Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I thank the Acting Chair. I have a lot to get through.

I thank Senators for inviting me to the House to discuss this important topic. I was here in March to speak about women's health on International Women's Day. Breast cancer was raised by several Senators then and many have raised it continually since.

As Senators are aware, approximately 3,600 women are diagnosed with breast cancer every year, making it the most common cancer among women in Ireland. One in seven women receive a breast cancer diagnosis in their lifetime. For example, in 2024, 9,000 people began chemotherapy treatment for cancer, 85% of whom were within the 15-day target, and 6,500 began radiation treatment, 75% of whom were within the 15-day target. It is a significant cancer in Ireland. While our overall five-year survival rate is now 88%, far too many women still die from breast cancer. It is important to reflect on the comparative figures. Our survival rates have improved to 88% for those diagnosed between 2014 and 2018. That is an important increase. Prior to that, for the period 2010 to 2014, it was 82%.We need to do more to continue this process of improvement, though. The programme for Government sets out several priority areas for improving cancer services, including the continued expansion of cancer screening programmes, improving access to medication and supporting survivorship and research programmes for all cancer patients.

Starting with the BreastCheck screening programme, which we all know to be fantastic, it has done 2.6 million mammograms and identified 18,000 cancers in total. Some 625,000 women are eligible for this screening programme and this figure has grown by 19% in six years, which is a significant expansion. The programme detects early-stage cancers, which are the ones capable of being treated the best. BreastCheck is currently inviting women aged between 50 and 69 years to have a mammogram at regular intervals.

Senators will be aware that we are trying to expand the programme and are asking the national screening advisory committee, which is independent, for the best evidence as to how best to do so. The question is whether it would be best to base the expansion on age or the very important issue of breast density measurement. This is a particularly important review because we have two competing pieces of scientific information, one from the European Commission initiative on breast cancer and, in contrast, one from the European Society of Breast Imaging. They take slightly different perspectives on the science, so we must ensure we are making an evidence-based scientific decision. It is important to say that the NSAC is asking HIQA to look at the scientific evidence for the expansion of the programme. Work is definitely expected to start by October but I am told potentially as early as next month. I expect the review will take approximately 18 months. It is an important scientific base for what we do next, and, of course, that is how we like to do things.

We have continued to expand the national screening service with an additional €2.9 million allocated to the BreastCheck programme this year. This will recruit an extra 22 whole-time-equivalent positions, mostly radiographers. That is in addition to the current 79 radiographers, so it is a significant expansion. These will be staff like the radiographers and radiologists I met recently on Eccles Street when I visited the BreastCheck clinic there to celebrate 25 years of BreastCheck, and the staff in the Merrion centre, Cork and Galway. This important funding will help to expand capacity and deal with some of the waiting list issues that have existed for a time.

Our nine symptomatic breast disease clinics are important for breast cancer diagnosis. The GP referral guidelines are also important. I believe the Senators will raise this issue. The referral guidelines provide a clear pathway to patients of all ages with suspected breast cancer to attend symptomatic breast disease clinics. Approximately 45,000 women are seen in these clinics every year and the clinics detect approximately two thirds of all breast cancers, with the other third being detected in the screening clinics. Attendance at these clinics is very high and, for many reasons, I do not want to see delays.

The HSE maintains a suite of clinical guidelines for cancer. Just last month, we launched the update to the HSE's clinical guidelines for the diagnosis and staging of breast cancer. This is all fine but we must ensure that we have the medicine for people who need it. New medicines have played an important role in improving the outcomes for cancer patients. The HSE approved reimbursement for 74 drugs for cancer treatment between 2021 and 2024. Our budget for that has been €645 million, which is significant. Since 2022, eight drugs for breast cancer alone have been approved for treatment of early and late stages of the disease as well different types of the disease. However, I recognise that we want to have these drugs, where appropriate, approved at a faster pace. The HSE recently recruited 34 additional staff to the pricing and reimbursement process. It is important to recognise that this is a 100% increase on the number of people there, which is a significant expansion. Of course, it is my job to ensure that the HSE's processes are such that it is using these additional resources in an effective and efficient way. We have also introduced an application tracker, administered by the HSE, to increase transparency in the medicines assessment process. On the one hand, this is for the HSE to do well, but it is also for the drug companies to do well. A bit like financial services and the Central Bank, both parties have to submit things on time and keep up with the process. I will be monitoring this matter closely.

Alongside improved detection and treatment, we must really drive more on clinical trials. Last month, I was delighted to officially launch a new phase of the philanthropic partnership between the University of Galway and the National Breast Cancer Research Institute, which is an extraordinary place doing extraordinary research. A donation of €4 million was made to it by community fundraising right across the west to support breast cancer research, building on the already significant investment in place.However, it is very widely accepted that we have to do more to support clinical trials. The national clinical trials oversight group is identifying some challenges and formatting solutions to increase the number of clinical trials, and I expect its final draft report in the coming months. I want to see greater access to clinical trials. I want to be very clear about that.

Since 1996, our national cancer strategies have been shaping and informing cancer controls. We have seen sustained investment and very clear strategic direction. The centres of excellence model has worked in large part, but we want to make sure treatment is available as locally as it can be. In budget 2025, an additional €23 million was secured for the national cancer strategy. The Government has invested more than €230 million in additional funding for cancer services since 2017. However, the benefit is seen in the number of patients who are surviving a cancer diagnosis. When the strategy was published in 2017, that figure was 150,000. Today, it is 220,000 and that, of course, is 220,000 people in our families and communities who are surviving cancer better. Behind every one of those numbers is an individual whose cancer is unique and very deeply personal, and they really do deserve the very best care. What I am encouraged about is that the treatment has become so very personal. I really learned that in the research institute in County Galway. We have these personalised, individualised treatment programmes that identify, manipulate and interrupt cancer in a very different way. I was hugely encouraged to see that. I know Senators have more contributions, so I will finish.