Éireann,

recognises that:

—there are approximately 1,700 cases of women with breast cancer each year;

—approximately 640 women die each year from breast cancer;

—cancer screening plays a significant role in reducing deaths from cancer;

—women in the Republic of Ireland are suffering because of the failure of the Government to extend BreastCheck nationally;

—the Government misled the people in the south and west of the country in relation to the timeframe of the roll-out of BreastCheck;

—the failure of the Government to roll out the national cervical screening programme has left numerous women in Ireland go undetected for cervical cancer; and

calls on the Government to immediately roll out BreastCheck and the national cervical screening programme together with a true and accurate timeframe.

I wish to share time with Deputies Hogan, Connaughton, Deenihan, Hayes and Ó Caoláin.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Is that agreed? Agreed.

Liam Twomey (Wexford, Fine Gael)
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This motion concerns two cancers that affect women of all age groups. Breast cancer is more common in women over 50 and women with a strong family history of the disease. Cervical cancer, or cancer of the cervix, which is part of the uterus or womb, has a number of risk factors. These factors include smoking, the incidence of which is increasing among young women, and the human papilloma virus, the incidence of which is also increasing in the female population. The more sexual partners a woman has, the more likely she is to contract cervical cancer. In the treatment of all cancers, time is of the essence and early detection through screening is critically important.

In two years, Fianna Fáil will have been in power for ten years and we will still not have a nationwide breast cancer screening programme. It is now five years since phase one of the service commenced in the eastern region. It is four years since the publication of the national cancer strategy, which promised that breast and cervical cancer screening would be extended nationwide. In the intervening period, we have had nothing but a litany of announcements that amounted to nothing. The former Minister for Health and Children was well known for the number of press releases he issued. He issued them almost on a daily basis. It is therefore no wonder that patients in the south and west were expecting breast cancer screening in 2005 but, sadly, as we now know, that will not be the case.

Serious questions must be asked about why the roll-out has been delayed so severely. For example, capital funding for the roll-out of BreastCheck was not allocated until 18 months after the Department of Health and Children announced its national extension. Why? Why have BreastCheck's press releases indicated that its understanding of the roll-out timeframe was at odds with that of the Department? This kind of disarray has become increasingly common under the Government. Tragically, the implications of the delay in the roll-out of these services have been under estimated.

One of the former Minister's press statements from February 2003 states:

In relation to the extension to the remaining counties, the Minister said that the Board of BreastCheck has submitted a Business Plan to his Department. A number of key issues have been raised by health boards and health professionals in relation to the national roll out of BreastCheck which need to be addressed in advance of further expansion. I am fully committed to the extension of the programme to the remaining counties in the West and South and I will be meeting with BreastCheck shortly to discuss these issues.

We on this side of the House would dearly like to know what those issues were and the concerns of the professionals and the health boards. In the two years since that announcement, there has been zero movement in regard to BreastCheck and breast screening in the south and west.

Women are being told they will have to wait until 2008 to be screened and treated for breast cancer on an equal basis. In 2008, women in Northern Ireland will celebrate 15 years of breast cancer screening and a reduction of one fifth in deaths from the disease. By that time, because of delays in the roll-out of the programme, hundreds of women in the Republic of Ireland will have lost their lives in their battle against breast cancer. This is not an exaggeration. Hundreds more will have endured devastating and radical surgery to control advanced breast carcinoma. This is terrible.

The late diagnosis of cancer will require more severe chemotherapy for the patients involved and women will suffer the terrible side effects of the radiotherapy required to bring advanced cancer under control. At the same time, many women will have had their uteruses removed because cancers will have spread before treatment can be given, denying some women the chance to have children. This is because it is often a disease of young women. It will deny some children the chance of having a mother. These are the implications of a delay in the roll-out of a screening programme. Such a programme is taken for granted by our near neighbours in Northern Ireland.

The Government has no idea of the cost to the quality of life of all the women who endure cancer treatment, nor does it know what is entailed. This is the case for all cancer patients but I refer in particular to those who could benefit from two very vital screening programmes that would have been implemented long before now if the Government was really serious about the health service. It is not a question of what we have been reading in the papers for the past six months.

There are changes in our society and behaviour that make the roll-out of cervical cancer screening more urgent than is generally acknowledged. I have already pointed out some of these changes in regard to cervical cancer and the risk factors involved, such as smoking, the human papilloma virus and the number of sexual partners a woman may have. Given the risk factors, screening should begin six months after a woman becomes sexually active. Screening is relatively straightforward and involves a smear test. Thousands of these tests are carried out each year in many general practitioners' surgeries. It is known as opportunistic screening because it is done by general practitioners when they offer the service to patients or when the patients request it from them.

Is it not strange that the smear test, which can be carried out in the general practitioner's surgery by either the general practitioner or practice nurse, has been available for more than two decades in Northern Ireland? It is a good question to ask where we stand in the South. Five years ago, a pilot programme started in the Limerick region but five years later it has made precisely zero progress.

The national cancer strategy itself contains some inequalities which should be addressed and which I have raised before in the House with the Minister. For example, the cancer screening test, the smear test for cervical cancer, is not available to medical card patients or young women on low incomes. Young women are particularly at risk of cervical cancer.

The cavalier attitude of the former Minister for Health and Children and his Minister of State with responsibility for the elderly is reflected in the ageism associated with restricting the planned breast screening services to those aged between 50 and 64 and cervical cancer screening to those aged up to 60.

It is acceptable that there be a starting point for every screening programme but the end point should be based on the same medical criteria. I would accept the Minister's attaching an age limit to the programme if it was just to get it off the ground in two or three years. However, the age limit is unacceptable given that half the female population has had to wait five years for the programme to reach them. Cervical cancer can be diagnosed after the age of 60 and breast cancer can be diagnosed after 65. The average female lifespan in Ireland is approximately 82 years which should be reflected in any screening programme. Stopping a screening programme 22 years before the average woman may die is ageism.

Unfortunately, the Government has no commitment to any form of primary screening. The piecemeal and incoherent roll-out of a national programme for BreastCheck and cervical screening is a sad reflection on the Government and is leading to a devastating outcome for the women of Ireland.

Fianna Fáil has not only failed to provide cancer screening but it has also failed to provide proper facilities for the treatment of all cancers. It has failed to publish reports, including the radiotherapy report that sat in the Department of Health and Children for almost the full tenure of the former Minister, Deputy Martin. He received the report in 2000 and did not publish it until shortly before he left the Department. He almost made it his trademark to issue reports but cancer screening and treatment services are at Third World standard. This Government can have no excuse for this.

Just over half the population can avail of BreastCheck. It might be important for politicians in whose constituencies there is no BreastCheck facility to see what happens. An appointment for a routine mammogram can take between six and 12 months in an area which does not have access to BreastCheck. I have seen women who missed early diagnosis because the wait for the appointment was too long or because to make an earlier appointment they had to pay for it, and were later diagnosed with breast cancer. These women may not have had palpable lumps but had risk factors.

BreastCheck has made a dramatic improvement in patient care and reducing the morbidity associated with breast cancer. Morbidity refers to the side effects of cancer, for example, swollen arms, losing a breast and all the related psychological problems. Affected women may also die. The Government should take this on board and do something about it immediately. I hope the Government parties will accept the points we make tonight and demand that the Government roll out BreastCheck and the national cervical screening programme and stop the dallying of the past four years.

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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I thank Deputy Twomey for putting this motion before the House and facilitating a debate on such an important health issue. A great deal of money has been wasted on electronic voting, Abbottstown and Punchestown, and has been scattered like confetti at election time. Promises have been made yet one of the major issues, the health service and, in particular in the context of this motion, women's health have been taken for granted. In my constituency of Carlow-Kilkenny a roll-out of the BreastCheck programme and the national cervical screening programme was promised but it has not happened.

People took this political promise in good faith before the last general election and it has been thrown back in their faces almost three years later. The Taoiseach, the Minister for Health and Children and local government representatives promised a radiotherapy service for the south east, based at Waterford Regional Hospital, in advance of the 2002 general election, but that has been abandoned and there is no sign of its implementation.

People have taken to the streets in Waterford and the south east to ask for basic facilities for preventative medicine in the form of these two programmes. The failure to implement the programmes shows the low priority the Government assigns to women's health. It is unacceptable when it has significant resources at its disposal that such low priority is given to a modest scheme that would help provide early and accurate diagnosis of cancer in women.

Families worry about health. No family has escaped tragedy of some kind, one of the greatest of which, apart from a sudden death, is the prolonged worry about and fear of cancer, its treatment and the services available. This trauma which women in particular have suffered, for want of the early diagnosis these schemes could provide, indicates the callousness of the Department, the Minister for Health and Children and the Government in general.

The former Minister for Health and Children commissioned many consultancy groups and reports but regrettably took no action. The present Minister seeks to hide behind a commitment to develop cancer services further without indicating the timescale for the implementation of the two programmes. The Government should stop making promises about these schemes. They should implement the programmes promised years ago, particularly before the last general election. I call on them to roll out the BreastCheck programme for my constituents in Carlow-Kilkenny and implement a proper public radiotherapy service for the people of the south east on the campus of Waterford Regional Hospital without delay.

Paul Connaughton Snr (Galway East, Fine Gael)
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I congratulate Deputy Twomey on tabling this motion. I am pleased to see the Minister of State at the Department of the Environment, Heritage and Local Government, Deputy Batt O'Keeffe, here. As I drove here today I heard an advertisement on the radio extolling the virtues of BreastCheck and inviting women to apply, but it was of no use to the 57,598 women in Connacht, Tipperary North Riding and County Clare. There are no BreastCheck facilities in those areas and there will not be. A total of 150 women aged between 50 and 64 years of age in that cohort of women have the potential to contract the disease. For every subsequent year between 70 and 80 women will be so diagnosed. That is a potential death sentence for those women. Why five years ago were women in an area around Dublin and the midlands given the opportunity to come forward for BreastCheck while those in the rest of the country were sent to the back of the queue? How can that be justified? Women are infuriated by this. If the women about whom I am speaking can pay for a check, they will get it, but what about the thousands of women who cannot pay for it? These women are condemned as second-class citizens.

The Government and the Minister for Health and Children are involved in a PR stunt. They are giving the impression throughout the country that the service is available to everyone. Every now and again, a Minister promotes this idea which everyone knows is very important when women reach that stage in their life. However, the money is not being put into the system. Those involved in the national screening programme and I believe that if funding was made available, every area would be covered within the next year. There is no need to further test the waters in this area. This has been going on since 1998. All the facilities and procedures have been put in place.

The Minister of State is being most unfair to the 57,000 women who live in the area I know best, namely, Connacht, Tipperary North Riding and County Clare. Funding is available to the Minister and the Government to provide this service because Exchequer returns the week before last indicate the Government never had more money at its disposal. It is not good enough to say to that cohort of women, who have reared their families and helped this economy, that they must wait for this service until 2007, 2008, 2009 and God knows how long more. There will be a backlash as a result of this and I am pleased to have had an opportunity to make my views on this important matter known to the Government parties. People are not prepared to gamble with their lives. It would be different if everyone was in a financial position to pay for a breast check, but that is not the case.

It will be interesting tomorrow night to see what Members will do when the Government parties vote on this matter. They will take a different stance from the message they portray when they are in the constituencies throughout the country. We will see the colour of their money when they vote. Many of them are giving the impression that this matter will be solved within the next year, but my understanding is that people in the west, who should be able to have such a check tomorrow morning, cannot expect a free breast check until 2008 or 2009, which is a disgrace.

Jimmy Deenihan (Kerry North, Fine Gael)
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It is recognised that the early detection of cancer by screening is one of the strategic areas of cancer prevention. Clinical trials of specific screening methods have been shown to be effective in detecting breast and cervical cancer.

Breast cancer has now overtaken both lung and bowel cancer to become the second most common cancer in Ireland. Women in the Republic are suffering because of the failure to extend BreastCheck nationally. The national breast screening programme commenced in February 2000 and to date it has only been rolled out in very small pockets of the country. We know from our neighbours in Northern Ireland, where the cancer screening programme was rolled out some time ago, that the rate of cancer there is considerably lower than in the South.

I would like to refer specifically to County Kerry. Deputy McManus recently organised a seminar in Tralee which was attended by approximately 250 people. Women in County Kerry are very concerned about their health, and rightly so. The rate of breast cancer in Kerry is among the highest in the country. Treatment in the county is symptomatic because women are only treated when they find a lump or when their GP refers them for a mammogram to Tralee. There are no screening services in the county. As the Minister of State will be aware, if cancer is undetected, it will get larger and spread. However, if it is detected early, it can be treated successfully, and there is less need for mutilating surgery, which is very important for women. Lack of screening services in Kerry is leading to more deaths and more mutilating surgery, which is very distressing for women.

The number of full mastectomies in Kerry is much higher than in the rest of the country. This is another factor which should be considered seriously. Each year, approximately 60 new cases of breast cancer are presented in the county. Given the population of the county the fact that there are no screening services means at least another 30 people do not present themselves for a check. Unfortunately, it is too late for many of these people when their GP becomes suspicious that a lump in the breast could be cancerous.

I appeal to the Minister of State, who comes from the southern area, to use his influence to ensure the current timescale of the end of 2008, when it is expected to have a screening programme in Kerry, is brought forward considerably. There is no doubt that this will be a big issue in the next election. Commitments in this regard were given by the Government. Prior to the last election, the people of Kerry were told that a screening programme would be put in place within two years, but now they must wait for more than six years for such a programme. At the time, a clear commitment was given to the women of Kerry, but it has not been honoured and people are furious. While people may not be affected themselves, they know of women who have died unnecessarily from cancer.

I thank Deputy Twomey for raising this issue. As a medical doctor, he is well aware of the distress and the number of deaths breast cancer causes throughout the country. Deputies from many parts of the country will be aware of people who have died from breast cancer or who have had their breast removed. From discussing the issue with women, we know at first-hand and can relate in the House this evening the stories of women who have breast cancer. I hope the Government will take note of what has been said.

Tom Hayes (Tipperary South, Fine Gael)
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I am pleased to have an opportunity to speak on this important motion. I commend Deputy Twomey for tabling it and bringing his knowledge in the medical field to the House. We as politicians need to be reminded of the urgency of treating cancer and the frightening experience many families have had to endure because of a close relative, neighbour or friend who has suffered from this deadly disease. We have had many reports and consultations. However, if we are worth our salt we should give people the opportunity to have proper breast checks. It is unfair to allow such a situation to arise.

I recently received a note from a 25 year old lady who has found a lump on her breast. She said she will be visiting the doctor in the next few days but she thinks screening should be made available. A close relative had both breasts removed last June. She is 50 years old and her doctor ordered a priority mammogram. She got an appointment for November 2005. Recently, a woman in her fifties, who has worked in nursing since she left school, came to my clinic to get her appointment at a Dublin hospital brought forward. It is deplorable to put people in this situation. We could talk about the issue for hours but this is a deadly disease and the Government should be upfront with people and do something that will help them. They are at a vulnerable stage in their lives.

I represent a constituency formerly represented by the late Ms Theresa Ahearne who died from cancer. Prior to her death she spoke about the poor state of services. She was complimentary about the hospital she attended but very vocal with regard to what she saw as the problems experienced by people with cancer.

A campaign for improved cancer services is ongoing in the south east. There is no commitment with regard to that. The Government does not take the issue seriously. Money is wasted on an endless list of initiatives such as e-voting. We have a duty and a responsibility. As a member of the Committee of Public Accounts, I see money wasted on a weekly basis. It is deplorable that money is not made available for people with cancer. It affects many people and families, which is why I fully support this motion.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Ba mhaith liom tacú leis an rún ar son Theachtaí Shinn Féin. This is a timely and important motion which I fully support on behalf of Sinn Féin. I thank my Fine Gael colleagues for the opportunity to speak.

The Irish Cancer Society is to be commended for its current campaign which calls for the roll-out of a national cervical cancer screening programme. On the day the Dáil rose for its Easter recess, 23 March, I questioned the Tánaiste and Minister for Health and Children, Deputy Harney, on this issue. In response, she stated she favoured the roll-out of such a national programme. She also stated that she would support cross-Border co-operation in this area. I welcome that and hope she keeps her word. However, the Government amendment to this motion is disappointing in that regard and I cannot support its request for us to have blind faith in the Tánaiste or any other Minister.

I call on the Government to act in accordance with this motion, as tabled by Deputy Twomey. It should also heed the call of the Irish Cancer Society and 24 organisations, including trade unions, professional bodies and women's networks which joined together on 24 February in a unanimous call for a national pre-cancer screening programme.

In 2000, there were 1,090 cases of in situ cervical cancer, a pre-cancerous state, 193 cases of invasive cancer and 65 deaths. Comprehensive screening leading to early detection and treatment can dramatically reduce both the development of cancer and the death toll arising from the disease. The Minister should therefore roll-out a screening programme as soon as possible. Screening should be available free of charge to all women over the age of 25. There should not be a ceiling age of 65. We must recognise that women beyond that age are equally entitled to full access and all necessary treatments. There should be a register of women to facilitate such a programme.

The Government will cite the costs of such a programme but the Minister should explore ways in which these can be reduced, including economies of scale. This is where all-Ireland co-operation has a role. The Minister has described such co-operation as a good idea and she should act accordingly.

As stated in the motion, the roll-out of the BreastCheck service has not happened as promised and, as a result, cancer will go undetected and lives will undoubtedly be lost. According to the National Cancer Registry one in 13 women in Ireland will develop breast cancer and a woman living in Ireland is four times more likely to die from the disease than her European counterparts. These are very worrying statistics and affect every family. Every Member knows the harrowing reality of cancer within their own family, as I do.

By failing to put these programmes in place, the Government is operating a false economy. Comprehensive cancer screening programmes will save massive resources for the health services through early detection and prevention. Above all, it will save women's lives. This must be the key motivation and central focus for each of us. There is no excuse for failing to deliver on this issue. In the regrettable absence of the Minister's support for the motion, I urge the Minister of State, Deputy Tim O'Malley, to ensure the Minister proceeds with the indications she gave on 23 March. I welcomed them at the time and continue to urge and encourage her in that regard.

Tim O'Malley (Limerick East, Progressive Democrats)
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I apologise on behalf of the Tánaiste who cannot be here as she has a prior engagement.

I move amendment No. 1:

To delete all words after "Dáil Éireann" and to substitute the following:

"commends the Government for the significant increases in investment in cancer services, in particular the development of services for women with breast cancer and cervical cancer, and supports the Tánaiste and Minister for Health and Children in her commitment to further develop cancer services nationally."

There have been significant increases in investment in cancer services since 1997. In parallel, we have also seen major improvements in cancer across all modalities of care, specifically medical oncology, oncology surgery, radiation oncology and supportive care.

Overall relative survival from cancers increased for men and women between 1995 and 2002. With regard to women, there were increases in survival of the four most common cancers: breast, lung, colorectal and lymphoma. With regard to men, survival improved for almost all cancers, notably for cancer of prostate and stomach, as well as lymphoma and leukaemia. By far the best survival rate for the commonest cancers was for female breast cancer. The overall true risk of developing cancer, allowing for the effects of population changes and ageing, is not increasing for women and is increasing by only 0.6% for men. The true risk of dying from cancer is decreasing by about 1% per annum. We have seen a substantial increase in oncology related activity in hospitals. The number of patients with a diagnosis of cancer rose from 58,000 in 1998 to over 80,000 in 2002. The number of day cases increased by 68% between 1998 and 2002.

International evidence demonstrates the proven efficacy of population-based screening programmes that are effectively managed and meet quality assurance standards. The Tánaiste is fully committed to implementing screening programmes which have proven efficacy in line with best international standards. The European Commission's recommendations on cancer screening were adopted by the European Council in December 2003. These recommendations proposed that screening tests which have demonstrated their efficacy should be seriously considered, and that the decision to implement such programmes should be based on available professional expertise and priority setting for health care resources in each member state. Population-based screening programmes for breast and cervical cancer have been proven to reduce mortality, with subsequent improvements in population health in terms of survival, morbidity and quality of life. Screening aims to improve survival from cancer, limit morbidity from cancer and improve the quality of life of those who have developed cancer.

I am pleased to have this opportunity to outline the considerable investment that has been made in recent years in the national breast screening programme and the Irish cervical screening programme. I take this opportunity to set out the current position on the development of these services nationally. The extension of the current breast screening programme to the remaining counties in the country is a major priority in the development of cancer services nationally, as is the extension of the pilot cervical screening programme. The Tánaiste has committed to making sure that BreastCheck will be available to women in all parts of the country. I am confident that during 2007 screening will commence in the western and southern counties.

BreastCheck, the national breast screening programme, commenced in the eastern, north-eastern and midland regions in February 2000. Screening is offered free of charge to women in the 50 to 64 age group in these regions. From the commencement of the screening programme to September 2004, 167,000 women were invited for screening and 120,000 women availed of the service. Under the national expansion, all women in the relevant age group will have access to breast screening and follow-up treatment, where appropriate. It is estimated that the cancer detection rate is approximately 7.8 per 1,000 screened and to date over 1,000 cancers have been detected. Screening uptake among eligible women is almost 77%, which is in excess of the 70% required to reach the target of reducing mortality by 20%.

The expansion of the BreastCheck programme to counties Carlow, Kilkenny and Wexford is under way. Screening commenced in Wexford in March 2004. BreastCheck expects to commence screening in Carlow in April this year and screening will follow in County Kilkenny when the first round screening in Carlow is completed. There are approximately 18,000 women in the target age group in the south-eastern area.

The national roll-out of the programme required detailed planning for the development of essential infrastructure to provide for two clinical units, one in Cork and one in Galway. This detailed planning involved considerable work by BreastCheck, University College Hospital, Galway, the South Infirmary-Victoria Hospital, Cork, and the Department of Health and Children. There are approximately 130,000 women in the target population for screening in the southern and western regions.

The planning of two static clinical units necessitated the establishment of two capital project teams to develop briefs for the construction of the two units. The former Western Health Board prepared detailed option appraisals for the BreastCheck development at University College Hospital, Galway. The brief proposals, with cost and phasing options, were then submitted to the Department for consideration. After careful evaluation the most appropriate option was selected. The South Infirmary-Victoria Hospital considered it necessary to commission a site strategy study to ensure the integration of the breast screening service into the present and future developments at the hospital. The Department made a capital grant of €230,000 available for the study to be undertaken by professional architectural, engineering and quantity surveying experts. This study was completed in mid-2004 and brief proposals were submitted to the Department.

After the evaluation of both briefs the Department was in a position to determine the capital funding requirements for the progression of both developments. These requirements were considered in the context of the overall capital investment framework and in September 2004 approval for a capital investment of approximately €21 million was given for the construction of the units. This investment will also provide for the mobile units which will be available to screen women throughout the country.

Subsequently, discussions took place between BreastCheck, the South Infirmary-Victoria Hospital, the former Western Health Board and the Department in regard to design issues surrounding the development of the static units. In addition, it was decided to relocate and develop the symptomatic breast service back to back with the BreastCheck development at University College Hospital, Galway. In December 2004 the Tánaiste approved additional capital funding of €3 million to support this development.

Capital funding for the facilities at Cork and Galway has been identified under the capital investment framework 2005-09. Funding has also been approved for the relocation and development of the symptomatic breast disease unit at University College Hospital, Galway. This unit will be developed in tandem with the BreastCheck development. The Health Service Executive, in conjunction with the Department, is examining the health capital investment framework with a view to initiating, as quickly as possible, new capital commitments for this and subsequent years.

It is intended to progress the developments at Cork and Galway simultaneously and it is anticipated that the advertisement of the appointment of a design team will be placed in the EU Journal shortly. Given the scale of the investment involved, EU tendering procedures will apply. The design construction and commissioning of projects of this nature generally take approximately two and a half years.

Since February 2000, cumulative revenue funding of approximately €60 million and €12 million capital funding has been allocated to support the programme. Additional revenue funding of €750,000 was provided by the Department in 2005 to further support the national roll-out to counties Wexford, Carlow and Kilkenny.

BreastCheck requires highly skilled specialists working together to ensure best outcomes for patients. A key requirement and dependency for the national roll-out of BreastCheck is the recruitment of a wide range of specialist staff. The largest single requirement in terms of staff numbers is specially trained radiographers who will provide screening services both at the static centres and at mobile clinics.

Until now specialist mammography training for both screening and symptomatic breast services has been undertaken overseas. The Department is supporting the development of a national training centre in mammography to be operated under the auspices of BreastCheck adjacent to its Eccles unit on the campus of the Mater Misericordiae Hospital in Dublin. This facility will greatly enhance our training capacity and enable Ireland's needs to be met here at home. The physical infrastructure for this centre requires an investment of more than €750,000 and BreastCheck is now seeking tenders for this work. The centre will be led by a specialist tutor and will provide training for BreastCheck and symptomatic services. The centre will open at the end of this year and will be in position to support the roll-out of BreastCheck.

Interim proposals regarding a limited screening service through the deployment of some mobile units and the deployment of temporary facilities have been considered by BreastCheck, pending the roll-out of the national breast-screening programme. BreastCheck is primarily a radiological, as opposed to surgical programme, with fewer than eight women per 1,000 requiring surgical interventions. The competence of the radiologist is crucial in the detection of screened cancers.

Radiological quality assurance for breast cancer screening dictates a minimum viable screening throughput of 22,500 mammograms per annum. Based on a 75% uptake this requires an eligible population of 30,000 per annum or 60,000 over two years. The 2002 census shows that the total eligible population in the western region is 57,288 and is 71,888 in the southern region. It would not be possible to quality assure a population-based screening programme for a smaller population than this within quality assurance parameters. BreastCheck has advised the Department that to ensure that a quality assured breast-screening programme is available to all women here, the optimum approach is to work towards the development of the two static clinical units referred to earlier.

The current priority is to progress the roll-out of breast screening to women in the target age group throughout the rest of the country. When the national roll-out of the programme is sufficiently developed and it is assured that quality service is being delivered at national level, consideration will be given to including older women and continuing screening of women in the programme who have reached 65 years of age. More than 60% of women diagnosed with cancer here are under 65 years of age. However, we have no plans to target women below the age of 50 years. This position is consistent with the report, Development of Services for Symptomatic Breast Disease, which states that clear proof of the value of population screening has up to now been confined to women over the age of 50 years. This is also consistent with the recent recommendations adopted by the European Union, advocating the introduction of cancer-screening programmes, which have demonstrated their efficacy having regard to professional expertise and priority setting for health care resources.

The majority of women diagnosed with breast cancer will be diagnosed and treated outside of the BreastCheck programme. It is necessary therefore that we support both the symptomatic breast disease services and the screening services to ensure that comprehensive breast cancer services are available for all women. The report, Development of Services for Symptomatic Breast Disease, which was published in 2000, recommended the development of new organisational structures for the provision of symptomatic breast disease services to improve the quality of care. It made a number of recommendations based on the requirement of good care, which included the establishment of specialist breast units throughout the country. The report recommended that each unit should be based on a population of 250,000 to 300,000 from which it is expected to identify a minimum of 100 new primary breast cancers per annum. The report concluded that this level of workload is necessary to sustain the collective workload of the multi-disciplinary team involving surgeon, radiologist, pathologist, medical oncologist, radiation oncologist and clinical nurse.

Breast cancer is the individual site-specific cancer which has received the most investment in recent years and more than €60 million has been made available for development of these services since 2000. The benefit of this investment is reflected in the significant increase in activity, which has occurred with inpatient breast cancer procedures increasing from 1,386 cases in 1997 to 1,812 in 2003, an increase of more than 30%.

The Government is also committed to the national roll-out of a cervical screening programme in line with international best practice. International evidence demonstrates the proven efficacy of programmes that are effectively managed and meet quality assurance standards. Careful planning and consultation with relevant professional and advocacy stakeholders is required before definite policy decisions are made on a national roll-out. The pilot cervical screening programme commenced in October 2000 and is available to eligible women resident in counties Limerick, Clare and Tipperary North. Under the programme cervical screening is being offered, free of charge, to approximately 74,000 women in the age group 25 to 60, at five-year intervals. Almost 83,000 smears have been processed through the programme.

To December 2003 histology findings relating to pre-cancerous indicators were reported in 747 women screened. Carcinoma was diagnosed in a further five women. The national roll-out of the cervical screening programme is a major undertaking with significant logistical and resource implications. The former Health Board Executive commissioned an international expert in cervical screening to examine the feasibility and implications of a national roll-out of a cervical screening programme. The examination included an evaluation of the pilot programme, quality assurance, laboratory capacity and organisation and the establishment of national governance arrangements. The evaluation of the pilot programme is a key element in informing the development of a high quality cervical screening model for Ireland. The expert's report was published in December 2004. The report reviewed the operation of the pilot programme in the mid-western region and identified improvements that may be needed in the context of a national expansion.

The Department is now consulting the Irish College of General Practitioners, An Bord Altranais, the Academy of Medical Laboratory Science, the Institute of Obstetricians and Gynaecologists of the Royal College of Physicians of Ireland, the faculty of pathology of the Royal College of Physicians of Ireland, the Women's Health Council and the Irish Cancer Society. Consultation with these key stakeholders is well advanced and will be completed in a matter of weeks. The Department has also met representatives of the Well Woman Centres. All the groups consulted so far are fully committed to a national cervical screening programme. Following completion of the consultation process the Department will examine options for the roll-out of a national cervical screening programme.

A key concern for the pilot programme and any future national roll-out was the need to provide a quality service in line with best international standards. In this regard, a national expert advisory group on cervical screening was set up to oversee the implementation and operation of the pilot programme. This group produced quality assurance guidelines for the national cervical screening programme. These guidelines established standards and targets for the main stakeholders involved in the delivery of the screening programme, including GPs or smear-takers, laboratories, colposcopy service and the register office.

Outside of the programme many women present for opportunistic smear tests, the number of which has increased substantially in recent years. Overall, more than 230,000 smear tests were carried out in laboratories throughout the country last year. To meet this increased demand additional cumulative funding of approximately €14.5 million has been provided by the Department since 2002 to enhance laboratory and colposcopy services. This funding has enabled the laboratories to employ additional personnel and purchase new equipment, thereby increasing the volume of activity. These initiatives have resulted in a reduction in waiting times for smear test results.

The programme also supports opportunistic services, particularly in the area of quality assurance and new technology. Additional revenue funding of €1.1 million was allocated to the programme this year to support the introduction of liquid based technology in laboratories where it is not available and support the development of quality assurance and training programmes. The introduction of this technology will result in fewer unsatisfactory slides which require women to come back for repeat smears and will, therefore, substantially improve throughput in the laboratories. It will also enhance the capacity of the laboratories to deal with any expansion of the current cervical screening programme. The transition of the remaining laboratories to new, more effective testing methods are essential preparatory elements in a national roll-out.

With regard to cancer services generally, there has been a cumulative investment of approximately €720 million in the development of appropriate treatment and care services for people with cancer since the implementation of the national cancer strategy commenced in 1997. The key goal of the national cancer strategy 1996 was to achieve a 15% decrease in mortality from cancer in the under 65 year age group in the ten year period from 1994. The Deloitte evaluation of the 1996 national cancer strategy demonstrated that this figure was achieved in 2001, three years ahead of target.

This substantial investment has enabled the funding of 109 additional consultant posts in key areas such as medical oncology, radiology, palliative care, histopathology and haematology. An additional 245 clinical nurse specialists have also been appointed in the cancer services area. This investment includes the sum of €23.5 million, including €11.5 million for radiation oncology services, provided in 2005 to ensure we continue to address increasing demands in cancer services throughout the country.

The Government's policy on radiation oncology is based on the report, The Development of Radiation Oncology Services in Ireland. Considerable investment will be provided for radiation oncology services in the coming years. The central aim is to ensure access by cancer patients throughout the country to high quality radiation oncology in line with best international standards. Significant progress is being made in implementing the report's recommendations.

Immediate developments in Cork and Galway will result in a significant increase in the numbers of patients receiving radiation oncology in the short term. Two additional linear accelerators are being provided at the supra-regional centre at Cork University Hospital at a capital cost of more than €4 million. The first of these linear accelerators has been installed and the second is expected to be commissioned by the autumn. Last year, approval issued for the appointment of 29 staff for this unit and additional ongoing revenue funding of €3 million to cater for this expansion.

Two additional consultant radiation oncologists will be appointed at Cork University Hospital with sessional commitments to the south-eastern and the mid-western health areas. Cork University Hospital is also in the process of recruiting to fill other key posts required for the commissioning of the new linear accelerators.

The supra-regional centre at University College Hospital Galway commenced treatments for radiotherapy recently. Last year, approval issued for the appointment of 102 staff for this unit, together with ongoing revenue funding of €12 million to cater for this expansion. Approval issued for the appointment of an additional consultant medical oncologist and three consultant radiation oncologists, two of whom have significant sessional commitments to the north-western and mid-western areas. Key staffing is in place and the first two consultant radiation oncologists have taken up their posts.

In addition to revenue funding, approximately €95 million in capital funding has been allocated specifically for the development of cancer related initiatives since 1997. This investment includes €60 million for radiation oncology and €11.9 million for the BreastCheck programme.

Data from the National Cancer Registry show that the overall survival rate from cancer increased between 1995 and 1997 and between 1998 and 2000, with the five year survival rate from breast cancer increasing from 73% to 79% over the period. This reflects the level of investment made by the Government in cancer services. The developments I outlined in cancer services generally and in both screening programmes are a clear indication of the considerable progress made in addressing the burden of cancer in our community. I am glad of the opportunity to put on record the substantial developments which have taken place and to outline the extensive preparatory work necessary before a national screening programme can be implemented. The Government is fully committed to the extension of both programmes to all women throughout the country.

Liz McManus (Wicklow, Labour)
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I wish to share time with Deputies Moynihan-Cronin, Lynch and O'Sullivan.

I would also like to share my chance of life with them but cannot because I am the only female Labour Party Deputy present who can avail of free breast cancer screening. The reason is that I happen to live in Leinster while my colleagues live in Munster. BreastCheck has been available in County Wicklow where I live for a number of years. I and other women in the county have been called and screened twice under the programme, while the women of 13 counties are still waiting for their first visit.

For reasons of geography the chance of early detection of breast cancer among women is diminished. Given that early detection means better outcomes, women in the 13 counties in question are being denied the best chance of surviving breast cancer. We have seen significant political and resource investment in cross-Border efforts between North and South arising from the Troubles. There is, however, an east-west divide which can literally be a divide between life and death. An invisible border extends down the middle of Ireland and a form of apartheid persists for those west and south of the line.

Breast cancer screening is an essential and, at times, life-saving service, yet thousands of women are being denied it because they live at the wrong address. Why did this happen and why is it allowed to continue? The answers can be reduced to one simple problem, namely, a lack of willingness on the part of the Government to provide the resources needed to roll out a nationwide service.

The national breast cancer screening programme was started in 2000. The Government, particularly the then Minister for Health and Children, Deputy Martin, set deadlines which it promptly ignored. Initially, the Minister promised a national roll-out for 2002, after which he promised the programme would be extended in 2005, but we are still waiting. Shamefully, the new Minister for Health and Children, Deputy Harney, has set a new deadline of 2007, with no guarantee the programme will be rolled out by that date.

It is important that the Minister for Health and Children understands that women refuse to wait any longer. The Labour Party has been running a campaign in Connacht and Munster to highlight the issue. The latest meeting in the campaign was headed by Deputy Moynihan-Cronin in Tralee and attracted hundreds of women as well as many men. At the recent annual Progressive Democrats Party conference in Cork, the Tánaiste and Minister for Health and Children as well as the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, were met by cancer survivors demanding screening services there.

It is worth noting that a new cancer support group has been established this evening in County Donegal. Women in particular are desperately concerned about the breast cancer statistics whereby women who present late have less chance of surviving breast cancer and a greater chance of being obliged to have a mastectomy. There is also a campaign underway in the south-eastern part of the country regarding radiotherapy services. In various parts of the country, despite the Minister's statements about investment in cancer services, people are organising to ensure the chance of life for themselves and their loved ones is improved by better cancer services.

To put it mildly, it is disturbing that a Government with unprecedented resources available to it seems to believe it is all right to keep women waiting which, as a result, puts their lives at risk. Somehow, this Government has not got around to giving this issue the priority it needs. We understand there are not always simple answers in the provision of cancer services and that choices must be made and standards of excellence must be balanced with accessibility. However, as far as breast cancer screening is concerned, there is no difficulty. Everyone understands the issue and wants to see a nationwide roll-out of the programme. However, time and again, the Government promises the implementation but does not deliver. The wonderful thing about BreastCheck is that it works and is a very fine service. The people working in BreastCheck can take pride in what they are doing. They deliver a high quality service and have been able to reach many of their targets. It is a part of our health system that works well. The problem and shame is that so many women are denied it.

It is also important to observe that while many women might be fearful of coming forward for breast cancer screening, it is an experience that should not engender fear. It is a very professional and accessible service and no woman who qualifies should feel any worry or anxiety about coming forward for breast cancer screening. This is demonstrated by the high numbers of women who come forward where the service is available. There is a twin benefit in screening in that in areas where it takes place, a higher level of awareness and information about breast cancer, how it can be tackled and how women can assist in protecting their own health exists. However, where screening is not available,a lack of information and to a degree, a lack of knowledge persists.

I will defer to my colleagues who are directly affected by the issue as they represent constituents who are denied the service. I represent a county that has the service. I want to support the people and women in particular who are denied access to a screening service to which they are entitled by right, that literally protects lives and would ensure a reduction in the death rate from breast cancer, as we have seen in Northern Ireland, Britain and other countries that have done what this Government should have done but has yet failed to do.

Jan O'Sullivan (Limerick East, Labour)
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I welcome the opportunity to speak on this debate. I speak, as Deputy McManus noted, as a representative of a constituency where breast screening has not been rolled out. If it had been rolled out according to the original timetable which envisaged its introduction in 2005, I would be one of 12,976 women in County Limerick who would be screened this year, the constituency also represented by the Minister of State at the Department of Health and Children, Deputy Tim O'Malley. According to the statistics provided by BreastCheck, approximately 30 of that 12,976 women could expect to have early detection symptoms, had the implementation in County Limerick proceeded. However, the roll-out of the programme has not taken place and as it appears that we must wait until 2007, we will not be screened and will not know whether we have early symptoms of breast cancer which could be detected by BreastCheck. It is extraordinary that women in the west and south should be obliged to live with this. If the screening programme was in place, we would know if we were safe.

Our lives are as important as the lives of women in other parts of the country and there is a deep anger in this region that the issue has not been given the priority it deserves. Many other issues have been prioritised by this Government in a time of wealth in our Celtic tiger economy. However, despite the fact that this programme was planned and announced many times by the former Minister for Health and Children, Deputy Martin, it has not happened, as Deputy McManus noted. We are now expected to wait until 2007, which is not good enough. It is not good enough for someone like me, with no reason to believe that I might have breast cancer. However, it is particularly unacceptable for women coming from families with a high incidence of cancer, for women who have an internal fear that they might be one of the 30 women who could be detected this year in County Limerick. I speak for County Limerick, as my other colleagues will discuss the statistics in other areas, where if cancers were detected at an early stage, women would have a very good chance of complete recovery. This is how serious the issue is and why people are so angry that the programme has not been rolled out in accordance with the timetable.

We listen to an advertisement on radio featuring Marian Finucane which tells women to be tested, that it is a positive thing with nothing to fear and that early detection is vital. However, at the end of the advertisement, she states that this only applies if one lives in the eastern or midland regions. Women in our region listen to this advertisement and come to us as public representatives to ask why they cannot be included in the screening programme. We listen to it on national radio and yet it is not available to us. On the other hand, people know the statistics from Northern Ireland for example, where breast cancer has been reduced by 20%. We are aware of the statistics and the value of the service but it is not available to us.

The Tánaiste and Minister for Health and Children, Deputy Harney, has been in office for nearly six months. However, she has not seen fit to further this programme to any great extent. As far as I understand, it is a question of resources. There is no reason why the headquarters buildings in Cork and Galway could not have proceeded at this stage, or could not have gone ahead during Deputy Martin's tenure as Minister. It was simply a lack of political will to deploy the resources to ensure that women in our regions are screened for breast cancer. This is what is most unacceptable. It is quite clear from reading the reports of BreastCheck that it was willing to proceed and had the internal resources and skills to do so, if given Government resources. Clearly, it was a matter of political decision-making and we will not accept any further delay. It is not sufficient to make announcements every six months or year that the programme will be implemented when it still has not been.

Women in these regions will not be satisfied until we see the screening buildings and programmes up and running and we will no longer tolerate any delay. The campaign referred to by Deputy McManus in which the Labour Party is involved will continue to escalate until such time as we see real progress. Good government is about making decisions that matter to people's lives. Unfortunately, in this case, we do not see good government and we will not tolerate it. We will continue to campaign until such time as BreastCheck is rolled out throughout the country.

Breeda Moynihan-Cronin (Kerry South, Labour)
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I welcome the opportunity to contribute to this debate. I am amazed at the amendment commending the Government. If anyone from the Government parties attended the public meeting referred to by Deputy McManus in Tralee two weeks ago, which I organised, they would have seen very little commendation for the Government. Hundreds of men and women attended the meeting. Some of them did not understand the issue prior to attending the meeting. However, when they learned about the apartheid-like practices in the area of women's health, they understood that people in the south west are again being treated differently from those on the east coast.

At the meeting, people whose lives have been affected by cancer, particularly breast cancer, spoke publicly about their frustration and outrage at the failure of this Government to extend BreastCheck to Kerry, Cork and the Munster region. What really annoyed them was the fact that the former Minister for Health and Children, Deputy Micheál Martin, had promised that the BreastCheck programme would be extended to the entire country by 2002. We now hear the scheme will only be extended in 2007 or 2008. However, people in Kerry are not prepared to wait any longer for the roll-out of BreastCheck and will mobilise because they have accepted this system from this Government for too long.

A woman who was born in Germany and who spoke at the meeting could not believe that she was denied access to a service simply because she chose to live in County Kerry. It is not only the people of Kerry, Cork and Limerick who are frustrated about the lack of action over BreastCheck. The PRO of BreastCheck is also exasperated with the Government's delay in sanctioning the roll-out of the programme to the rest of the country. He said recently:

We are ready to go but we need approval from the Department of Health and we have not got the go-ahead. Each week that we have no decision from Mary Harney, the later this will happen.

This statement puts the ball in the Government's court. I assure the Minister for State and all his Cabinet colleagues that we will pursue this matter until the extension of BreastCheck is delivered.

What is the Minister for Health and Children saying to the women of my county who rightly ask why they are being discriminated against because of where they live? What makes the lives of these women — and my life — less valuable than the lives of women on the east coast, including my colleague Deputy McManus? It would only cost €25 million to extend the scheme to the rest of the country, which is not a huge amount in the order of things. I ask the Government to take the opportunity tonight to announce the provision of the money to deliver the scheme to the rest of the country because the Minister will rue the day if it does not. Irish women now realise that a form of apartheid exists regarding access to health services and they will not tolerate it anymore.

Kathleen Lynch (Cork North Central, Labour)
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It is interesting to examine the issues this Government considers important —€18 million was allocated for stables for horses without the issue coming before the Cabinet and €56 million was allocated for electronic voting, disregarding the cost of storing the equipment. The overall cost must be approximately €70 million at this stage. Yet this same Government cannot spare €25 million to extend the BreastCheck programme to the entire country. If this had taken place approximately 15 years ago, the Government's reluctance to sanction the release of an amount like that would be understandable. However, it is not understandable given the country's current wealth. The Government is prepared to put the lives of women outside Leinster at risk for a paltry amount of money.

It was not just in 2000 that promises that BreastCheck would be extended to the rest of the country were made. The former Minister for Health and Children, Deputy Martin, made the same promise in 1999 on a local basis. He again announced it in 2002 and 2004. Just before he left office, he again assured us that the programme would be extended in 2007. These dates are significant because they were election years. The former Minister played politics with BreastCheck. The willingness of people in the rest of the country to believe Deputy Martin because he was from Cork always worried me. He did as little in Cork as he did in the rest of the country.

Ministerial promises on the delivery of linear accelerators go back to 1998. A linear accelerator, which is now about to be installed in CUH, is at the end of the pipeline. We hope that there would be many women who would never need to be treated with a linear accelerator if BreastCheck was rolled out to the Munster area. We will all be using linear accelerators if we have to wait as long for the delivery of promises by the current Minister as we did for those of the previous Minister. I do not think that is a pleasant experience.

Last weekend, the Progressive Democrats had their conference in Cork. The only thing I looked forward to was listening to Deputy Harney's speech, which had to be more entertaining than "Friends", for example. However, I received a telephone call on Wednesday from a woman called Noreen who had never attended the meetings and demonstrations about BreastCheck because she believed the Government's promises and who is now being treated for breast cancer. She told me that she had asked to meet the Minister for Health and Children when she arrived in Cork and planned to give her a letter. However, the Minister was refusing to meet her and she was at a loss as to what to do. She asked for my help and I provided her with assistance. If one looks at the demonstration outside Silver Springs Hotel, it was made up of women who are non-political but who had either been recently diagnosed with, were being treated for or had survived breast cancer. They are articulate women with no political bent who realised very early on that the political will to ensure the early detection of breast cancer in their cases was not present and who are now worried for their daughters. They are worried that their daughters will have to endure what they did. All the Minister has to do is sanction the release of the money to BreastCheck. The site survey has been done, the building is in place and everything needed to run the BreastCheck programme is present. BreastCheck is prepared to roll-out the programme in the morning. The only thing missing is the money.

We received a visit from a Progressive Democrats politician who I will not name and who told us the decision was imminent. She would not specify which decision was imminent. Maybe she meant the decision to extend BreastCheck and that it would be announced tonight. We are all hoping that the decision regarding the money to extend BreastCheck is imminent for the sake of the women of the country.