John Crown (Independent)

I welcome the announcement, reported today, that the State is undertaking that women who were victimised by the implantation of industrial-grade silicon in PIP breast implants will have recourse to it if the companies responsible for inserting the implants cannot be forced to look after them. I encourage the Minister for Health to use all power at his disposal in national and international law to pursue relentlessly those extra-jurisdictional organisations which were responsible for this grotesque departure from good practice.

On an allied issue, I was extremely distressed when I received a letter from a patient recently. I shall not name her but she told me she had had a surgical mastectomy of both breasts performed preventively because she had been diagnosed with a genetic predisposition to breast cancer. This is a very sad circumstance that arises. The great majority of breast cancers are not genetic in that sense but a minority are. For the small minority of women who carry one of the identified genes the lifetime risk of developing breast cancer is believed to be so high that the option of preventive surgery, an extremely difficult decision for any woman to make, is one they often confront and have to make. One of the things that in some sense has lessened - though not removed - the pain of being forced to undergo such potentially mutilating surgery, often at a relatively young age, is the fact that reconstructive surgery is available. Using plastics procedures, this surgery gives patients a reconstructed artificial breast that goes some measure towards dealing with issues of self-esteem, cosmesis, etc. I was horrified to hear that Aviva Insurance, one of the leading private insurers in the country, refused coverage to a patient for this surgery, stating that the treatment was performed "prophylactically and therefore was not deemed medically necessary". A person who has the gene in question has an 80% lifetime risk of getting breast cancer and when it occurs the type of cancer can be very aggressive. This surgery is absolutely medically necessary.

Will the Leader bring this matter to the attention of the Minister? I know he does not have jurisdiction over Aviva but one wonders if there is some place within health insurance regulation whereby somebody can enforce standards because this is an appalling decision. If women believe they cannot have reconstruction done, they may make the decision not to have the surgery that could save their life in the first place. This situation also applies to the great majority of women who do not have genetic breast cancer but who may at some stage need a mastectomy. One of the factors that makes mastectomy palatable is the possibility of having reconstructive surgery. I was really distressed to hear this account. I have had an extensive correspondence with the patient in question. I could not believe that such a decision could be made by a leading insurance company in a modern Western country.