Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Paudie Coffey.

Marc MacSharry (Fianna Fail)
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Notwithstanding the fact that the Minister of State has taken the time to come to the House, I am disappointed that the Minister, Deputy Varadkar, is not here for the debate on this very important issue. Some weeks ago, I raised with the Minister the issue of ladies being referred to the symptomatic breast clinic at University Hospital Galway and who, effectively, were being sent home to undertake a form-filling exercise and to self-monitor for three months. At that time, I expressed concern to the effect that this is critical time that could be lost for those people, particularly if they are among the 7% of individuals who go from suffering with mastalgia, or breast pain, to developing the more serious problem of breast cancer. I was particularly worried by the fact that the Minister described the person on whose behalf I raised the matter as being the subject of an inappropriate referral. That proved not to be the case. The woman in question was lucky enough to have the funds available to allow her to have a private assessment carried out.Thankfully, it happens that all is well and she is not one of the 7%, but the question that I rightly posed at the time was about those who were.

Today has seen a worse situation. Following the press coverage of my raising the matter with the Minister, Deputy Varadkar, a lady contacted me. I will quote most of her e-mail, as it speaks for itself. She wrote:

On reading the article I felt a pang of personal concern as I am currently on the public waiting list to see a doctor in Galway Breast Clinic. Initially I was told by the clinic I would only be 4-6 weeks due to the fact I was referred with a lump and discomfort in each breast and I am in a high risk group. The clinic confirmed on the day of my appointment to see the doctor if required any tests, mammograms would be completed.

After the 6 weeks passed, I re-contacted the hospital to learn that it may be up to next Feb before I see a doctor and any tests I may require will not be completed on the day. The lady was very kind and mentioned to contact my GP, [but that] realistically it is highly unlikely I would be seen before Christmas. Earliest may be Jan, latest end of Feb.

I am now quietly scared and worried, I had an encounter with cancer over ten years ago and it was early detection through the public system that prevented me having to go through a lot of treatment. Surgery and careful monitoring was [sufficient].

I am doing my best to stay positive, I do understand and take on board that over 70% of women with lumps and discomfort are usually okay and it can be hormonal or contraception issues. At the back of my troubled mind is the little nagging doubt... when I get to Galway will I have lost vital time?

These words are compelling and speak for themselves. While I appreciate that the Minister of State's area of responsibility is the environment and not health, this is an issue that requires the highest action by the Government. Recent years have seen debacles in the shutting down of various breast clinics, the setting up of other breast clinics and the so-called centres of excellence. In a matter of a couple of weeks, we have encountered two further incidents, one involving someone who had cancer previously and is in a high-risk age group being put on the never-never and another involving someone who was sent a booklet and told to self-monitor and fill out forms. The first person, who had more serious symptoms in terms of lumps and pain, was told that the clinic might get to her by the end of February and that not all of her tests would be done on that day.

There are also reports that the symptomatic breast clinic in Letterkenny is only seeing 16% of high-priority patients within the required timeframe. It is important to portray the health system as going well and, when one is lucky enough to access the service, the health professionals are probably doing very good work for people, but it is not acceptable for us to massage waiting lists and put patients like these two ladies at risk. I am sure that is not the Minister of State's intention. I worked with him in this House when he was a Senator.

It is unacceptable that the Minister, Deputy Varadkar's approach to this issue when it was first raised a few weeks ago concerning a different patient was to speak of inappropriate referrals. The Minister of State has heard this lady's words. She had a brush with cancer previously and is in the high-risk age group, yet she, too, is being put on the never-never. When the Minister of State leaves the Chamber, will he immediately contact the Minister, if not the Taoiseach as well, and ask that the appropriate interventions be made in the first instance for this patient, on whose behalf I have written to the Minister, and to outline how many people are only in this space because we seemingly do not have the resources in the Galway-Letterkenny-Sligo area to deal with them? We will seek to amend the Order of Business to bring the Minister to the House on other health matters. I might have an opportunity to raise this issue with him then, but this is not the appropriate time and I do not want to take from the importance of this issue.

Paudie Coffey (Waterford, Fine Gael)
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I thank Senator MacSharry for raising this issue and giving me the opportunity to update the House. I am taking this debate on behalf of the Minister, Deputy Varadkar, who apologises for unfortunately not being able to attend.

The symptomatic breast clinic in Galway forms part of a range of services that is in place for women with breast symptoms. Referrals are dealt with in accordance with the guidelines that have been developed by the national cancer control programme, NCCP. Most women experience breast pain at some stage. While this can cause worry, it is found that, in the absence of other symptoms, breast pain is rarely indicative of breast cancer. The NCCP, in collaboration with the Irish College of General Practitioners, ICGP, developed a booklet to support women with breast pain. It explains the types of breast pain, their possible causes and how pain might be easily remedied. It contains a three-month diary to help determine whether the pain is cyclical, as this information can help with prevention and care. This approach is evidence-based and regarded as good practice. The booklet highlights the importance of making a specialist referral if other symptoms are present.

General Practitioners, GPs, have also been provided with a guideline for managing breast pain in primary care centres. This guideline contains the same advice as that in the patient booklet. Where the patient's clinical examination is normal, she is asked to follow the advice in the booklet for three months. If, after that time, the pain has not been resolved, a referral is warranted. All referrals to the symptomatic breast clinics in Dublin, Cork, Waterford, Limerick, Galway and Letterkenny are triaged on receipt and appointments are then offered.

Breast cancer survival rates have increased significantly in recent years due to a combined approach of screening, symptomatic detection and improved treatment. Breast cancer five-year survival is estimated at 81% for women diagnosed between 2006 and 2011, representing an increase from 72% for those diagnosed between 1994 and 1999.

Last November, the Minister announced the extension of BreastCheck to the 65-69 year age group in keeping with EU guidelines. I am pleased to confirm that the first invitations have issued and the screening of 500 women in that cohort will take place this year. Earlier this year, the Minister launched the national clinical guidelines on the diagnosis, staging and treatment of patients with breast cancer. Clinical effectiveness is fundamental to our health service. Implementing good quality clinical guidelines and audits can improve health outcomes for patients, reduce variations in practice and improve the quality of clinical decisions.

The Minister has asked me to assure the Senator that all women with breast symptoms are welcome at specialist breast services, including those with persistent and troublesome breast pain as outlined in the guidelines.

Marc MacSharry (Fianna Fail)
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What about lumps? We heard nothing about those. This is not the Minister of State's core area but, to quote the lady in question, "when I get to Galway will I have lost vital time?" These patients are not being referred by lay people, traffic wardens or people in the street. They are being referred by medical professionals with seven years of training. I am bound to say that these delays and the speeches today and by the Minister about best medical practice do not stack up. There was no mention of the individual patient, but the Minister's office is aware of this case. Will the Minister of State raise her case with the Minister? She is on the never-never. She has breast lumps and pain, so it is not just mastalgia. The form filling, book reading exercise is not one that gives confidence to the ladies of the north west.

Paudie Coffey (Waterford, Fine Gael)
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I welcome the Senator's raising of an important matter. Any elected representative would identify cancer as a major challenge for any family touched by it. The Senator is right to state that concerns arise where ladies find lumps in their breasts. It is important that there be early intervention and diagnosis to deal with problems.

I will reiterate the Minister's comments. He assures the House that all women with breast symptoms are welcome at specialist breast services, including women with persistent and troublesome breast pain as outlined in the guidelines. As to the specific case raised by the Senator, I undertake to relay his concerns to the Minister directly.