Vol. 435 No. 9
15 Ms McManus asked the Minister for Health if, in view of the serious level of breast cancer in Ireland compared with other European countries, and the claim by the director of the National Breast Cancer Research Institute that screening could save up to 300 lives, he will introduce a national breast screening programme based on mammography; and if he will make a statement on the matter.
111 Ms F. Fitzgerald asked the Minister for Health if he has satisfied himself with the level of mammography service available througout the country; and if he will make a statement on the matter.
238 Mrs. Doyle asked the Minister for Health if he will introduce a national screening programme for women in the 50-64 age group and other risk categories in view of the critical need to detect breast cancer as early as possible.
I propose to take Questions Nos. 15, 111 and 238 together.
At present, it is not possible to say with certainty what the incidence of breast cancer is in Ireland each year. This information will be available from next year from the National Cancer Register.
Unlike lung cancer, for example, with its well documented links with smoking, the causes of breast cancer remain to be clearly established. Emphasis is therefore placed on early detection at the pre-invasive stage through mammography, and consequent early treatment. The yield from mammography is highly dependent upon the medical equipment being used and the expertise of the health professionals involved.
At present in Ireland, mammography is used largely as a diagnostic tool for symtomatic or worried women on referral by their general practitioners. There are now diagnostic mammography units at 17 hospitals throughout the country and expertise has been growing in all aspects of the early detection of breast cancer and its treatment.
There has been considerable debate and discussion regarding the effectiveness of mammography screening in reducing mortality from breast cancer. Mammography screening involves the carrying out of mammography on a mass population basis to detect those women with unrecognised breast cancer.
Studies have been carried out abroad which suggest that well organised screening programmes can reduce deaths from breast cancer in women aged 50 years and over by 25 to 30 per cent among the screened population. It must be said, however, that medical opinion is divded on the value of mammography as a mass population screening tool and some doctors consider it to be ineffective.
It is important to mention also that mammography screening programmes tend to be directed at women aged between 50 to 65 years. Mammography screening programmes are not effective in reducing mortality in younger women and older women have proved reluctant to come forward for screening.
As a first step, it is essential to establish whether a reduction in the incidence of breast cancer can be achieved in Ireland.
For these reasons, my Department is supporting a major mammographic breast screening programme currently underway at the Mater foundation. This programme, the Eccles Breast Screening Programme, is part of a network of seven pilot schemes on breast cancer screening being carried out within the European Community. The programme is being carried out in a defined catchment area, North Dublin and Cavan/Monaghan, and this catchment area represents both urban and rural populations. All women in the catchment area aged between 50 and 64 years are eligible to attend and will be included in two rounds of screening. Written invitations suggesting a date for screening were issued and these were followed with a second invitation in cases where there was no response. The age group to be screened complies with EC criteria. The objectives of the study are: to evaluate the impact of mammography screening on mortality from breast cancer among Irish women; to document compliance with a breast screening programme in Irish women and to compare the specificity, sensitivity and predictive value of mammography screening with that reported internationally.
The programme is expected to conclude towards the end of next year. The Eccles Breast Screening Programme is the first study of its kind undertaken in this country and, as indicated in the Programme for Economic and Social Progress, decisions on national policy will be based on the conclusions of that survey.
I welcome any research being carried out in the area of breast cancer but will the Minister not agree that while this research is being carried out, Irish women are dying? By the end of next year over 660 Irish women will have been killed by breast cancer. It is simply not good enough to wait for the results of research — and I accept the Minister's point about the younger women — when quite clearly, looking at the 50 to 69 age group, the arguments for mammography and for a national breast cancer screening programme are irrefutable. We are one of the few European countries without a screening programme, certainly within the EC, and we have the highest mortality rate in Europe from this disease. From the responses of women who are concerned about the effect this is having on their peer group, I would have thought the Minister would be taking a far more pro-active role in relation to the whole question of screening. If we are to wait another 12 months——
I want to assist the Deputy elicit information but she must proceed by way of question.
I accept that, a Cheann Comhairle, but I feel very strongly about this issue. Will the Minister not accept that Irish women cannot wait for the results of this research when there is so much research and evidence already available that lives can be saved now if a national screening programme is introduced? It could quite easily be introduced in Ireland now rather than waiting on the results of the research.
That is a very long question.
I share the Deputy's concern about the incidence of breast cancer in Ireland. It is obviously a worrying factor and it is an issue that I have asked my Department to examine. However, the Deputy is wrong to suggest that we are out of step with the rest of the European Union. There are only two organised national mammography screening programmes within the European Union, In the United Kingdom and the Netherlands. All the other countries are evaluating, as we are. In fact, the regional pilot study to which I alluded in my initial reply is part of a Community-wide analysis of the effectiveness of screening. Seven of our EC partners are joining with us in evaluating the effects of screening. The UK and the Netherlands have established a national screening programme and while the indications from the United Kingdom, for example, are hopeful, my officials and the professionals in the World Health Organisation have indicated that it is too early to say that the UK national screening programme will have a significant impact on reducing mortality. I want to see the data for Ireland and I want to devise a programme that will be appropriate to the Irish context and will have the impact that we all require in reducing mortality rates from what is a very worrying disease.
A very brief question from Deputy McManus. The time for dealing with Priority Questions is quite exhausted.
My understanding is that while Scandinavian countries may not undertake breast screening on a national level in the same way as is done in the United Kingdom, certainly they have used mammography to reduce levels of breast cancer. Would the Minister not accept that the position here cannot be allowed continue until this research has been evaluated? Would he agree that our facilities are overloaded, that, for example if one goes to St. Vincent's Clinic one may find 120 to 130 women attending a morning clinic that is held once a week, that the clinic is very often under staffed and that, as the figures indicate, the services for women at risk at these clinics is inadequate to meet requirements? Would the Minister agree also that we do not need to have a register compiled to tell us that 660 women die annually from breast cancer, a statistic which indicates the necessity for urgent attention and a proactive response on his part? Would the Minister not agree that we have the highest mortality rate within Europe, a matter requiring immediate action, rather than simply viewing it as a general European phenomenon? Would he not agree, too that this is peculiar to Ireland in that we have a particularly high level of incidence of the disease as a result of which Irish women are dying?
I do not accept that breast cancer is unique in Ireland——
The high level is.
——and we can learn a good deal from research and programmes in existence elsewhere. The fact that we identify a problem does not mean that we must jump at the first solution offered. If I am to put a national screening programme in place I want to be convinced in the first instance that it will have the impact we all desire, that of reducing mortality. I am awaiting the concrete results of the initiatives already in place to determine the value of screening. I must refute the suggestion that facilities here are totally inadequate to protect women's health. This is an area that receives particular focus within the national health strategy. Indeed I hope to see an improvement in the already reasonable facilities obtaining.
