Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I thank Senators for giving me the opportunity to listen to them and I acknowledge the important issues they have raised.

First and foremost, I again recognise the women and their families who are impacted. So many people in this room have either been impacted very directly and personally or have a close family member who has been. I am no different, so I recognise the importance of BreastCheck in diagnosing breast cancer and the ongoing care it gives to women.

I wish to state clearly that I have every confidence in the breast screening service and every interest in expanding it in ways that are scientifically appropriate. I want to first make sure the science is there and ensure expansion is based on science.

On the screening programme, I visited Eccles Street where I spoke to the radiographers and radiologists. They very clearly acknowledged the limitations of any screening programme. It is a screening programme, so it is never going to detect 100% of cases. They said to me that people must understand the balance whereby, if 99% of cases are picked up, then the screening is worthwhile. There are inherent known limitations to screening programmes, but that does not mean they are not of very considerable value in reducing an overall disease burden in a population generally. We must recognise that screening is not diagnostic. Also, even a screening programme at 99% excellence is going to miss things and there will be harms done. However, we know the evidence we have been able to pick up with screening programmes and the value they are in themselves. That is important, and so we try to think about the best way of extending screening programmes. Let us not forget that there is a very significant cost element and we will have to deal with that on a different day in the form of Estimates and so on. We must strike the right balance when it comes to expansion. The programme has already been expanded to cover people aged 50 to 69 years, when it was formerly 64 years. We are conducting an assessment on how best to extend the programme. Is it 45 to 49 years or is it 70 to 74 years? There is also the breast density issue. That needs to be a scientific analysis.

On the breast density piece, I am glad so many Senators have raised this issue and placed an important focus on that aspect. I thank Martha Lovett Cullen for her contribution to the debate today and recognise her very important words, on behalf of her mother.

I do hear what Senators are saying, but I am a politician and I am not able to make a scientific decision on it no more than on the screening programme. As I may have mentioned before, during negotiations on the programme for Government, we considered extending the ages but realised that none of knew what we were talking about and should ask the actual people who knew what they were talking about. In the same way with the breast density issue, there is competing evidence at a European level about how that is best done. Breast density has gained greater attention and Senators have described how it appears on a mammogram. There are differences in international clinical perspectives on the effective integration of this in breast cancer screening, as I have said. The recently updated European Commission initiative on breast cancer and European guidelines on breast cancer screening and diagnosis talk about the low certainty of evidence incorporating breast density measurements into population health screening programmes. It directly contrasts with the recommendation by the European Society for Breast Imaging, which recommends that women with extremely dense breast tissue be offered screening with breast MRI. We need to have a scientific reconciliation of those pieces of evidence. Thankfully, we remain in a democracy that does rely on experts. This work will take about 18 months and I ask for the Senators to support me in ensuring experts are given the opportunity to do that. Those experts tell me that most public population screening programmes like BreastCheck do not use breast density measurements but I recognise there are those that do. Let us get the scientific evidence and take the best steps forward while recognising there will be a cost, which we will have to address together.

Recognising that, Senators will be aware the NDP review is coming up. I encourage Senators to contact their favourite Cabinet Ministers about investment for health infrastructure throughout the country, but that is a little shameless of me to say so. Of course I want to extend hospital infrastructure throughout the country.

Nevertheless, there have been important budgetary supports that have enabled us to increase the number of consultant radiologists. Today, there are 185 working in the system and we have 43 training places, which is an increase of 5%. That is a really important investment that will make a difference in time.

I am conscious Senators have raised the issue of people not attending for BreastCheck appointments. It does not sit well with me that almost 50% of appointments issued with a time and date for screening using a mammogram are not attended. Such a situation does not work. We do take steps to try to address do-not-attends across the health system.For example, the chronic disease management hub in Sligo has managed to make real progress with the number of people who fail to attend appointments. At the end of the day, people need to turn up to appointments and have the benefit of them.

Focusing on the underserved populations is important. I recently funded a project through the women’s health fund to deliver education on how to be aware of symptoms, specifically targeting underserved populations. We are doing that in partnership with the Marie Keating Foundation, which is an important measure.

I thank Senator Costello in particular for her range of different questions. I will follow up on every one of them to the extent I can. Some of her questions relate to clinically-based decisions, however, and I will need better information to respond to them. The Senator is quite right to highlight lymphedema, for example. There are approximately 2,000 people with chronic lymphedema in this State. Its risk is, as she said, ever present and important. While there are some clinical questions I cannot address, I will ensure she gets a proper answer to them.

With regard to the KPIs, my understanding is that the most recent data are available from September 2024. I can provide detailed information to the Senator in this regard, as that might be better. I thank Senators generally for their genuine focus on this matter. While we spend this time talking about breast cancer, we must equally consider people who are not getting lung cancer diagnoses for the absence of a screening programme, colorectal cancers and the range of other cancers that are important. We could have a similar debate about any one of those cancers.

A point was made with regard to Donegal. Surgical capacity in Donegal is important. We want to see surgeons having the opportunity to continue to perfect and develop their craft in Letterkenny as much as anywhere else.