Victor Boyhan (Independent)
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I welcome the Minister, Deputy Carroll MacNeill. As I was looking at the long list of speakers, I did not see her come in. I apologise. It is always great to see the senior Minister in the Seanad. Senators greatly appreciate that.

The Minister will have eight minutes to address the House. Group spokespersons will have ten minutes and all other Senators will have three minutes. I will call the Minister to reply not later than 5.38 p.m. The statements are to conclude at 5.45 p.m. I ask that people respect the time. We are under a certain amount of pressure.

Minister, the floor is yours.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Acting Chair. I have a lot to get through.

I thank Senators for inviting me to the House to discuss this important topic. I was here in March to speak about women's health on International Women's Day. Breast cancer was raised by several Senators then and many have raised it continually since.

As Senators are aware, approximately 3,600 women are diagnosed with breast cancer every year, making it the most common cancer among women in Ireland. One in seven women receive a breast cancer diagnosis in their lifetime. For example, in 2024, 9,000 people began chemotherapy treatment for cancer, 85% of whom were within the 15-day target, and 6,500 began radiation treatment, 75% of whom were within the 15-day target. It is a significant cancer in Ireland. While our overall five-year survival rate is now 88%, far too many women still die from breast cancer. It is important to reflect on the comparative figures. Our survival rates have improved to 88% for those diagnosed between 2014 and 2018. That is an important increase. Prior to that, for the period 2010 to 2014, it was 82%.We need to do more to continue this process of improvement, though. The programme for Government sets out several priority areas for improving cancer services, including the continued expansion of cancer screening programmes, improving access to medication and supporting survivorship and research programmes for all cancer patients.

Starting with the BreastCheck screening programme, which we all know to be fantastic, it has done 2.6 million mammograms and identified 18,000 cancers in total. Some 625,000 women are eligible for this screening programme and this figure has grown by 19% in six years, which is a significant expansion. The programme detects early-stage cancers, which are the ones capable of being treated the best. BreastCheck is currently inviting women aged between 50 and 69 years to have a mammogram at regular intervals.

Senators will be aware that we are trying to expand the programme and are asking the national screening advisory committee, which is independent, for the best evidence as to how best to do so. The question is whether it would be best to base the expansion on age or the very important issue of breast density measurement. This is a particularly important review because we have two competing pieces of scientific information, one from the European Commission initiative on breast cancer and, in contrast, one from the European Society of Breast Imaging. They take slightly different perspectives on the science, so we must ensure we are making an evidence-based scientific decision. It is important to say that the NSAC is asking HIQA to look at the scientific evidence for the expansion of the programme. Work is definitely expected to start by October but I am told potentially as early as next month. I expect the review will take approximately 18 months. It is an important scientific base for what we do next, and, of course, that is how we like to do things.

We have continued to expand the national screening service with an additional €2.9 million allocated to the BreastCheck programme this year. This will recruit an extra 22 whole-time-equivalent positions, mostly radiographers. That is in addition to the current 79 radiographers, so it is a significant expansion. These will be staff like the radiographers and radiologists I met recently on Eccles Street when I visited the BreastCheck clinic there to celebrate 25 years of BreastCheck, and the staff in the Merrion centre, Cork and Galway. This important funding will help to expand capacity and deal with some of the waiting list issues that have existed for a time.

Our nine symptomatic breast disease clinics are important for breast cancer diagnosis. The GP referral guidelines are also important. I believe the Senators will raise this issue. The referral guidelines provide a clear pathway to patients of all ages with suspected breast cancer to attend symptomatic breast disease clinics. Approximately 45,000 women are seen in these clinics every year and the clinics detect approximately two thirds of all breast cancers, with the other third being detected in the screening clinics. Attendance at these clinics is very high and, for many reasons, I do not want to see delays.

The HSE maintains a suite of clinical guidelines for cancer. Just last month, we launched the update to the HSE's clinical guidelines for the diagnosis and staging of breast cancer. This is all fine but we must ensure that we have the medicine for people who need it. New medicines have played an important role in improving the outcomes for cancer patients. The HSE approved reimbursement for 74 drugs for cancer treatment between 2021 and 2024. Our budget for that has been €645 million, which is significant. Since 2022, eight drugs for breast cancer alone have been approved for treatment of early and late stages of the disease as well different types of the disease. However, I recognise that we want to have these drugs, where appropriate, approved at a faster pace. The HSE recently recruited 34 additional staff to the pricing and reimbursement process. It is important to recognise that this is a 100% increase on the number of people there, which is a significant expansion. Of course, it is my job to ensure that the HSE's processes are such that it is using these additional resources in an effective and efficient way. We have also introduced an application tracker, administered by the HSE, to increase transparency in the medicines assessment process. On the one hand, this is for the HSE to do well, but it is also for the drug companies to do well. A bit like financial services and the Central Bank, both parties have to submit things on time and keep up with the process. I will be monitoring this matter closely.

Alongside improved detection and treatment, we must really drive more on clinical trials. Last month, I was delighted to officially launch a new phase of the philanthropic partnership between the University of Galway and the National Breast Cancer Research Institute, which is an extraordinary place doing extraordinary research. A donation of €4 million was made to it by community fundraising right across the west to support breast cancer research, building on the already significant investment in place.However, it is very widely accepted that we have to do more to support clinical trials. The national clinical trials oversight group is identifying some challenges and formatting solutions to increase the number of clinical trials, and I expect its final draft report in the coming months. I want to see greater access to clinical trials. I want to be very clear about that.

Since 1996, our national cancer strategies have been shaping and informing cancer controls. We have seen sustained investment and very clear strategic direction. The centres of excellence model has worked in large part, but we want to make sure treatment is available as locally as it can be. In budget 2025, an additional €23 million was secured for the national cancer strategy. The Government has invested more than €230 million in additional funding for cancer services since 2017. However, the benefit is seen in the number of patients who are surviving a cancer diagnosis. When the strategy was published in 2017, that figure was 150,000. Today, it is 220,000 and that, of course, is 220,000 people in our families and communities who are surviving cancer better. Behind every one of those numbers is an individual whose cancer is unique and very deeply personal, and they really do deserve the very best care. What I am encouraged about is that the treatment has become so very personal. I really learned that in the research institute in County Galway. We have these personalised, individualised treatment programmes that identify, manipulate and interrupt cancer in a very different way. I was hugely encouraged to see that. I know Senators have more contributions, so I will finish.

Victor Boyhan (Independent)
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Before we move on, I welcome guests of Senator Costello to the Chamber, namely, Erica Tierney, Muireann McColgan, Niamh Noonan and Ziva Cussen. They are all very welcome, as are the other guests in the Gallery.

Maria Byrne (Fine Gael)
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I thank the Minister so much for coming to the House to discuss this all-important issue. I compliment her and the Department for their work to date. It has been very proactive. If we look back ten years ago, we can see the difference now. The Minister highlighted the fact that more cancers are being resolved, and it is down to that collaboration between research and science but also with the specialists and teams that are working. There are so many people working in cancer care, from the nurses to the support groups to the oncologists, etc., and the teams who support them.

One of the first things I would like to highlight is the fact that University Hospital Limerick, which is often in the news for the wrong reasons, has a 98% success rate and has surpassed the required number of people it needed to see. There is a very successful programme running there and the support services have been put in place. I highlight that because the hospital can often get the wrong publicity. I acknowledge the staff who are working within the services there.

The Irish Cancer Society is seeking the expansion of the programme, which the Minister referred to, to be in line with European norms. That would mean, perhaps, extending or bringing down the age range. Currently, BreastCheck starts at age 50 and goes up to 69, but the society is looking at it to be brought to age 44 or 45 and expanded to maybe 74 or 75. The Minister highlighted that HIQA will be doing the report. I would love to see that report. While I know it has work to do and it has to be on a scientific basis, it is something I would love to see happening if the scientific evidence shows it. I know people in both age categories who have started because the programme has been successful. I was there recently for my own breast check and it was so efficient.I met so many people going into the service and coming out of it. They were singing its praises. They spoke about its efficiency and how well they were looked after by the team of staff. People are nervous going into it, especially if it is their first time. I know people who were caught through the BreastCheck service who got treatment and came out the other side. It is something that is very important.

I question whether we have enough people going into college. This is a specialist field and it requires surgeons, healthcare workers and nurses - the specially trained staff who work in the sector. How can we, once they have their qualifications, retain them and keep them working in Ireland? It is important to keep people with specialist training in these fields.

Predicting diagnostic pathways is another issue I wish to raise, as well as investing in infrastructure. Some hospitals are far advanced while others are not at the same level. How can we create uniformity and a similar level in hospitals in Ireland? Some places have centres of excellence while others may not have the same level of expertise.

Sometimes, people who are invited for screening by BreastCheck do not turn up. The national figure for attendance is approximately 70%. Is there anything we can do, education-wise, to show people how important it is to go for screening when they get called? It is very important that people go when they are called because there is such a positive outcome. While none of us envisage that we will be diagnosed, four out of every ten or three out of every four who attend are diagnosed. I am sorry; I suspect my figures are wrong. We must put the emphasis on getting people to attend. It is crucial to get people to attend within ten days of being called. That is part of the education piece.

The approach has been holistic. There is a very proactive team in University Hospital Limerick. They are very good at supporting and encouraging people, especially when they receive a diagnosis. It does not just affect the person who is diagnosed; it affects the whole family as well.

Linda Nelson Murray (Fine Gael)
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Self-examination is key. If anyone takes anything from my speech today, I plead with them to hear the words "self-examination". The Minister is very passionate about health. I welcome the opportunity to speak to her today about BreastCheck and breast cancer.

As we are all aware, breast cancer is the commonest invasive cancer among women. It touches the lives of thousands of individuals and families in Ireland and leaves a lasting impact. I know that only too well from my own family. Almost every person in Ireland knows somebody in their family who has faced this diagnosis. Only last week, one of my dear friends was diagnosed with breast cancer, thankfully early, because of BreastCheck. Some families have lost people far too soon but, thankfully, BreastCheck is saving lives by offering free mammograms to those aged 50 to 69. It is helping to get breast cancer before it becomes advanced, with early detection, aiding in treatment and by providing support.

We are making great strides. The Minister mentioned that. She gave us a great introduction. At total of 3,500 women are diagnosed with breast cancer each year in Ireland. It is estimated that one in seven women will be diagnosed with breast cancer in their lifetime, and one in 700 men.

Today, I want to speak about how we must improve breast cancer services in Ireland. To begin, we need to lower the age. I welcome what the Minister said earlier. We must also expand the age. We should open the screening out. I am going to turn 50 on 26 August. I am letting everybody know now as we might have a little party.

As soon as I wake up on that morning, I am registering for BreastCheck. Some 13% of women are diagnosed between the ages of 15 and 44 and 26% of women between 45 and 54, but I was not aware that a further 19% of women over the age of 75 are diagnosed. The BreastCheck programme must include those aged 45 to 49 and 70 to 74. We know that diagnosis leads to better outcomes and we should align ourselves with the upper age limit in the EU of 74.

I appreciate that the Minister has reported the NSAC is progressing work to consider the further expansion of the cancer screening programmes and has submitted a request to HIQA to assess the evidence for a proposed expansion of the age range eligibility of the BreastCheck programme, in particular for those aged 45 to 49 and 70 to 74. I strongly support this. I urge that it would happen sooner rather than later. If we know BreastCheck saves lives, then let us save more lives.

I wish to raise something I knew nothing about until it was raised by my colleague, Senator Cosgrove, that is, breast density. I never even heard of it until she said it. Nearly 50% of Irish women have dense breasts, which masks tumours on mammograms. We cannot tell how dense our breasts are by looking at them or feeling them. Dense breast tissue appears white on a mammogram. The big "but" is that cancer also appears white on a mammogram. I urge that we would research this more and make patients aware of it at their exam. Do they need a triple check breast exam, like they have in the Mater hospital?

We must boost screening and uptake access. Marginalised communities have a lower uptake and they often face significant disparities. I refer to rural residents, low-income populations, immigrants and people with disabilities. Going back to what my colleague, Senator Maria Byrne, mentioned, let us get the 27% of people who are not going to BreastCheck. Let us do a little advertising campaign for them and get them to attend.

Significant investment continues to be made in the cancer screening programmes. The Minister mentioned that additional funding of €2.9 million was allocated to BreastCheck, which I very much welcome, but we must commit to building and actioning a system that is faster and fairer for every mother, daughter, sister, friend, and man who faces this diagnosis.

Victor Boyhan (Independent)
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Before we move on, I welcome guests of Deputy Louise O'Reilly – members of the Rush senior citizens group. They are very welcome.

Teresa Costello (Fianna Fail)
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I welcome the Minister to the Seanad once again today. I appreciate her time and focus on this matter. I also welcome the four brave ladies who have already been introduced. I acknowledge their journey. They have had a huge input into what I will say here today.

I could spend hours talking about breast cancer, as I have lived through it myself. I run one of Ireland's largest online support communities for people affected by breast cancer. Every day, I hear the challenges and fears people face, from the moment they notice something is not right to when in some cases a diagnosis lands on them. Cases of breast cancer are rising, with almost 3,600 women diagnosed in Ireland each year. Some 23% are aged 49 or younger. Just over 37% are aged 50 to 64, and just over 39% are aged 65. Since the 1990s, breast cancer diagnoses have increased by 120%.

I start by recognising the great care people receive during treatment. I was one of those people, and I would not be standing here today without the wonderful team at St. James's Hospital, or my GP, who did not suspect breast cancer but still referred me to the symptomatic breast clinic. That decision saved my life. We have seen real progress in breast cancer survival in Ireland, with five-year survival rates now around 85% compared with 70% two decades ago. For younger women, survival rates can be high when the cancer is caught early, but their cancer tends to be more aggressive, making early detection crucial. For those with metastatic breast cancer, survival rates are lower, which is why timely access to diagnostics, equitable care across all regions and ongoing research into advanced breast cancer must remain priorities.

Just as I acknowledged the good, I feel a responsibility to speak openly about where things need to improve, because we should always strive for better. I welcome the updated GP referral guidelines for breast cancer from 2023. GPs are often the first step in saving lives. Physical examinations must be made available for younger women to ensure they know how to examine their own breasts correctly, as a form of surveillance, before they are at the age to have free mammograms. I speak for young girls whom I have spoken to who have received a diagnosis before the age of 40. They are often told by healthcare professionals not to worry, that they are too young. Although this statement may not be said in a harmful manner, when a girl gets a diagnosis, it can leave her feeling very dismissed and not reassured.

I must mention delays in diagnostic scanning, especially for younger women. In response to a query I raised, the Minister said that once a referral is received, patients are triaged as urgent or non-urgent. The KPI is ten working days for urgent referrals and 12 weeks for non-urgent referrals. In 2024, national compliance was 76%. Scans for new patients should take place within 12 weeks of the consultant's assessment. Compliance with this was 92%. I did look for recent KPI reports and the most up-to-date ones I could find were from 2010. I would like to see the latest ones, as I was told in 2024 that timely access varied by hospital, with the lowest being 29%. That concerns me. Another hospital was 91%, which is almost a perfect level of service.

My concern about the diagnostic process for younger women is that when a young woman with a lump gets referred by a GP, depending on the urgency indicated, they could wait between two weeks and three months to see a consultant, only to be examined without a scan, and then sent away and have to wait another three months for imaging. Some women, especially those in their 20s and 30s are waiting six months or more to be properly assessed. That delay could mean the difference between catching cancer early or finding it too late. We know breast cancer in younger women tends to be more aggressive. We also know that early detection saves lives. It is a message we are constantly relaying to people.

When I was diagnosed in 2013, I received a triple assessment on the day of my appointment in the clinic. My chemotherapy was organised almost immediately. My cancer was aggressive and at stage 3, so swift action was needed. I wonder if the system has changed and, if so, when and why did it change? I cannot understand the reason for a scan not being part of the first appointment in the breast clinic. It is as if the girls are being retriaged, which is a waste of resources. It is literally bringing someone in to send them away for several months with no answer. I am interested in learning the percentage of girls who attend a breast clinic who require a scan. I imagine very few attending the breast clinic do not need to get a scan. I do not agree that someone with a lump should be sent away on the day of their appointment without a scan.

I want to talk about pregnancy and post-partum diagnosis. It is something I am seeing more and more. Young women are being diagnosed during pregnancy or shortly after giving birth. It is devastating. A time that should be filled with joy becomes terrifying. We need more awareness that this can happen so women and healthcare professionals are alert to the signs.

The Minister knows I have been very vocal about expanding BreastCheck to include women aged 40 and upwards, as the current age range of 50 to 69 is not sufficient. I have made my submission to the NSAC and it is currently being reviewed by HIQA. One of the most regular requests I get, as a breast cancer advocate, is that I should fight to get the age of free breast cancer screening lowered. The women I speak to are realistic about the age they feel it should be lowered to. That is something I believe we will see change, as the evidence is there to prove screening is beneficial from the age of 40. I am aware the age range of 40 to 74 is being examined, which is a good start.

As part of my submission, I also referred to the option to advise women of the category of their breast density. We should give women whose breasts are dense that information so they can make informed decisions regarding other effective screening options for their breast type. I attach that comment to my colleague, Senator Blaney.

We often talk about diagnosis and treatment, but not enough about life after cancer, which is where the journey can get hard. When treatment ends, there is an emotional and physical impact, the fear of recurrence and the difficulty of returning to work. Some people cannot go back to work at all, especially those with stage 4 disease, who are on treatment for life. One big issue I keep hearing about is the lack of clear, accessible information on what people are entitled to in terms of medical cards, counselling, follow-up care and wage subsidy benefits.This information should be handed to every patient as standard. Lymphoedema is a condition that can flare up in any cancer patient who has had an axillary clearance of his or her lymph nodes. I am one of them. More information and better options for care are necessary in respect of this condition. It is an awful condition for those women who suffer from it and the risk of it occurring never goes away.

Another major challenge is menopause. It is a side effect many of us face. For most, HRT is not an option because of the hormone-sensitive cancer. We have moved forward a great deal in this country in recent times with the introduction of menopause clinics and the roll-out of free HRT but, for those of us who have had breast cancer, options and advice are extremely limited. That is why I want to highlight Veoza. It is a non-hormonal medication to manage moderate to severe menopause symptoms. It works by targeting neurokinin 3 receptors in the brain - I have probably pronounced that wrong - rather than through hormones. It became available in Ireland in late 2023 and is under review for inclusion in the drug payment scheme as confirmed in the response to a parliamentary question in March 2025. As of June 2025, it is only available privately at a cost of approximately €70 a month. For women who cannot take HRT, this could be life-changing but, right now, cost is a barrier. I would love to see Veoza made available and affordable for breast cancer survivors as part of the HRT programme.

One final issue is waiting times for reconstruction surgery. For some women, this surgery is essential to their recovery. I refer to their emotional recovery rather than their physical recovery. For those who choose it, waiting years is incredibly difficult. It is a deeply personal choice but those who want it should not have to suffer more because of delays.

I again thank the Minister for taking the time to be here to listen. We share the common goal of improving outcomes and experiences for people affected by breast cancer. I reiterate that treatment is good and that breast cancer care in Ireland is not bad, as we can see in the outcomes of the majority of patients. However, the points I have raised today come from a place of care, lived experience and determination because I know we can do better.

Victor Boyhan (Independent)
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I welcome the Probus group from Tullamore, County Offaly.

Nicole Ryan (Sinn Fein)
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It is lovely to see the Minister again today. As she will know, breast cancer affects a great many women across Ireland. There is an urgent need to improve how we detect, support and treat those who are affected. Breast cancer is the most common cancer among women in Ireland and yet, according to Breast Cancer Ireland, only 19% of women who do not regularly check their breasts say they would recognise a symptom of breast cancer. That is quite alarming and tells us that we are not doing enough to educate and empower women as regards BreastCheck and breast cancer. I am mortified to admit that I only learnt how to properly check myself last year. I am 32 so I was 31 years of age. There is a demographic group of such women. I only learnt by chance. A fantastic woman from Breast Cancer Ireland named Juliette was doing workshops on checking breasts and looking for lumps in a school for any young women and men who wanted to participate. She mentioned things like rashes. I did not have a clue that a rash could be a sign of cancer. If I had not been in that school on that day, I would never have learnt that. My generation, those in our 30s, 40s and even a little bit younger, never had education like that in school. We were never taught about checking your breasts or what to look out for. If we are not looking at checking women who are younger, we need to empower them and build out the education system as to what to look out for and when to worry.

As other Senators have said, we need to talk about breast density because it is a topic that is not spoken about enough. It was first mentioned by my colleague Senator Cosgrove. Women with dense breast tissue are often at a higher risk of developing cancer but the dense tissue also makes it very hard to detect the cancer through standard mammograms. Sometimes it is like trying to find a little snowball in a snowstorm. Most women are never actually told that they have dense breasts. This is a barrier in our diagnostic process and it is costing people their lives. The lack of awareness and transparency around breast density has to be addressed. We need to ensure that women are informed about their breast density status and what it means for their risk levels and screening needs.

However, that will not be enough if access continues to be limited. As other Senators have said, the Irish Cancer Society has pointed out that marginalised groups, including Travellers, migrants, disabled people and women in poverty, face greater obstacles in accessing services. This might include transport, a language barrier or, sometimes, discrimination. These structural issues require immediate policy action for women. While BreastCheck currently sees women who are 50 to 64 and there are plans to extend this to the age of 69, we must ensure there is an extension nationally without delay. I accept the scientific caution as regards extending screening to those under 50. The risks of false positives, overdiagnosis and unnecessary treatment are real. However, when cancer is present in younger women, it often seems to be more aggressive. If this is combined with high breast density, early detection is even harder.

Our breast symptomatic services have improved. The detection rates are significant. That proves that proper investment and timely, well-resourced and accessible diagnostic care really does work. However, these services can sometimes be overstretched and women still face delays in follow-up, particularly in rural or underserved areas. I ask that we invest in a public awareness campaign for women like me who are not educated on BreastCheck, what that entails, how to check our breasts and what to look out for. This would educate all of us who are younger as to how to check our breasts, how often we need to do it and all that kind of stuff. We also need to ensure that breast cancer services are inclusive and accessible to all, especially those from under-represented communities, from a Travelling background or whatever. Symptomatic services should be expanded to ensure every woman is seen promptly and treated with the needed dignity and urgency. Breast cancer does not wait for budgets or for policies to come out. It does not discriminate but our system sometimes does. Women in Ireland deserve better. We need real change that is rooted in science, compassion and equality.

Victor Boyhan (Independent)
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Next is the Cross-Party Group. Senators Cosgrove and Harmon are down on my list. Senator Noonan wants to speak as well. I think we will have time. I propose that Senators Cosgrove and Harmon take five minutes. We will have another slot. We will fit Senator Noonan in there.

Nessa Cosgrove (Labour)
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The Minister is very welcome. I thank everyone for raising the issue of breast density. I particularly thank Senator Costello. She is such a strong advocate for those with breast cancer. We really thank her for that. I have learned a great deal just from listening to her. I am delighted Deputy Carroll MacNeill is the Minister for Health. She is very proactive. I am delighted that we can make statements on breast cancer today.

Exactly two weeks ago, I hosted an event in the audiovisual room addressing the topic of dense breasts. It is very reassuring to hear so many people bring the issue up today. Like so many other Senators, I had no idea about dense breasts until I was approached by two women in my area. The event was attended by many Senators and TDs. We heard testimonies from Siobhán Freeney, a survivor of breast cancer, and Martha Lovett Cullen, whose mother, Marian, died from breast cancer less than a year ago. Along with dozens of other women who stood outside Leinster House last year, Siobhán and Marian, whom I spoke to before and after the event, had something in common. All had received clear mammograms and assumed this meant they were clear of breast cancer. In fact, all that these clear mammograms had indicated was that cancer had not been detected. Six months after her clear mammogram, Siobhán received a diagnosis of stage 3 invasive cancer. Some 12 months after she received her clear mammogram, Marian received the devastating news that she had stage 4 terminal cancer. A year later, she was dead. I will read out a latter from Marian's daughter, Martha, who spoke at our briefing in the audiovisual room last week.She wanted me to read this out today:

To the Members of [the Oireachtas], My name is Martha Lovett Cullen, and I lost my mum, Marian Lovett, to stage 4 metastatic breast cancer last August.

She was 61.

She was a mother, a writer, a researcher, and a feminist.

She spent her life fighting for justice and if she were still here, she would be the one writing this. But she isn’t. So I’m doing it for her.

My mum went to every BreastCheck appointment.

She trusted the system.

In August 2022, she received a letter saying her mammogram was clear.

One year later, in October 2023, she was diagnosed with incurable breast cancer - the same week she was finally told that she had dense breast tissue.

Information that had been visible on her mammograms all along.

Information that was never disclosed to her.

Dense breast tissue significantly increases your risk of breast cancer and makes it harder to detect on a mammogram.

It is one of the most important pieces of information a woman can receive after a scan. My mum never got that chance.

She died asking, "why was this allowed to happen?" She should still be alive today. And my family and I will never stop asking the question: what if she had been told sooner? If she had known her risk, she might still be here.

That's the reality. As of today, June 9th, the petition I started calling for mandatory breast density notification has reached 9,639 signatures and is fast approaching 10,000.

That's not just a number. That's a message from the women, families, and people of Ireland: this matters.

We are waking up to this silent failure in our screening system, and we are demanding better. Once we hit 10,000, you will have no choice but to listen, because we will not be silent. We are not asking for the impossible.

We are asking for a single, crucial line in a results letter.

A line that tells women their breast density. A line that gives them knowledge.

A line that could save their lives. Ireland is behind. Other countries already notify women of their breast density such as the US, Canada, Australia, parts of Europe.

Why not here? Why not now? And ask yourself this - what if it was your mother?

Your daughter? Your sister? What if it was you?

Wouldn't you want to know? [We] have the chance to act before more women are failed like my mother was. Before more families are left grieving.

Before more lives are needlessly lost.

Please don't let this opportunity to do the right thing pass [us]. Signed, Martha Lovett Cullen

I say to the Department that this is the most important thing we can do, as almost 50% of women have dense breasts, 10% have extremely dense and 40% have heterogeneously dense. Dense breast material shows up on a mammogram as being white. Cancer or potentially cancerous material also shows up as being white. Up to 50% of cancers in women with dense breasts may be missed. Breast density not only potentially masks cancers but is also a significant risk factor in the development of cancer. Every woman deserves to know what her level of breast density is and what the consequence of that is. That is why there must be mandatory reporting. I ask the Minister to introduce a mandatory reporting Bill on breast density or else allow a backbencher in the Government to maybe do the same.

Laura Harmon (Labour)
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I thank the Minister for being here for this important discussion. I thank my fellow Senators, especially Senator Costello for all of her advocacy and awareness raising. I am learning so much being part of these discussions in the Seanad. Like many others here, I did not receive any education through school on breast cancer, checking our breasts and what we need to do in terms of minding our health.

When it comes to breast cancer, one of the most important things is getting seen to in a timely manner. Despite the fact that we have more than 3,600 people diagnosed with breast cancer annually in Ireland, which is a 120% increase since the 90s. Despite these high figures, one in four people is left waiting longer than the recommended time, which is ten days, at an urgent symptomatic breast disease clinic. We need to ensure that people get seen to on time.

Another stark figure that was sent to me by the Irish Cancer Society is that those from disadvantaged backgrounds have poorer outcomes when it comes to breast cancer. Those from deprived backgrounds are more at risk of getting diagnosed at a later stage. We see that 83% of those in the most affluent areas are diagnosed at stage 1 or 2 compared to 78% in the most deprived areas. This is a five percentage point difference.

We know that cancer screening works. We need to expand it. Nine out of ten people are diagnosed at stage 1 or 2 via BreastCheck compared to just seven out of ten in outside screening. The scheme's attendance rate is in line with its target of 70%, but it needs to be expanded in terms of its age range. We must expand this screening from the age of 40 to 74 in line with the European Council's recommendation on strengthening prevention through early detection.

I commend my colleague Senator Cosgrove on the work and campaigning she is doing as regards breast density. There is a lack of awareness of the issue of breast density and how it can mask the cancer cells during screening. We need more awareness, and more work needs to be done to ensure that we are diagnosing people when they need it. We also need to have infrastructure and investment in diagnostic pathways, as committed to in the programme for Government. The Minister outlined in her opening statement that there is work in the pipeline in terms of the workforce in radiology. That has to continue so that we have the proper workforce in place to conduct these screenings.

Ultimately, we need more of an investment in primary care, screening, testing and treatment capacity, with a particular emphasis on staffing in healthcare professionals.

Victor Boyhan (Independent)
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I thank Senator Harmon very much. Before I proceed, I welcome the guests of Senator Curley, namely, Councillor Martin Monaghan and his wife Deirdre.

Three more Senators are listed to speak, namely, Senators Blaney, Kyne and Noonan.

Niall Blaney (Fianna Fail)
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The Minister is welcome. I thank her for staying for the whole debate.

I am certainly no expert when it comes to breast cancer diagnosis, but I have been lobbied by people in my constituency, and one in particular in County Donegal who is part of Lobular Ireland. Senator Costello and others discussed breast density. What Lobular Ireland is calling for is the introduction of standardised mandatory breast density reporting for all women who have mammograms. It is saying that software is available, and I am told it is working well in other screening jurisdictions. I have no doubt that AI will play its part in this process, but I hope sooner rather than later.

I concur with Senator Costello on the early detection of younger women. It is imperative that younger women who have symptoms be looked at sooner. On the day of their screening, when this realisation takes place, a further investigation should take place there and then because some patients are waiting far too long.

It would be remiss of me not to mention to the Minister the surgical hub for Donegal. We will chat to her further outside of the Chamber, but there will be much noise about the fact that Donegal has not been selected as one of the areas for a surgical hub by the HSE. We are not too happy with how we have been treated by HSE senior personnel. We will talk to the Minister later in that regard. We in Donegal cannot be left behind. We are entitled to the same rights as the rest of the country. That is all we are asking for.

I thank the Minister for her time.

Seán Kyne (Fine Gael)
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The Minister is welcome. I thank her for agreeing to come to the Chamber. I made the request on foot of Senator Costello's request. It is an important debate. I thank the Minister for coming down to Galway recently to meet the team. She got a positive and uplifting presentation from Professor Michael Kerin. I commend his work. To quote his own words in the Cancer Centre Annual Report 2023:

The quantity and quality of care provided in the context of ever increasing demand and poor infrastructure is extraordinary.

[...]

We are dedicated to working collaboratively with our academic partners to advance education, research, and training to improve patient outcomes and support the development of highly skilled multidisciplinary teams across the network.

[...]

We envisage a Cancer centre at the level 4 hospital at GUH with ambulatory centres across the region. This is a key priority, empowering it to respond to increased demand, new and innovative technologies, ensuring that patients in the Saolta catchment have equitable access to high quality facilities, close to home and world renowned cancer care leading to enhanced patient outcomes.

That is what Professor Kerin has been advocating for some time. As the Minister will know, people in the west have lower outcomes for cancer than those in the rest of the country.I welcome the commitments given in the programme for Government, such as, for example, ongoing investment and the extension of the age for screening. I also acknowledge that the overall five-year survival rate is high but it is lower for those who are assessed and diagnosed at a later stage. There is ongoing investment and research and there are fundraising efforts, which the Minister witnessed and commended. There is the work of the Lambe Institute. I acknowledge all those impressive people who were there to showcase their work and research in Galway on that day.

I wish to discuss the requirement to locate a cancer centre in the Galway region. A first stage of that would be improved access and the improved dignity of treatment. I say that because patients in Galway must seek treatment through the emergency department because there is no stand-alone cancer centre. To have a cancer centre we need investment in additional beds - protected cancer beds. That is part of the vision that was outlined in the masterplan on that day in Galway. That level of dignity is a requirement. I therefore ask the Minister to prioritise the provision of additional beds for Galway once the masterplan is approved.

Professor Kerin has done tremendous work to showcase and highlight the needs of the west. There is a masterplan and I ask the Minister to continue to promote it and ensure investment in University Hospital Galway for all cancer patients.

Malcolm Noonan (Green Party)
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Cuirim fáilte roimh an Aire. The Minister is very welcome and I welcome this debate.

The points have been well made in respect of breast density. I bring this on behalf of a friend of mine who has campaigned on this issue. The main points she asked me to mention are that women with dense breasts are at a higher risk of getting breast cancer. Also, they do not know whether they have dense breasts. When the BreastCheck service and hospitals conduct mammograms, the radiologist reporting on the mammograms knows but the information is currently not reported to the woman, as it is in most other countries. This fact has been highlighted by other Senators here this evening.

Another aspect is that women diagnosed with ductal or lobular breast cancer should have an annual MRI as standard because the mammogram does not always diagnose lobular breast cancer. My friend also asked me to mention a fact about the annual mammogram. Her last ductal breast cancer was in 2008 and her mammogram in 2022 reported her as being clear. A year later, however, her mammogram diagnosed extensive lobular breast cancer, with 55 of 59 auxiliary glands positive for cancer cells. A woman's breast density can be assessed by a radiologist's reading of her mammogram images. Breast density is a highly visible radiological finding. There are four levels or categories of breast density. Category C is heterogeneously dense and category D means extremely dense, and these categories are considered to be dense breasts.

It has previously been reported that BreastCheck radiologists are not willing to make a subjective decision about whether a woman's breast tissue is dense. Therefore, there is no standardised reporting. Women who have dense breasts have no other way of knowing unless the radiologist reports it. Currently, women with dense breasts are left in the dark about their increased risk of developing breast cancer and radiologists, in turn, turn a blind eye to the issue - an additional risk of masking. In view of this and to adjudicate, it is important to point out that software is available. It works well in other breast screen jurisdictions along with their existing 2D mammogram equipment screening in hospital settings. It is known to be accurate and matches well with the subjective density measurement in terms of predicting risk and masking. Again, like other Members, I ask the Minister to introduce standardised mandatory breast density reporting for all women who have mammograms in Ireland.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank Senators for giving me the opportunity to listen to them and I acknowledge the important issues they have raised.

First and foremost, I again recognise the women and their families who are impacted. So many people in this room have either been impacted very directly and personally or have a close family member who has been. I am no different, so I recognise the importance of BreastCheck in diagnosing breast cancer and the ongoing care it gives to women.

I wish to state clearly that I have every confidence in the breast screening service and every interest in expanding it in ways that are scientifically appropriate. I want to first make sure the science is there and ensure expansion is based on science.

On the screening programme, I visited Eccles Street where I spoke to the radiographers and radiologists. They very clearly acknowledged the limitations of any screening programme. It is a screening programme, so it is never going to detect 100% of cases. They said to me that people must understand the balance whereby, if 99% of cases are picked up, then the screening is worthwhile. There are inherent known limitations to screening programmes, but that does not mean they are not of very considerable value in reducing an overall disease burden in a population generally. We must recognise that screening is not diagnostic. Also, even a screening programme at 99% excellence is going to miss things and there will be harms done. However, we know the evidence we have been able to pick up with screening programmes and the value they are in themselves. That is important, and so we try to think about the best way of extending screening programmes. Let us not forget that there is a very significant cost element and we will have to deal with that on a different day in the form of Estimates and so on. We must strike the right balance when it comes to expansion. The programme has already been expanded to cover people aged 50 to 69 years, when it was formerly 64 years. We are conducting an assessment on how best to extend the programme. Is it 45 to 49 years or is it 70 to 74 years? There is also the breast density issue. That needs to be a scientific analysis.

On the breast density piece, I am glad so many Senators have raised this issue and placed an important focus on that aspect. I thank Martha Lovett Cullen for her contribution to the debate today and recognise her very important words, on behalf of her mother.

I do hear what Senators are saying, but I am a politician and I am not able to make a scientific decision on it no more than on the screening programme. As I may have mentioned before, during negotiations on the programme for Government, we considered extending the ages but realised that none of knew what we were talking about and should ask the actual people who knew what they were talking about. In the same way with the breast density issue, there is competing evidence at a European level about how that is best done. Breast density has gained greater attention and Senators have described how it appears on a mammogram. There are differences in international clinical perspectives on the effective integration of this in breast cancer screening, as I have said. The recently updated European Commission initiative on breast cancer and European guidelines on breast cancer screening and diagnosis talk about the low certainty of evidence incorporating breast density measurements into population health screening programmes. It directly contrasts with the recommendation by the European Society for Breast Imaging, which recommends that women with extremely dense breast tissue be offered screening with breast MRI. We need to have a scientific reconciliation of those pieces of evidence. Thankfully, we remain in a democracy that does rely on experts. This work will take about 18 months and I ask for the Senators to support me in ensuring experts are given the opportunity to do that. Those experts tell me that most public population screening programmes like BreastCheck do not use breast density measurements but I recognise there are those that do. Let us get the scientific evidence and take the best steps forward while recognising there will be a cost, which we will have to address together.

Recognising that, Senators will be aware the NDP review is coming up. I encourage Senators to contact their favourite Cabinet Ministers about investment for health infrastructure throughout the country, but that is a little shameless of me to say so. Of course I want to extend hospital infrastructure throughout the country.

Nevertheless, there have been important budgetary supports that have enabled us to increase the number of consultant radiologists. Today, there are 185 working in the system and we have 43 training places, which is an increase of 5%. That is a really important investment that will make a difference in time.

I am conscious Senators have raised the issue of people not attending for BreastCheck appointments. It does not sit well with me that almost 50% of appointments issued with a time and date for screening using a mammogram are not attended. Such a situation does not work. We do take steps to try to address do-not-attends across the health system.For example, the chronic disease management hub in Sligo has managed to make real progress with the number of people who fail to attend appointments. At the end of the day, people need to turn up to appointments and have the benefit of them.

Focusing on the underserved populations is important. I recently funded a project through the women’s health fund to deliver education on how to be aware of symptoms, specifically targeting underserved populations. We are doing that in partnership with the Marie Keating Foundation, which is an important measure.

I thank Senator Costello in particular for her range of different questions. I will follow up on every one of them to the extent I can. Some of her questions relate to clinically-based decisions, however, and I will need better information to respond to them. The Senator is quite right to highlight lymphedema, for example. There are approximately 2,000 people with chronic lymphedema in this State. Its risk is, as she said, ever present and important. While there are some clinical questions I cannot address, I will ensure she gets a proper answer to them.

With regard to the KPIs, my understanding is that the most recent data are available from September 2024. I can provide detailed information to the Senator in this regard, as that might be better. I thank Senators generally for their genuine focus on this matter. While we spend this time talking about breast cancer, we must equally consider people who are not getting lung cancer diagnoses for the absence of a screening programme, colorectal cancers and the range of other cancers that are important. We could have a similar debate about any one of those cancers.

A point was made with regard to Donegal. Surgical capacity in Donegal is important. We want to see surgeons having the opportunity to continue to perfect and develop their craft in Letterkenny as much as anywhere else.

Victor Boyhan (Independent)
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I thank the Minister very much for what was a meaningful and constructive debate. We value and appreciate her and her officials coming to the House.