Frank Feighan (Sligo-Leitrim, Fine Gael) | Oireachtas source

I confirm that it has not been decided to suspend this service at St. James's Hospital. Urgent and time-sensitive surgeries for women with cancer diagnoses are prioritised to provide priority access to care based on clinical need as assessed by treating physicians. Preventative mastectomies are usually risk-reducing surgeries for women who have been diagnosed with a BRCA gene alteration. As the Senator will be aware, people who inherit harmful variants in one of these genes may have an increased risk of breast cancer. Testing for inherited cancer-causing genes is commonly carried out following assessment and discussion with a genetic counsellor, either at the cancer genetics service at St James's Hospital or in the department of clinical genetics at Children's Health Ireland at Crumlin hospital.

Women who have been diagnosed with a BRCA gene alteration usually elect to undergo a period of surveillance with breast imaging prior to considering a bilateral mastectomy. For the minority of women who decide to undergo a risk-reducing bilateral mastectomy along with a bilateral reconstruction, this is a complex procedure requiring significant theatre time and expert surgeons. Because these women do not yet have breast cancer, they may be prioritised behind women diagnosed with cancer who are awaiting surgery. This has been a particular issue during the pandemic given, when hospitals and staffing levels are under unprecedented pressure, elective surgical services are curtailed and cancer treatment surgeries are prioritised over risk-reducing surgery. A further challenge is that it is not generally suitable or appropriate to outsource this type of complex surgery.

The HSE's national cancer control programme is working on a needs assessment for those with a BRCA gene alteration and this is close to completion. The needs assessment has been developed with a broad range of stakeholders, including representatives of those with a BRCA gene alteration, and will inform the planning of investment in the required services. The growing role of genetics in cancer care is well recognised and the development of a model of care for cancer genetics has been prioritised by the national cancer control programme. It has established an advisory group to agree a national framework for hereditary cancer services. This will incorporate the identification of those with an inherited cancer predisposition and their ongoing management. It will also consider the resources required to deliver this model within cancer centres, specialist cancer genetics services or other national enablers. It will be essential that investment in and development of services will extend to the required healthcare for those who have been found to have a genetic predisposition, including the resourcing of risk-reducing surgeries. The work of this advisory group will also inform the hereditary cancer aspects of the national genetics and genomics strategy, which is expected to be completed by the HSE in late 2022.