Marc MacSharry (Fianna Fail) | Oireachtas source

My matter concerns the need for the Minister for Health to confirm that patients with breast pain referred by general practitioners in the north west to the national cancer control programme's symptomatic breast clinic in Galway are having their referrals returned to general practitioners without assessment and with instructions for the patient to self monitor with the aid of a booklet and form filling for three months. I ask the Minister to account for the effects this three-month delay will have on the 7% of women whose symptoms are the result of life-limiting conditions such as breast cancer.

The Minister will be aware of a letter I sent him, to which I have had no response as yet and which I also sent to the head of the national cancer control programme, Dr. Susan O'Reilly. The letter relates to a case of a lady in her 40s who presented to her GP with breast pain, mastalgia. The GP referred her to the symptomatic breast clinic in Galway. Some time later she received a letter from her GP stating that a response from the breast clinic on her referral had been received and asking her to come in to discuss it at her earliest convenience. Naturally, she was very concerned and went to her GP. I have a copy of the unsigned letter from the clinic which I have also sent to the Minister. Whether it is unsigned to preserve plausible deniability, I do not know. The letter is headed "Symptomatic Breast Service, University Hospital, Galway" and it states that the numbers of patients attending symptomatic breast clinics nationally has gone up from 22,000 to 39,000, that the numbers being seen are causing difficulties in terms of volumes attending and it further goes on to say that it is felt that certain people might be better dealt with initially in primacy care settings.

One wonders about primary care. She went to her GP, the GP referred her to the clinic and the clinic sent her back because it seems volumes are causing difficulties. She was then presented with a booklet, the cover of which I have with me, on breast pain. The back page of the booklet has a table that one can fill out. The patient is supposed to diligently fill out when she has had pain. There is one small box per day for three months. I do not know how accurate this can be. As the lady said to me, if she had eight instances of pain throughout the day or sporadic pain, how would she record it? On the surface, it seems like a very poor way to reduce numbers attending a clinic. I need not remind the Minister of the mistakes of the past.While we celebrate the statistical improvements and benefits of the national cancer control programme and other clinical programmes like cardiac care, the north west of the country has been left completely on its own. While the population of the region is a little bit smaller than the rest of the country and statistically the country looks good because 80% of the people live elsewhere, the reality is that the closest breast clinic for the region is in Galway because the one that was in Sligo was moved. Now it seems that ladies, when they are referred, are being sent back, and I do not know whether that is due to an administrative exercise or whether it is a trained oncology nurse or an oncology specialist who decides they are fine and that they will not bother seeing the patients with mastalgia given what the GP has told them in referring the patients. I know statistically that 93% of women that present with mastalgia are fine but 7% are not and, sadly, they will go on and have a much more serious illness.

Does the three-month delay impinge in any way on the outcomes for these patients? Does it impinge on the success of treatment that would be available to them? Does the delay threaten their lives? Luckily for this lady to whom I refer, who is a health professional and a very formidable woman, she had the financial means to book a private mammography within a week. However, she was still unhappy and contacted the breast clinic to complain. After she was passed from Billy to Jack, she was told she should never have seen the letter to the GP and that it was not intended for her. She kicked up a fuss and got an appointment in the end. How many people are less formidable? How many people at their most vulnerable, suffering breast pain and who are worried about what it could be - one hopes they are in the 93% rather than the 7% - are diligently filling out forms at home because we cannot cope with the numbers? Is that affecting their health? That is a legitimate question. What is of concern is that there was an unsigned letter to a GP, no response from the Minister's office and no response from Dr. Susan O'Reilly. This whole issue is of concern to me.

Perhaps the Minister might also comment on the following. His colleague, Deputy John Perry, has announced in media in the north west today the return of post-surgery mammography services at Sligo General Hospital. Will the Minister confirm, deny or explain the situation?