Erin McGreehan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of State, Deputy Feighan. I welcome the opportunity to speak on this important issue that involves saving lives. It is of utmost importance to many women, men and families all round the country. I have worked with my Fianna Fáil colleague, Councillor Teresa Costello, in South Dublin County Council on many breast care issues. This is another issue that she and I work on regularly. I ask for an update from the Department of Health on the waiting list for preventive mastectomies and about the service at St. James' Hospital in particular. This is a life-saving service. There is excess demand for it, so it is important that the service is expanded without delay. People with a higher risk of cancer due to their family history have to wait far too long for genetic testing in the first place. There are long, stressful waiting times for preventive mastectomies due to overstretched services and due to delays caused by Covid.

Inherited faulty genes play a major role in 5% to 10% of all cancers. Genetic testing is an important tool in aiding understanding of an individual's risk of certain types of cancers, including breast, bowel and ovarian cancers. Not knowing whether their family history of cancer puts them at higher risk of developing the disease can be a cause of great anxiety and stress for people. Having early access to genetic testing can provide options for that preventive treatment and reduce the possibility of ever receiving a cancer diagnosis at all. A growing number of women are taking the difficult decision of having double mastectomies and then reconstruction or of having their ovaries removed to reduce the risk.

There are major delays at many of our public hospitals. As a genetically inherited alteration passes through those family lines, the breast cancer gene, BRCA, significantly increases a person's risk of developing cancer. A mastectomy can reduce the chances of people who carry those BRCA genes developing cancer by 90% to 95%. That is an astronomical figure.

A recent survey by the Irish Cancer Society found that one in seven people have been waiting for more than a year for tests, with some waiting for more than two years for risk-reducing procedures. I highlight issues at St. James's Hospital in particular. In 2018, the family history service was curtailed due to excessive demand. I know that urgent and high-risk patients continue to be seen at the family risk clinic, but there is only one consultant plastic surgeon who supports the breast care service. There is increasing demand for the symptomatic breast service, diagnosed cancer, surgical treatment and reconstruction. They are being targeted but it is not enough. I understand a business case is being developed, but it is a crass way of describing an important preventive measure that is designed to save people's lives.

Frank Feighan (Sligo-Leitrim, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I confirm that it has not been decided to suspend this service at St. James's Hospital. Urgent and time-sensitive surgeries for women with cancer diagnoses are prioritised to provide priority access to care based on clinical need as assessed by treating physicians. Preventative mastectomies are usually risk-reducing surgeries for women who have been diagnosed with a BRCA gene alteration. As the Senator will be aware, people who inherit harmful variants in one of these genes may have an increased risk of breast cancer. Testing for inherited cancer-causing genes is commonly carried out following assessment and discussion with a genetic counsellor, either at the cancer genetics service at St James's Hospital or in the department of clinical genetics at Children's Health Ireland at Crumlin hospital.

Women who have been diagnosed with a BRCA gene alteration usually elect to undergo a period of surveillance with breast imaging prior to considering a bilateral mastectomy. For the minority of women who decide to undergo a risk-reducing bilateral mastectomy along with a bilateral reconstruction, this is a complex procedure requiring significant theatre time and expert surgeons. Because these women do not yet have breast cancer, they may be prioritised behind women diagnosed with cancer who are awaiting surgery. This has been a particular issue during the pandemic given, when hospitals and staffing levels are under unprecedented pressure, elective surgical services are curtailed and cancer treatment surgeries are prioritised over risk-reducing surgery. A further challenge is that it is not generally suitable or appropriate to outsource this type of complex surgery.

The HSE's national cancer control programme is working on a needs assessment for those with a BRCA gene alteration and this is close to completion. The needs assessment has been developed with a broad range of stakeholders, including representatives of those with a BRCA gene alteration, and will inform the planning of investment in the required services. The growing role of genetics in cancer care is well recognised and the development of a model of care for cancer genetics has been prioritised by the national cancer control programme. It has established an advisory group to agree a national framework for hereditary cancer services. This will incorporate the identification of those with an inherited cancer predisposition and their ongoing management. It will also consider the resources required to deliver this model within cancer centres, specialist cancer genetics services or other national enablers. It will be essential that investment in and development of services will extend to the required healthcare for those who have been found to have a genetic predisposition, including the resourcing of risk-reducing surgeries. The work of this advisory group will also inform the hereditary cancer aspects of the national genetics and genomics strategy, which is expected to be completed by the HSE in late 2022.

Erin McGreehan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State. It is good news that the advisory group will report. I very much welcome the ongoing work by the Department in all services to reduce waiting lists, increase care and improve outcomes for many patients. I will follow up with the Department on specific details about the waiting lists and ask which services will be expanded in the short term before the advisory group reports. If someone is awaiting a feared cancer diagnosis, late 2022 is too far off. I will push for that, therefore, with the Minister for Health and his Department in order that there will be, I hope, additional services in the meantime.

Frank Feighan (Sligo-Leitrim, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Senator for her contribution on this matter, which has been very helpful. The HSE's national cancer control programme is aware of the waiting times for risk-reducing mastectomy surgery within the designated cancer centres. These surgeries are carried as part of a prioritisation with other cancer surgeries, and tumour-directed breast cancer surgery for a woman with a cancer diagnosis will invariably be prioritised. I reiterate it has not been decided to suspend this service at St. James's Hospital. Significant funding has been provided by the Government in recent years for cancer services and funding for €20 million of our new development funding was allocated for implementing the recommendations of the national cancer strategy in 2021, with an additional €20 million allocated for the implementation of the strategy in 2022. The model of care will be aligned with the development of a national genetics and genomics strategy to be completed later this year, although we hope it will be sooner.