James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 256 to 258, inclusive, together.

BreastCheck, the National Breast Screening Programme, offers a population-based ongoing call and recall programme every two years to all eligible women aged 50-64. BreastCheck has a clear commitment to providing transparent information to women invited for screening - with the benefits and limitations of screening clearly explained. Breast cancer survival in Ireland has improved significantly in recent years due to the combined approach of screening, symptomatic detection and improved treatment. Breast cancer 5 year survival is now estimated at 81.8% for people diagnosed between 2003-2007, up from 76.8% for people diagnosed between 1998-2002.

BreastCheck's ‘Guidelines for Quality Assurance in Mammography Screening’ is available for public review and download from the publications section of . These guidelines are consistent with those of the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services which is the EU standard.

BreastCheck utilises digital mammography as it is the most advanced method available, giving enhanced image quality and significant reductions in the radiation dose associated with screening examinations. While not all breast cancers can be found by mammogram, breast screening helps to identify cancers at an early stage when it easier to treat the patient. This leads to less extensive surgical treatment, a better chance of good recovery and improved quality of life.

BreastCheck is fully audited against a range of quality-led criteria including those published in the BreastCheck Women’s Charter. BreastCheck seeks to achieve or surpass standards set down for breast screening, including those outlined in the Charter, and outcomes are reported in the BreastCheck programme report (most recent figures relate to 2011). BreastCheck provides comprehensive and transparent information and encourages woman to share in decision-making regarding treatment. They also highlight the woman’s right to refuse treatment, obtain a second opinion or choose alternative treatment.

The standardised detection ratio (SDR) is a useful composite score by which to measure the performance of an overall screening programme and it is used to benchmark radiological performance against other international programmes. The most recently published figures for 2011 reflect an improved programme performance by BreastCheck.

James Reilly (Dublin North, Fine Gael)
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BreastCheck, the national breast cancer screening programme, operates standards and quality assurance systems that are in line with international guidelines to ensure that the most effective service is provided to women. A specialist BreastCheck multidisciplinary team provides the screening service. Quality assurance standards in operation include the double reading of all mammograms by two specially trained radiologists. Pathologists take part in external Quality Assurance and independent slide review. The entire BreastCheck programme is subject to external review by EUREF, the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services, with the next review scheduled for Autumn 2014.

Women who have an abnormality on screening will be recalled to an assessment clinic for triple assessment. Such clinics are attended by a radiologist, a breast surgeon, a breast care nurse and appropriate radiography staff. Further imaging, including supplementary mammographic views and ultrasound, clinical examination and either needle biopsy or fine needle aspiration as required is carried out.

A multidisciplinary meeting takes place on a regular basis at each unit to review individual cases. Radiation oncologists and medical oncologists involved in the programme are normally involved in the medical review of all cases of diagnosed breast cancer. Correlation of clinical, radiological and pathological results is performed and the outcome is documented. Further clinical management as required is arranged immediately.

The BreastCheck Women's Charter encourages women to share in decision-making regarding treatment. The Charter highlights the woman’s right to refuse treatment for whatever reason, to obtain a second opinion or to choose alternative treatment. If she so wishes, the woman is encouraged to include a partner, friend or relative in any discussions. Copies of their medical results can be obtained by all women.

James Reilly (Dublin North, Fine Gael)
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Interval cancers, involving breast cancers diagnosed in the interval between scheduled screenings, where women have been given a normal screening result at their most recent screening, inevitably arise in any screening programme.

Cancer can occur at any time, including during periods between mammograms. Also, not all breast cancers can be found by means of mammogram. Some non-invasive cancers will not be found by screening and interval cancers can occur in such cases.

However, the overall benefits of breast screening are clear. Breast screening helps to diagnose breast cancer at an early stage when it is easier to treat, thus exposing the women involved to less extensive surgical treatment and giving them better chances of good recoveries and improved quality of life.

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 261 to 263, inclusive, together.

Prior to its introduction on a national scale,digital mammography was introduced on a pilot basis in Ireland. Based on the success of the pilot, BreastCheck transferred to digital mammography. Digital mammography gives enhanced image quality with improved visualisation of dense breast tissue. It allows images to be acquired more quickly and enables the manipulation of images to obtain better detail. Digital mammography also involves a significant reduction in the radiation dose associated with screening examinations.

A research study sponsored by the US National Cancer Institute, Digital Mammographic Imaging Screening Trial (DMIST), provides evidence to support the efficacy and safety of digital mammography. BreastCheck continues to review all relevant research as it is published. The extensive independent breast screening review for the United Kingdom (Marmot Review) published in 2012 demonstrated that breast screening leads to a reduction in mortality.

A clinical trial on digital mammography has not been carried out in Ireland.