Gareth Scahill (Fine Gael)
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I welcome the Minister of State, Deputy Murnane O’Connor, to the House.

Teresa Costello (Fianna Fail)
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I thank the Minister of State for being here today. October is breast cancer awareness month so it is very timely that I am raising this issue today, the same day that I will attend my annual mammogram. I will most certainly be repeating myself today as I have spoken previously about the delays in scanning in symptomatic breast clinics. I will continue to repeat myself because the situation really concerns me.

I am speaking both as a breast cancer survivor and as the founder of one of Ireland's largest online support communities for people affected by breast cancer. Every day I hear of the challenges and fears people face, from the moment they have a concern to when, if they are unfortunate, they receive a diagnosis. Breast cancer cases are rising, with almost 3,600 women diagnosed in Ireland each year. Approximately 23% of them are under 49 and 37% are aged between 50 and 64, while 39% are over 65 years of age. Since the 1990s, breast cancer diagnoses have increased by 120%. Survival rates have improved. The five-year survival rates are now around 85% compared with 70% two decades ago. For younger women, cancers tend to be more aggressive, making early detection critical. For those with metastatic disease, survival is far lower. This is why timely access to diagnostics and equitable care across all regions must remain a national priority.

I welcome the updated GP referral guidelines from 2023 because GPs are often the first step in saving lives. I know because I have my own GP, Dr. Barry Quinn, to thank for my timely referral. However, guidelines only matter if the system delivers. Key performance indicators state that urgent referrals should be seen within ten working days and non-urgent referrals within 12 weeks. In 2024, compliance nationally was 76% but this varied hugely by hospital. It was as low as 29% in some and as high as 91% in others. That is an unacceptable gap. Scans for new patients should take place within 12 weeks of a consultant's assessment. Compliance with this was reported to be 92% but here is the real problem: many younger women who see a consultant are examined but not scanned. They are then sent away to wait for another three months for imaging, with some ending up waiting six months or more for a full assessment. For aggressive cancers, that delay could mean the difference between early detection and a late-stage diagnosis.

When I was diagnosed in 2013 I received a triple assessment on the day of my first appointment and my chemotherapy was organised almost immediately. I was at stage three and swift action saved my life. I must ask again, as I have done previously, if the process or policy has changed? If so, why has it changed? What is the point of the first appointment if no scan takes place? Most women attending breast clinics will require a scan so why not perform it that day? Stories from younger women are devastating. The Too Young to be Heard campaign highlights how young women feel that they are being dismissed because of their age and, when they finally reach a clinic, delays continue. They are not asking for special treatment but for timely, appropriate care. Today I am asking for a clear commitment that symptomatic breast clinics will be resourced to carry out diagnostic scans at the first appointment, ensuring that younger women will no longer feel dismissed or be left waiting months for a scan. I speak from experience when I say that breast cancer treatment in Ireland is very good. The outcome for many patients is positive but the delay in diagnosing younger women risks costing those women their lives or costing them precious time.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Senator for her very passionate words as a cancer survivor. It is so important that the Senator, through her role, highlights these concerns. It is great to see her doing so well today. We all know how cancer can affect families. There is not a family in Ireland that has not been affected in some way by cancer. I thank her for her advocacy and hope that her health will be brilliant. She is doing a very good job, for which I thank her.

Breast cancer is the most common invasive cancer among women in Ireland and accounts for 32% of all invasive cancers diagnosed in women.One in seven Irish women will be diagnosed with breast cancer in their lifetime. Early detection improves survival rates, allows for less invasive management and enhances quality of life for patients.

Symptomatic breast disease, SBD, rapid-access clinics are run in each of the eight designated cancer centres and in one networked centre. Each year approximately 45,000 women are seen in these clinics and this figure is increasing year on year. That is a concern, as the Senator said. The SBD clinics triage referrals according to symptoms, with patients triaged as either urgent or non-urgent. HSE key performance indicators, KPIs, set out that urgent referrals are to be offered an appointment within ten working days, while non-urgent referrals are to be offered an appointment within 12 weeks. I will highlight this to the Minister, Deputy Carroll MacNeill, and ask what we can do to improve it. Everything to do with breast care is about timing.

The HSE advises that when breast cancer is suspected, diagnosis in the breast clinic is made by triple assessment consisting of a clinical assessment, which is an exam; a scan; and a biopsy. Not all patients who attend SBD clinics require triple assessment. Within SBD clinics, referrals are triaged by clinicians and where a triple assessment is deemed necessary, the timing of these tests is determined by clinical concern. It is all clinician-led.

With regard to the matter raised by the Senator, the HSE has a KPI monitoring compliance with the target that breast imaging clinical requests - that is, mammography or ultrasound - for new patients should be carried out within 12 weeks of the consultant surgeon’s assessment in the specialist clinic. National compliance with this KPI for the last 12 months on a rolling basis is 90%.

For urgent patients attending a triple assessment clinic, this imaging is frequently completed on the same day as the clinic. The Early Diagnosis of Symptomatic Cancer Plan 2022-2025, which has been extended to 2027, emphasises the need to continually identify and address health-system factors that affect the timeliness of diagnoses. That is crucial. The national cancer control programme monitors progress on this data on a regular basis.

Advances in cancer detection and treatment have been achieved through sustained investment in our health services. In budget 2025, an additional €23 million was secured for the national cancer strategy. This means over €105 million has been invested in the strategy since 2017, which has enabled the recruitment of over 670 staff to our national cancer services.

The Government remains committed to the implementation of the national cancer strategy and to continuing to build on improvements to services and better outcomes for patients.

Teresa Costello (Fianna Fail)
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I thank the Minister of State for her response. I have concerns. There is a specific issue with the symptomatic breast disease clinics. It is about when a girl, generally of 36 years or under, presents after being referred by her GP with a lump and is sent away without a scan that day. I think something has changed over the years. Years ago when I was diagnosed, I never met anybody who was sent away without a scan on the day. The question I have asked several times is whether something changed. Did something change around the time the early diagnosis of symptomatic cancer plan was put together? I will follow up with the Minister for an answer on that issue.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I will be delighted to follow up with the Minister, Deputy Carroll MacNeill, today. It is like everything in life. The Senator mentioned the good things that happened in the process but when someone has gone through the process, the only concern really is the timing of assessments, whether the scan, the biopsy or the test. I will definitely go back to the Minister on that.

Early diagnosis is so important in cases of cancer. Since the first national cancer strategy in 1996, detection and diagnosis at the earliest possible stage has been a key priority for us. Cancer services and infrastructure have been designed and delivered through successful national cancer strategies alongside developments in treatment, which have led to improvements in cancer survival rates. Breast cancer survivors constitute the largest cancer survivor group in Ireland, comprising 22% of all cancer survivors. As I said, nearly 50% of women at last count are breast cancer survivors, which is really important.

In relation to concerns over waiting times, the time of the triple assessment is determined by a clinician. This is a clinical concern so urgent patients are prioritised. I will definitely come back to the Senator on that.

Access to diagnostics is a challenge across all cancer services and is suggestive of wider pressures on radiology across the health system. The national cancer control programme has produced a range of guidelines aimed at ensuring standardised access to cancer services. These will reduce variations in the management of patients, including those referred for triple assessment, and will lead to more appropriate referral and management of patients. I will get the Senator more information on that.

Where hospitals are challenged to meet their targets, it is important to say this is often due to staff vacancies. Regarding accessing diagnostics and capacity issues, individual hospitals respond to these challenges with local improvement plans, whether additional clinics, outsourcing diagnostics or reviewing patient pathways to another process.

The Government remains committed to implementation of the national cancer strategy and to building on the significant investment and process already made to improve outcomes of patients. This is a timely and important area.

I want to thank the Senator and say how well she is doing. She is an example to all breast cancer survivors in Ireland.