Michael Finneran (Roscommon-South Leitrim, Fianna Fail)

I have been asked by the Minister for Health and Children, Deputy Harney, to respond to this question on her behalf. The Government welcomes the opportunity to address the House and to outline the position on breast cancer screening under the BreastCheck programme.

Breast cancer is the most commonly diagnosed cancer in women in Ireland. More than 2,300 women are diagnosed with breast cancer each year in Ireland and approximately 670 women die of the disease. However, survival rates for breast cancer are improving. Latest figures from the National Cancer Registry of Ireland show that five-year survival for breast cancer is more than 77% for women diagnosed between 2000 and 2004. Early detection is known to be a significant factor in improving outcomes. In this regard, breast screening has a key role. Its primary objective is to reduce mortality from breast cancer through early detection.

BreastCheck, the national breast screening programme, provides free mammograms to women aged between 50 and 64 years. In 2008 and early 2009, BreastCheck provided free mammograms to more than 90,000 women. Of these, 672 women were diagnosed with breast cancer. Indeed, from the commencement of screening in 2000 until 31 March 2009, BreastCheck had provided almost 500,000 screening appointments to 236,000 women and 3,075 cancers were detected. In 2009, the national roll-out of BreastCheck to all counties was completed with the commencement of screening in Donegal. An estimated 120,000 women were screened in 2009 overall. This year, more than €22 million has been allocated for BreastCheck.

BreastCheck invites women aged 50 to 64 for regular screening as the incidence of breast cancer is highest in this age group. In Ireland more than 70% of breast cancers occur in women over 50 years of age. While the incidence of breast cancer in women aged 40 to 49 is increasing, the incidence is still approximately 50% lower than that for the 50 to 59 age range.

Given that the incidence and risk of breast cancer in women increases with age, it remains the intention of the Minister for Health and Children to extend BreastCheck to women in the 65 to 69 age group as soon as resources and capacity allow. However, the immediate priority for the National Cancer Screening Service is to ensure that preparatory work for the national colorectal screening programme takes place this year and in 2011 in order for screening to commence in early 2012 for men and women in the 60-69 age group.

The effectiveness of screening below age 50 remains an issue of debate. Several randomised controlled trials in screening have included younger age groups but have not confirmed significant reductions in mortality in the 40-49 age group. In 1991, the UK's National Health Service set up a large randomised controlled trial to measure the effectiveness of screening women from age 40. The trial is ongoing and interim results indicate that a reduction in breast cancer mortality is likely to be observed. However, the size of the reduction is uncertain and this issue awaits further follow-up.

In 2008 the board of the National Cancer Screening Service commissioned an internal review to examine the evidence for reducing the lower screening age limit from 50 to 47. The review concluded that while a reduction in screening age might be of some benefit to some younger women, the merits of extending the programme age range downwards from a population-based screening perspective is still a matter of debate.

BreastCheck has now been extended to all parts of the country and €22 million has been allocated to the programme for 2010. The Minister intends to extend BreastCheck to women in the 65-69 age group as soon as resources and capacity allow. The effectiveness of screening below age 50, however, remains an issue of debate.

I reiterate that women of any age who have concerns about breast cancer should seek the advice of their GP who will, if appropriate, refer them to the symptomatic breast services in one of the eight designated specialist cancer centres.