Teresa Costello (Fianna Fail)

I welcome the Minister to the Seanad once again today. I appreciate her time and focus on this matter. I also welcome the four brave ladies who have already been introduced. I acknowledge their journey. They have had a huge input into what I will say here today.

I could spend hours talking about breast cancer, as I have lived through it myself. I run one of Ireland's largest online support communities for people affected by breast cancer. Every day, I hear the challenges and fears people face, from the moment they notice something is not right to when in some cases a diagnosis lands on them. Cases of breast cancer are rising, with almost 3,600 women diagnosed in Ireland each year. Some 23% are aged 49 or younger. Just over 37% are aged 50 to 64, and just over 39% are aged 65. Since the 1990s, breast cancer diagnoses have increased by 120%.

I start by recognising the great care people receive during treatment. I was one of those people, and I would not be standing here today without the wonderful team at St. James's Hospital, or my GP, who did not suspect breast cancer but still referred me to the symptomatic breast clinic. That decision saved my life. We have seen real progress in breast cancer survival in Ireland, with five-year survival rates now around 85% compared with 70% two decades ago. For younger women, survival rates can be high when the cancer is caught early, but their cancer tends to be more aggressive, making early detection crucial. For those with metastatic breast cancer, survival rates are lower, which is why timely access to diagnostics, equitable care across all regions and ongoing research into advanced breast cancer must remain priorities.

Just as I acknowledged the good, I feel a responsibility to speak openly about where things need to improve, because we should always strive for better. I welcome the updated GP referral guidelines for breast cancer from 2023. GPs are often the first step in saving lives. Physical examinations must be made available for younger women to ensure they know how to examine their own breasts correctly, as a form of surveillance, before they are at the age to have free mammograms. I speak for young girls whom I have spoken to who have received a diagnosis before the age of 40. They are often told by healthcare professionals not to worry, that they are too young. Although this statement may not be said in a harmful manner, when a girl gets a diagnosis, it can leave her feeling very dismissed and not reassured.

I must mention delays in diagnostic scanning, especially for younger women. In response to a query I raised, the Minister said that once a referral is received, patients are triaged as urgent or non-urgent. The KPI is ten working days for urgent referrals and 12 weeks for non-urgent referrals. In 2024, national compliance was 76%. Scans for new patients should take place within 12 weeks of the consultant's assessment. Compliance with this was 92%. I did look for recent KPI reports and the most up-to-date ones I could find were from 2010. I would like to see the latest ones, as I was told in 2024 that timely access varied by hospital, with the lowest being 29%. That concerns me. Another hospital was 91%, which is almost a perfect level of service.

My concern about the diagnostic process for younger women is that when a young woman with a lump gets referred by a GP, depending on the urgency indicated, they could wait between two weeks and three months to see a consultant, only to be examined without a scan, and then sent away and have to wait another three months for imaging. Some women, especially those in their 20s and 30s are waiting six months or more to be properly assessed. That delay could mean the difference between catching cancer early or finding it too late. We know breast cancer in younger women tends to be more aggressive. We also know that early detection saves lives. It is a message we are constantly relaying to people.

When I was diagnosed in 2013, I received a triple assessment on the day of my appointment in the clinic. My chemotherapy was organised almost immediately. My cancer was aggressive and at stage 3, so swift action was needed. I wonder if the system has changed and, if so, when and why did it change? I cannot understand the reason for a scan not being part of the first appointment in the breast clinic. It is as if the girls are being retriaged, which is a waste of resources. It is literally bringing someone in to send them away for several months with no answer. I am interested in learning the percentage of girls who attend a breast clinic who require a scan. I imagine very few attending the breast clinic do not need to get a scan. I do not agree that someone with a lump should be sent away on the day of their appointment without a scan.

I want to talk about pregnancy and post-partum diagnosis. It is something I am seeing more and more. Young women are being diagnosed during pregnancy or shortly after giving birth. It is devastating. A time that should be filled with joy becomes terrifying. We need more awareness that this can happen so women and healthcare professionals are alert to the signs.

The Minister knows I have been very vocal about expanding BreastCheck to include women aged 40 and upwards, as the current age range of 50 to 69 is not sufficient. I have made my submission to the NSAC and it is currently being reviewed by HIQA. One of the most regular requests I get, as a breast cancer advocate, is that I should fight to get the age of free breast cancer screening lowered. The women I speak to are realistic about the age they feel it should be lowered to. That is something I believe we will see change, as the evidence is there to prove screening is beneficial from the age of 40. I am aware the age range of 40 to 74 is being examined, which is a good start.

As part of my submission, I also referred to the option to advise women of the category of their breast density. We should give women whose breasts are dense that information so they can make informed decisions regarding other effective screening options for their breast type. I attach that comment to my colleague, Senator Blaney.

We often talk about diagnosis and treatment, but not enough about life after cancer, which is where the journey can get hard. When treatment ends, there is an emotional and physical impact, the fear of recurrence and the difficulty of returning to work. Some people cannot go back to work at all, especially those with stage 4 disease, who are on treatment for life. One big issue I keep hearing about is the lack of clear, accessible information on what people are entitled to in terms of medical cards, counselling, follow-up care and wage subsidy benefits.This information should be handed to every patient as standard. Lymphoedema is a condition that can flare up in any cancer patient who has had an axillary clearance of his or her lymph nodes. I am one of them. More information and better options for care are necessary in respect of this condition. It is an awful condition for those women who suffer from it and the risk of it occurring never goes away.

Another major challenge is menopause. It is a side effect many of us face. For most, HRT is not an option because of the hormone-sensitive cancer. We have moved forward a great deal in this country in recent times with the introduction of menopause clinics and the roll-out of free HRT but, for those of us who have had breast cancer, options and advice are extremely limited. That is why I want to highlight Veoza. It is a non-hormonal medication to manage moderate to severe menopause symptoms. It works by targeting neurokinin 3 receptors in the brain - I have probably pronounced that wrong - rather than through hormones. It became available in Ireland in late 2023 and is under review for inclusion in the drug payment scheme as confirmed in the response to a parliamentary question in March 2025. As of June 2025, it is only available privately at a cost of approximately €70 a month. For women who cannot take HRT, this could be life-changing but, right now, cost is a barrier. I would love to see Veoza made available and affordable for breast cancer survivors as part of the HRT programme.

One final issue is waiting times for reconstruction surgery. For some women, this surgery is essential to their recovery. I refer to their emotional recovery rather than their physical recovery. For those who choose it, waiting years is incredibly difficult. It is a deeply personal choice but those who want it should not have to suffer more because of delays.

I again thank the Minister for taking the time to be here to listen. We share the common goal of improving outcomes and experiences for people affected by breast cancer. I reiterate that treatment is good and that breast cancer care in Ireland is not bad, as we can see in the outcomes of the majority of patients. However, the points I have raised today come from a place of care, lived experience and determination because I know we can do better.