Tuesday, 29 September 2015
Cancer Screening Programmes
I thank the Cathaoirleach for giving me the opportunity to raise this critical issue. I welcome the Minister, Deputy Varadkar, and am pleased to be able to raise the critical issue of the rolling out of the free BreastCheck screening for women between the ages of 65 and 69. Since the introduction and publication of my first policy paper, A New Approach to Ageing and Ageism, in 2006 I have been passionately campaigning for the abolition of the 64 year age limit on BreastCheck as one in ten of all breast cancers occur in women between the ages of 65 and 69.
On 15 October 2014, the Minister announced that free BreastCheck screening would be rolled out to women between the ages of 65 and 69. I spoke to the Minister that day and was absolutely thrilled because I had been campaigning for that for a long time. Everyone at the announcement on 15 October was beaming with delight. The Irish Cancer Society welcomed the decision to make the necessary investment to ensure BreastCheck is extended to women aged 65 to 69, saying it was the right decision, which would save a minimum of 87 women's lives per year.
Some time later, in response to a parliamentary question submitted by Fianna Fáil spokesman on health, Deputy Billy Kelleher, I learned that the free BreastCheck for women aged 65-69 will not commence until the fourth quarter of 2015. I could not believe it. The Minister announced it on 15 October and I was sure something was going to happen quickly. I also learned that the screening of women in the 65-69 age group will only be fully implemented by 2021. In the meantime, 609 Irish women will lose their lives before any real progress is made by the Government's 2021 target. The day the Minister launched it, on 15 October last year, I was genuinely thrilled and so impressed with him. We then found out a couple of months later that it would not be rolled out until the fourth quarter of this year.
I am very disappointed. I felt I was led astray when the public announcement was made outside the gate of Leinster House. It was said it would commence in the fourth quarter of this year, 2015. I do not want to hear about any administrative difficulties or lack of radiographers. We were not told anything about that on the day of the launch. I am a very straight person and this is business, not personal. Given that the Minister launched it that day, I felt I was deceived to hear that this would take so long and that we would have to wait until the first quarter of 2015 for this free BreastCheck screening to be rolled out.
It is ageism that women are not getting a free BreastCheck. It is Irish ageism. There is more ageism in Ireland than in any other country in the world, from my experience. I do not notice it myself - I am very lucky - but it is endemic in society. This is typical. Women in this age group are more prone to breast cancer.
I thank Senator White for raising this issue again in the Seanad.BreastCheck is now in its 16th year and currently offers a free mammogram every two years to women aged 50 to 64. Under BreastCheck, more than 1.3 million mammograms have been provided to more than 478,000 women, and more than 8,300 cancers have been detected. Last November, I announced the extension of BreastCheck to the 65 to 69 age group, in keeping with EU guidelines. The age extension will be complete by 2021. The additional eligible population is approximately 100,000 and, when the programme is fully implemented, 540,000 women will be included in the BreastCheck programme. Due to the number of people who will be added to the breast screening service and the fact that women are screened on a two-year cycle, the task of extending the age cohort is a major logistical and operational undertaking. This is why the age extension will be implemented on an incremental basis in line with the capacity of the service to manage the additional screening and follow-up workload.
The National Screening Service will need to recruit and train additional radiographers, medical consultants and administrative support to accommodate the increased demand for the BreastCheck programme. Funding for this and for additional mobile units and medical equipment will be made available across the implementation period. A provision of €100,000 was made to commence implementation in the final quarter of 2015.
Breast cancer survival in Ireland has improved significantly in recent years, with the five-year survival rate now estimated at 81% for women diagnosed between 2006 and 2011. This is an increase from 72% for women diagnosed between 1994 and 1999. The increase is due to a combined approach of screening, symptomatic detection and improved treatment.
The national cancer control programme has focused on improving the quality of cancer services through reorganisation and expansion and by applying best practice in areas such as prevention, early detection, diagnosis and treatment. Surgery has been reorganised into the eight designated cancer centres, and full breast cancer services are also provided at Letterkenny General Hospital as a satellite of University Hospital Galway. Referral guidelines for GPs have also been developed to achieve a more effective and integrated service. In June 2015, I launched the national clinical guidelines on the diagnosis, staging and treatment of patients with breast cancer. Clinical effectiveness is fundamental to our health service, and implementing good-quality clinical guidelines and audit can improve health outcomes for patients, reduce variations in practice and improve the quality of clinical decisions.
In conclusion, I am committed to extending BreastCheck to those aged 65 to 69 on a phased basis between now and 2021. It is necessary to do this on an incremental basis in line with the capacity of the service to manage the additional screening of approximately 100,000 women and then to follow them up properly. If BreastCheck managers believe the process can be done more quickly, they will have my support, but I will not rush them. If the process is rushed, the standards may fall. I regret that the Senator felt led astray or deceived in any way but I was very clear in my budget statement that week as to what was happening. It was also made very clear in the service plan published in November. I certainly would encourage the Senator to inform herself fully by reading those speeches and the service plan before coming to conclusions. It may be the case that she was not led astray or deceived but rather that she was not fully informed.
To be honest, I took at face value what the Minister said on the day I met him. I believed that he would roll it out quickly. I will ask one question before pointing out another issue relating to BreastCheck. How many women in the final quarter will be able to avail of the free BreastCheck exam?
A serious matter was drawn to my attention by a woman at the weekend. She is not able to avail of the service because it has not yet been rolled out for her age group. She was also under the impression that the service would be rolled out.
This woman said she would pay for a breast exam but she wanted to have it done in the facility where she had free exams up to the age of 64. She was told she could not do that. It is unbelievable how this country can be run in silos. She was willing to pay money to BreastCheck, and the medical personnel could have examined all of her screenings to date.She would have liked to have been able to do this. I suggest the Minister does this. One of the advantages of the free BreastCheck service is that a letter is sent to every woman, but those aged over 64 stop getting letters to remind them to avail of the free BreastCheck. Many issues surrounding BreastCheck need to be dealt with efficiently. I thank the Minister and I wish him good luck.
On the first question, I do not have the figure available but I will certainly ask BreastCheck to forward it to the Senator. On the second question, it is not possible for anyone to pay for BreastCheck or for any of the national screening services. They are not run that way. They are run in such a way that they are population based screening programmes and people cannot buy their way in. Everyone is treated regardless of income or ability to pay. If people do want to pay, I imagine they can be referred privately through their doctor if that is what they wish to do, not to BreastCheck but to a different-----