Nessa Cosgrove (Labour)
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The Minister of State, Deputy Murnane O'Connor, is very welcome. Imagine going to the GP for a routine check-up, the equivalent of a national car test, NCT, when you reach a milestone birthday. The GP measures and weighs you, takes your blood pressure and temperature and listens to your pulse. It is, I assume, a thorough examination. The GP reassures you. Everything is clear and you appear to be perfectly healthy. If you keep living an active and balanced lifestyle, you can expect to live to a healthy old age.

Six months later, you receive the devastating news that you have a 7 cm growth. It is stage 3 invasive cancer. It was there at the time of your check-up but the GP did not stop it because it was as if you were wearing a coat that prevented them from carrying out a proper examination. This is what happened to Siobhán Freeney. She went for a routine mammogram in the summer of 2015. By Christmas, she had been diagnosed with a stage 3 invasive lobular carcinoma. It is a type of breast cancer that starts as a growth of cells in the breast's milk-producing glands.

Now imagine that the same thing happens to the person you love and depend on more than anyone else in the world, namely, your mother. That is what happened to Martha Lovett Cullen, whose mother, Marian, received even worse news. Twelve months after her clear mammogram in 2020, she received a diagnosis of terminal stage 4 metastatic breast cancer. How could this happen to two different women in different parts of the country seven years apart? They both had significant quantities of dense, non-fatty tissue within their breasts. This dense breast tissue, which is fibrous and muscular, makes it difficult for a standard mammogram to see potential growths or tumours. Breast density levels are impossible to assess visually or by touch. They can, however, be measured during a standard mammogram. The radiographer carrying out the mammogram should be able to note the presence of dense breast tissue and advise women undergoing a breast check that further investigation through an ultrasound or MRI scan will be required to confirm any seemingly clear results. I am not being alarmist, but women need to be aware that a clear mammogram result does not mean they are clear of cancer. It means that no cancer is visible. Absence of evidence is not the same as evidence of absence. Siobhán's treatment was successful. She beat the cancer and became a fierce advocate, highlighting the issue of breast density. Marian was not so lucky. In September 2024, the cancer took her life. Her daughter, Martha, found a purpose within her grief and just like her mother, Siobhán, she harnessed her fierce determination to ensure that Irish women were aware of the issue. This is how I, a woman who will shortly be attending my first mammogram when I turn 50 in September, first heard about breast density. If I had not been aware of it, I would have accepted a clear result as just that - clear. I know from the reaction of several of my senatorial colleagues and friends that when I raised this issue a month ago, it was the first time that many of us had heard of this also.

Breast density is not unusual. In fact, it is virtually the norm. It is estimated that between 43% and 50% of women have dense breast tissue. Siobhán, Martha and I hope that, as women, the Minister of State and the Minister will appreciate the urgency and necessity of this. It is already done in every state in America and in Australia, Canada and several of our European neighbours. This is information that is easily derived by the radiologist at the time of a mammogram and we ask that this be passed on to the women at the time of their screening. Clearly, women need to know whether they have dense breast tissue. They also need to know the potential consequences of that information. I implore the Minister, within the lifetime of the Seanad, to introduce a Bill to ensure that all women are clearly informed whether they have non-dense or dense breast tissue, after a mammogram. Clear guidance should also be provided on what their breast density means and on any additional screening options, such as an MRI or ultrasound. GPs should receive this information so that they can properly advise their patients.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Senator for telling those stories about the families affected by this. I see where she is coming from.

I am taking this matter on behalf of the Minister for Health, Deputy Jennifer Carroll MacNeill. The Minister and I are dedicated to enhancing Ireland's population screening programmes. These play a crucial role in our health services by facilitating early treatment and thereby promoting the overall health of our community. This is a priority for the Government.

Some 3,500 women are diagnosed with breast cancer in Ireland every year. About one third of these will have cancer detected through screening. The breast cancer screening programme currently invites women between the ages of 50 and 69 to attend. The Senator mentioned that she will go for her check-up soon. It is important that everyone who receives notice to attend for a check-up does so. It is crucial that women have their mammograms.

The programme for Government commits to raising the age for breast checks in accordance with the latest standards from the Health Information and Quality Authority, HIQA. To this end, the National Screening Advisory Committee, NSCA, has asked to look at the evidence for the expansion of the age range. This is being looked at. Significant investment continues to be made in BreastCheck. This includes an additional €2.9 million allocated this year, with the approval of 22 whole-time equivalent posts. This funding will assist in increasing capacity that will enable services to develop to meet women's evolving needs and ensure equal access for all.

Regarding the question of breast density, such a measurement is currently not captured for women attending screenings, as the Senator correctly noted. However, it is part of a routine practice in the symptomatic breast disease service to include a comment on breast density in a mammogram report. If something does happen within that, it is shown on the report. Nevertheless, conflating screening for healthy people, without symptoms, with those experiencing symptoms is not appropriate. The focus on benefits for screening is on the people without symptoms, whereas for symptomatic services, it is on ensuring that individual patients requiring investigation go to their doctors if they note any symptoms.

It is also important to highlight that the potential incorporation of breast density measures in screening procedures is complex. There are contrasting clinical opinions on this matter. For example, the updated European Commission initiative on breast cancer highlights the low certainty of evidence surrounding the incorporation of the breast density measurement into the screening programmes. Additionally, I note that in the European Union, only two countries, Austria and the Czech Republic, are currently reporting the breast density measurement as part of routine breast screening. I note that the European Society of Breast Imaging, EUSOBI, recommends the offering of breast MRI screening to women with extremely dense breast tissue, which is a minority of women with denser breast tissue. The existence of contrasting significant positions reinforces the need for careful and detailed consideration of the matter. In this regard, I highlight that any proposed changes to Ireland's cancer screening programmes will be facilitated through establishing evidence-driven protocols. That is being looked at. The NSAC is the independent expert group that considers any proposed changes to screening programmes. It reviews the evidence robustly and transparently and against internationally accepted criteria before making recommendations to the Minister for Health. I am pleased to confirm that the committee has asked the Health Information and Quality Authority to review evidence for both an expansion of the age range of the BreastCheck screening as well as to consider the potential introduction of a standard breast density measurement. That is the good news today. Work is expected to start in the coming months. It is important to note that, as both elements of the review are anticipated to be complex, it will need time to complete.

Nessa Cosgrove (Labour)
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The Minister of State's final comment on expanding the age range for mammograms and the introduction of a breast density check was good news, but this is a matter of urgency. As I outlined in those stories, six months for a diagnosis can make a significant difference. I know that there is a review. I invite the Minister of State and the Minister for Health to a briefing we are having in the AV room on 27 May at 1 p.m. We will be joined by Professor William Gallagher from UCD, and Martha and Siobhán will be there to present their own stories. They will present an informative, patient-centred look at breast density.

I have learned about breast density and I know what to ask for when I go to my radiographer but many people put their trust in their health professionals or might not have the confidence to raise this matter with a health professional. I do not think it is a big request. If the Minister for Health is not able to introduce a Bill herself, I would love it if she supported a Bill introduced by our Cross-Party Group or, in the Dáil, by my colleague Deputy Sherlock, who is our Labour Party spokesperson for health, and if the Government could get behind such a Bill.

Lynn Ruane (Independent)
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Unfortunately, I have to let the Minister of State go to vote in the Dáil.

Lynn Ruane (Independent)
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I ask the Minister of State to briefly respond to Senator Cosgrove and then we will move on.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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In summary, I reiterate that the matter of breast density measurements and screening is a complex one without clear scientific consensus on how best to proceed. I welcome the fact that work is due to commence shortly on this consideration. The Senator knows now at least it is being considered. The evidence review for the expansion of the BreastCheck, including potential introduction of a standardised breast density measure, remains a key priority for the NSAC and is expected to commence later this year. The Minister looks forward to receiving a recommendation from the committee.I recognise that attending breast cancer screening can be an anxious time for individuals. It is vital that the service provided is evidence-based and centred on the people who participate in it. Screening programmes must balance early detection with the need to minimise harm or worry.

It is important to remind the Chamber that screening is for healthy people without symptoms. Anyone who becomes aware of symptoms or has worries should contact medical professionals, who will arrange follow-up care. Screening saves lives and is free. Early detection may often mean simpler and more successful treatment. Therefore, I strongly encourage everyone to attend when they receive an invitation.