Thursday, 24 November 2016
Commencement Matters (Resumed)
Cancer Screening Programmes
I welcome the Minister of State, Deputy Marcella Corcoran Kennedy. I am delighted that she is here to speak on such a relevant topic. The BreastCheck programme is currently available to women between the ages of 50 and 69. According to the BreastCheck website, "the Department of Health and Children chose this age group for screening as there is a greater proportion of women at risk of dying from the disease in this age group". However, recent statistics have shown that the greater age group is actually those between the ages of 35 and 50. Under the screening programme for women between the ages of 50 and 69, women are checked for breast cancer, regardless of whether they have any symptoms. Screening and surveillance are secondary preventive measures that aim to detect breast cancer at the earliest possible stage to reduce the rate of breast cancer death. Screening refers to monitoring those at average risk of disease. Surveillance refers to the monitoring of those known to have an increased risk of the disease. Internationally recommended surveillance imaging options include digital mammography, magnetic resonance imaging or a combination of the two.
Every year, approximately 2,600 women are diagnosed with breast cancer and approximately 660 women die from the disease. One in ten women in Ireland will have breast cancer at some stage of their lives. I know from my own experience that women under the age of 50 are at a crucial stage of their lives in this respect. I went to school with three sisters, two of whom were diagnosed with breast cancer at the ages of 38 and 41. Their treatment has been very successful for them to date, but the fear is always there. The devastating effects of being diagnosed with advanced cancer for women under the age of 50 and their families should not be underestimated from an economic and social perspective. By the time women present with symptoms of breast cancer, it can often be quite advanced and may have spread. Approximately one in five women already have metastatic or secondary breast cancer at first presentation. Finding cancer as early as possible gives a large survival advantage in any age group.
The American Cancer Society and the American College of Radiology suggest that women should have annual mammograms from the age of 40. Many countries that have a basic screening service from the age of 50 also give women the option of avail of screening from the age of 35. BreastCheck plays a pivotal role in the prevention of breast cancer. Of the 92,061 women over the age of 50 who were screened between 2008 and 2009, 4,119 were recalled for further assessment and 672 were diagnosed with breast cancer.This represents 7.3 cancers per 1,000 women screened. The Health Information and Quality Authority, HIQA, recommended recently that for women with an identified risk of breast cancer an annual MRI between the ages of 30 and 49 is cost-effective compared with no surveillance. In another small cohort of women who have a high probability of breast cancer annual surveillance between the ages of 20 and 49 is the optimal strategy recommended by HIQA. It also advised the national cancer control programme on the implementation of an organised surveillance programme for women under the age of 50 in Ireland who are known to be at elevated risk of breast cancer due to these genetic or family history factors. I call on the Minister of State to consider reducing the age from 50 to 40 in the hope that this very worthwhile screening will save the lives of many women.
I thank Senator Byrne for raising this issue. We all have family members or friends who have been touched by this illness. I thank the Senator for giving me the opportunity to address the House on the national breast screening programme, BreastCheck. Population based screening programmes are an important element of early detection of cancer. BreastCheck provides free mammograms to eligible women every two years. This service is provided free of charge by the Health Service Executive, HSE, through its national screening services which also operate the CervicalCheck and BowelScreen screening programmes.
The EU guidelines on effective screening for breast cancer recommend that screening should be offered to women aged between 50 and 69 employing two-yearly mammography. BreastCheck has been available nationwide to women aged 50 to 64 for several years. The roll out of this service to women aged 65 to 69 began in late 2015. This age extension brings the screening programme fully in line with international best practice. The additional population who will be eligible for this programme is approximately 100,000 and, when fully implemented in 2021, a total of 540,000 women will be included in the BreastCheck programme. BreastCheck continually reviews new and emerging evidence on the benefits of screening, including the optimum age range for screening. International evidence does not currently support the introduction of population based breast screening below the age of 50. The risk of developing breast cancer increases with age and there is a higher prevalence of breast cancer in women aged 50 and over.
Screening aims to detect cancer before symptoms appear. Regular screening can help to detect cancer at an early stage when it is easier to treat and there is a higher chance of a good recovery. I welcome the current BreastCheck advertising campaign which aims to boost uptake rates and urges all women to take the time to do something very important for themselves by availing of the invitation to have a mammogram.
Breast screening is one element of our comprehensive cancer control programme. As part of its work across the full range of cancers, the HSE’s national cancer control programme provides symptomatic breast clinics in each of the eight cancer centres, with a satellite clinic of the Galway service in Letterkenny. Breast cancer survival in Ireland has improved significantly in recent years due to a combined approach of screening, symptomatic detection and improved treatment. Five-year survival for breast cancer is now estimated at 82% for people diagnosed between 2008 and 2012. This is a most encouraging figure and it shows a significant improvement from 75.1% for people diagnosed between 1994 and 1999.
In conclusion, BreastCheck is aimed at the age groups that will benefit most from a population based breast screening programme. While the international evidence in this area is continually under review, it is not envisaged at this time that the age range will be reduced below the age of 50. I take this opportunity to encourage all eligible women to avail of the free breast screening mammogram when it is offered to them. I assure the House that comprehensive breast services are also available to women in the designated cancer centres. Those of any age who have concerns about breast cancer should seek the advice of their general practitioner, GP, who will, if appropriate, refer them to the symptomatic breast services.
I thank the Minister of State for her response. I too would encourage all women to avail of the service but I also urge the Minister of State to keep it under review and take the statistics into account because there are people being diagnosed at a younger age, which is frightening. I would like the Minister of State to monitor that.