Maria Byrne (Fine Gael)
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The Minister of State, Deputy O'Donnell, is welcome this morning.

Teresa Costello (Fianna Fail)
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I thank the Minister of State for attending the Seanad.

Over the course of our lives, it is estimated that one in seven women will develop breast cancer. Each year in Ireland, there are approximately 3,600 new cases and around 23% of diagnosis occurs in women under the age of 50. Currently, BreastCheck is offered to women aged 50 to 69. I am aware that following submissions, including mine, HIQA is reviewing the expansion of the BreastCheck programme. What is the status of this review?

Looking beyond Ireland, we can learn from other countries' national breast screening programmes. Austria, for example, recommends starting screening at age 45, with an opt-in option available from age 40. In Iceland, Sweden, Türkiye and, further afield from Europe, Australia, national screening programmes are offered to women over 40. We need to be next. We need to be informing women if they have dense breasts, something that could easily be added to the BreastCheck screening service given that a mammogram identifies breast density, leaving women with an understanding that different methods of screening may be needed for them for accurate results. This too is already done in the US, Canada, France and Australia. It is vital that women of all ages check their breasts, know their own normal and attend their GP if they are concerned.

The message that early detection is vital in the fight against breast cancer is being communicated strongly and consistently. In 2013, when I presented to my GP with a lump, although he thought I was too young to have breast cancer, he had the good sense to exercise caution and referred me to the breast clinic at St. James's. On that day, I underwent a mammogram, an ultrasound and a biopsy. His caution saved my life. Early detection saves lives. I cannot say it enough. It is a message ingrained in our mindset, thankfully, due to the increased awareness and education surrounding breast cancer. However, if a woman is in her 20s or 30s, she may follow all the advice given, checking her breasts, knowing her normal and going to her GP if she finds something, but sometimes she is told not to worry because she is too young. Even when a woman is referred to the BreastCare clinic, she may be examined and sent home with the promise of a scan.

Take the case of Ziva Cussen, who was just 21 when she was referred to the BreastCare clinic by her GP. She was told not to worry and that she would be sent an appointment for a scan. Six months passed and Ziva was still waiting on this promised scan. The pain in her breast concerned her so much that she pushed for her scan. When she finally got it, her cancer had progressed to stage 4. Ziva did all the right things, but she was let down by a systematic failure. Muireann McColgan, who is 37, was 31 weeks pregnant when she expressed concerns. It was a midwife who urged her to seek a second opinion. When she originally presented, she was told that she was too young and that lumps and bumps during pregnancy were to be expected.

Ziva and Muireann are not isolated cases. I recently contacted a hospital on behalf of a 23-year-old girl who had waited over six months for her scan after attending a breast clinic. There was a family history. Thankfully, her lump was not cancerous, but the emotional stress experienced while waiting on the scans was simply unnecessary. Quite simply, when a woman in her 20s or 30s has an appointment at a BreastCare clinic, she should automatically have a scan on that day. No woman should have to walk around with a lump in her breast for six or seven months wondering and worrying, especially after having sat in the BreastCare clinic. Ziva and Muireann have been left feeling let down, asking what if they had been scanned earlier.

We need to move with the times. Cancer occurrences are increasing and younger women are being diagnosed more frequently. A screening programme offered to woman from the age of 40 is essential. Let women decide if they want to avail of it. Early detection saves lives, and we must continue to prioritise that message through both policy and practice. Diagnostic screening for younger women presenting with signs of breast cancer is essential and must be faster and more efficient.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank the Senator for raising this matter and sharing her own personal story. It was very brave.

I am taking this matter on behalf of my colleague the Minister for Health, Deputy Carroll MacNeill. Successive national cancer strategies have delivered continuing improvements in our outcomes for cancer patients.The benefit of our strategic approach to cancer control is shown by the improvement in the number of patients living after receiving a cancer diagnosis, which currently is 220,000 compared with 150,000 when the strategy was brought to the Government in 2017. Breast cancer is the most common cancer in women in Ireland, accounting for approximately 30% of invasive cancers in women. Almost 4,000 cases of breast cancer were diagnosed in Ireland in 2022. Of these, almost 60% were diagnosed at symptomatic breast disease clinics, SBDs, and one third were detected through screening. Fortunately, survival rates of breast cancer have improved. The most recent data indicate a five-year survival rate of 88% for people diagnosed between 2014 and 2018.

Of course the stage of diagnosis has a significant impact on survival rates and early diagnosis often leads to better outcomes. The Senator made that abundantly clear in her presentation, and in the case of the other women she spoke about as well. Symptomatic breast disease clinics are run in each of the designated cancer centres. In one networking centre, GPs or treating physicians can refer patients to an SBD when they have concerns. To support GPs in this referral process, the national cancer control programme, NCCP, developed a referral guideline and a referral form. This guideline facilitates GPs to identify the signs and symptoms most suspicious of cancer and covers all ages.

Each year approximately 45,000 women are seen in clinics. Patients who have been referred are triaged in SBDs, according to symptoms, as either urgent or non-urgent. Advances in cancer detection and treatment have been achieved with sustained investment in our health services. In budget 2025 an additional €23 million was secured for the national cancer strategy. This will mean over €105 million has been invested in the strategy since 2017. It has enabled recruitment of more than 670 staff to our national cancer services. The Government is committed to supporting our population screening programmes. The programme for Government identifies several priorities, including the BreastCheck programme. Page 87 of the programme for Government, under the heading of "cancer", states that the Government will extend the ages for the BreastCheck screening programme in line with updated standards from HIQA.

In budget 2025 some €2.8 million was allocated to the BreastCheck screening programme for new staff and resources to assist in expanding the footprint of the programme. An increase in staffing will allow additional capacity to meet increased demand. This is in addition to the significant investment in cancer screening in women's health that has been made in recent years.

The screening programme has changed over time according to the evidence. Most changes to Ireland's programme are facilitated through established evidence-driven protocols and the national screening advisory committee, NSAC. The independent expert group provides advice to the Minister for Health. Having a rigorous evidence-based process in place ensures our screening programmes are effective and quality assured. It also ensures that the benefits of screening outweigh the potential harms. The NSAC has requested that an assessment be undertaken of available evidence and the lowering of the age for BreastCheck programmes. HIQA will begin this project this year, as the Senator referenced in her contribution, and this will inform future decisions on the change in ages. There is a specific commitment in the programme for Government to look to extend the age for the BreastCheck screening programme in line with updated standards from HIQA. The Government remains committed to the implementation of the national cancer strategy in order to continue to build and improve services and better outcomes for patients, particularly women in terms of breast cancer.

Imelda Goldsboro (Fianna Fail)
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I welcome to the Visitors' Gallery this morning students from St. Finian's Community College, Swords, County Dublin. We hope they have a wonderful day.

Teresa Costello (Fianna Fail)
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I welcome HIQA's movement on this. I hope the Government does the right thing and lowers the age for breast cancer screening to 40 and informs women on their breast density. However, with the systematic failures I have outlined where younger women were sent away from a breast care clinic, I do not feel I have received an answer. Generally, when a doctor refers a woman the lump has to be in her breast for eight weeks. She can then have a four-month wait before getting a breast care clinic appointment. That four-month wait means the patient has been six months waiting. If she waits another six months for a scan, that means she has waited a year. When cancer gets to stage 4, it is not going to be cured. I would like that to go back to the Minister. I would like further comment from her on that and further discussion on it because that whole piece is simply unacceptable. It cannot continue. I thank the Minister of State.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Senator Costello for her contribution on this very important matter. I will bring the specific points she has raised to the attention of the Minister, Deputy Carroll MacNeill, and her officials.I will ask them to follow up with the Senator. She might email the Minister and her office directly on that particular point, but I certainly will follow it up. The officials will also have been watching this debate. It is a very important point.

Early diagnosis is very important in the case of cancer. Since the first national cancer strategy in 1996, detection and diagnosis at the earliest possible stage has been a key priority. Screening in the detection of cancer cases are often found in earlier stages than those detected through other pathways. BreastCheck, which is currently offered to women aged between 50 and 69, provides an opportunity for those cancers to be detected earlier. Over 155,000 women availed of BreastCheck in 2022. The work undertaken by the national cancer screening service will provide important evidence on the appropriate steps. As I stated, on the specific item raised by the Senator, the Government will look at extending the age groups covered by the BreastCheck screening programme, in line with updated HIQA standards.

On the additional point the Senator raised, I will bring it to the Minister's attention but I suggest that the Senator also follow up on it.