Nicky McFadden (Fine Gael)
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I welcome the Minister of State to the House. Women aged under 50 are being neglected in breast cancer screening. I reject the reasons given by the National Cancer Screening Service for not providing breast screening for women under 50. The service states that pre-menopausal women are unsuitable for routine screening because they would be exposed to excessive radiation as they would need to be screened annually. This is because the breast tissue of women who have not yet reached menopause is usually dense and therefore more difficult to detect a cancer with a mammogram.

Dr. Juliet McAleese who represents the cancer support group, Survive and Thrive, contradicts this assertion. I commend her and her group on highlighting the issue. She states that with digital screening, very low levels of radiation are emitted and such digital screening makes it much easier to view cancer, even in women aged under 50. The real issue, which is being avoided, is money. According to Dr. McAleese, many other countries provide screening for this age group. The American Cancer Society still advises annual mammograms for women starting at age 40. British Colombia in Canada, on which we have based our breast cancer services, also advocates annual breast screening, as does New Zealand and many other European countries.

The most worrying message being delivered by the National Cancer Screening Service is that women under 50 are not at risk of breast cancer, which is most definitely not the case. I know this to be true because many of my friends, acquaintances and constituents have been diagnosed with breast cancer under the age of 50, some with better outcomes than others.

Breast cancer is the biggest single killer in Ireland. Better access to ultrasound and mammography must be facilitated for women under 50. I am disgusted and appalled that BreastCheck nationally has recently decided against lowering the age for mammogram from 50 to 47. Finding cancer as early as possible gives a better chance of survival in all age groups. However, in Ireland the message given to women by the Government, the National Cancer Screening Service and BreastCheck is that breast cancer screening is only for women over 50. Recent figures indicate that 600 women aged under 50 were diagnosed with breast cancer in 2007. Some 455 of these women were in their 40s, which is a staggering figure.

Sadly when a woman first attends her general practitioner with a pain or a lump in her breast, the cancer can often have spread. One in five are presenting with secondary cancers at their first visit to a GP. There is no service for women who are not symptomatic but are just genuinely worried about the risk of cancer. To be screened, a woman must be either over 50, have detected a lump or be in pain. Why can BreastCheck not offer one hour per day for a walk-in service where women who are worried can make an appointment without a referral from a GP? It is foolhardy not to offer a service to women under 50. Women in their 40s are at their prime in their careers, in the middle of rearing and nurturing their little children or caring for ageing parents. We must surely acknowledge that they have a right to access screening, thereby increasing their chances of survival. It is a frightening indictment of the Government that lack of funding could be a reason that service is not extended to women under 50.

Michael Finneran (Roscommon-South Leitrim, Fianna Fail)
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I have been asked by the Minister for Health and Children, Deputy Harney, to respond to this question on her behalf. The Government welcomes the opportunity to address the House and to outline the position on breast cancer screening under the BreastCheck programme.

Breast cancer is the most commonly diagnosed cancer in women in Ireland. More than 2,300 women are diagnosed with breast cancer each year in Ireland and approximately 670 women die of the disease. However, survival rates for breast cancer are improving. Latest figures from the National Cancer Registry of Ireland show that five-year survival for breast cancer is more than 77% for women diagnosed between 2000 and 2004. Early detection is known to be a significant factor in improving outcomes. In this regard, breast screening has a key role. Its primary objective is to reduce mortality from breast cancer through early detection.

BreastCheck, the national breast screening programme, provides free mammograms to women aged between 50 and 64 years. In 2008 and early 2009, BreastCheck provided free mammograms to more than 90,000 women. Of these, 672 women were diagnosed with breast cancer. Indeed, from the commencement of screening in 2000 until 31 March 2009, BreastCheck had provided almost 500,000 screening appointments to 236,000 women and 3,075 cancers were detected. In 2009, the national roll-out of BreastCheck to all counties was completed with the commencement of screening in Donegal. An estimated 120,000 women were screened in 2009 overall. This year, more than €22 million has been allocated for BreastCheck.

BreastCheck invites women aged 50 to 64 for regular screening as the incidence of breast cancer is highest in this age group. In Ireland more than 70% of breast cancers occur in women over 50 years of age. While the incidence of breast cancer in women aged 40 to 49 is increasing, the incidence is still approximately 50% lower than that for the 50 to 59 age range.

Given that the incidence and risk of breast cancer in women increases with age, it remains the intention of the Minister for Health and Children to extend BreastCheck to women in the 65 to 69 age group as soon as resources and capacity allow. However, the immediate priority for the National Cancer Screening Service is to ensure that preparatory work for the national colorectal screening programme takes place this year and in 2011 in order for screening to commence in early 2012 for men and women in the 60-69 age group.

The effectiveness of screening below age 50 remains an issue of debate. Several randomised controlled trials in screening have included younger age groups but have not confirmed significant reductions in mortality in the 40-49 age group. In 1991, the UK's National Health Service set up a large randomised controlled trial to measure the effectiveness of screening women from age 40. The trial is ongoing and interim results indicate that a reduction in breast cancer mortality is likely to be observed. However, the size of the reduction is uncertain and this issue awaits further follow-up.

In 2008 the board of the National Cancer Screening Service commissioned an internal review to examine the evidence for reducing the lower screening age limit from 50 to 47. The review concluded that while a reduction in screening age might be of some benefit to some younger women, the merits of extending the programme age range downwards from a population-based screening perspective is still a matter of debate.

BreastCheck has now been extended to all parts of the country and €22 million has been allocated to the programme for 2010. The Minister intends to extend BreastCheck to women in the 65-69 age group as soon as resources and capacity allow. The effectiveness of screening below age 50, however, remains an issue of debate.

I reiterate that women of any age who have concerns about breast cancer should seek the advice of their GP who will, if appropriate, refer them to the symptomatic breast services in one of the eight designated specialist cancer centres.

Nicky McFadden (Fine Gael)
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Will the Minister please reply to my question as to whether BreastCheck could provide an hour's walk-in appointments service for women under 50? I believe that is a reasonable request. I accept all the Minister of State has said on behalf of the Minister for Health and Children. Really, she has reiterated just how good BreastCheck is, and how important is early detection. I also accept what she said about it remaining an issue for debate.

None the less, from my understanding of the situation and the people I know who have been diagnosed, some who have lymph cancer as well as breast cancer would have benefited from early detection. Accordingly, I cannot accept that it is not a major issue.

Michael Finneran (Roscommon-South Leitrim, Fianna Fail)
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I thank the Senator for her contributions and I realise this is a very important issue. I will certainly relay her further comments to the Minister for Health and Children on this issue. I know it is an issue that involves 50% of the population and as such, needs to be addressed. As the Minister has said, the debate on the review is ongoing and every input is worthy of consideration. I shall certainly take back the views that been expressed.