Vol. 457 No. 4
12 Mrs. Geoghegan-Quinn asked the Minister for Health the basis used by him to decide on the extension to the breast cancer screening programme for women; the reasons for the particular areas chosen; and if he will make a statement on the matter. [15624/95]
37 Kathleen Lynch asked the Minister for Health the criteria used when selecting the areas to be included in phase 1 of the breast screening campaign; whether the areas selected for phase 1 reflect the areas of greatest need; and if he will make a statement on the matter. [15491/95]
52 Miss Quill asked the Minister for Health the steps, if any, he proposes to take to ensure the success of the national breast screening programme recently introduced on a phased basis; and if he will make a statement on the matter. [15503/95]
87 Ms O'Donnell asked the Minister for Health when a start date will be given for the national breast screening programme at the Mater Hospital, Dublin, in view of the fact that a pledge has been made to set up this programme; the number of women who will be screened this year; and the cost involved; and if he will make a statement on the matter. [15892/95]
(Limerick East): The programme A Government of Renewal contains a commitment to expand the Eccles pilot breast screening programme on a phased basis. However, it was necessary to await the independent evaluation of the report from the Eccles programme on the epidemiological aspects of breast cancer screening. That evaluation report supports the introduction of a breast screening service, subject to the establishment of a population register. I was pleased, therefore, to be in a position to formally announce the phased expansion of the programme at the launch of Europe Against Cancer Week on Friday, 6 October 1995.
The decision to proceed on a phased basis is guided by the need for the achievement of acceptable compliance levels among the target population; ongoing evaluation of the programme from a quality assurance perspective; and availability of the necessary clinical expertise to conduct the programme. It is my intention to ensure that the phased introduction of the breast screening programme takes cognisance of these critical success factors.
As Deputies will be aware, there is an international debate surrounding the efficacy of the breast screening programmes. The debate centres on a number of key issues including: the impact on mortality of breast screening programmes; the concerns associated with false positive and false negative results; and the cost effectiveness of the breast screening programmes. I am confident that the phased introduction as I already outlined will address these concerns.
The question of whether the introduction of a national breast screening programme will impact significantly on mortality levels cannot be answered in the short-term. However, the evidence from international clincial trials suggests that reductions can be achieved through breast screening. For now, the emphasis must be on putting in place a programme which achieves the highest standards of quality at all levels. The staging of the programme will be related to the achievement of performance targets in line with these quality measures.
It is my intention that the first phase of the programme will commence as soon as possible and will cover the Eastern, North Eastern and Midland Health Board areas. It will target 120,000 women in the age cohort 50 to 64 which represents 50 per cent of the national target population.
The Eccles pilot breast screening programme has been recognised by the European Network of Reference Centres for Breast Cancer Screening as a centre of excellence. The decision to include the Eastern, Midland and North Eastern Health Board areas in phase 1 was based, primarily, on the need to draw on the clinical expertise which has been built up in the Eccles programme.
Officers of my Department will shortly be meeting the director and senior staff of the Eccles pilot programme to agree a detailed work programme, costings, management and evaluation arrangements for this phase. The development of a comprehensive population register will be an essential step in this programme.
The Minister referred to "acceptable compliance levels" among the national target population. What would be consider an acceptable compliance level? Will he state whether the necessary clinical expertise to conduct the programme is available in each of the three health board areas chosen and what organisational structures have been put in place?
(Limerick East): Approximately 75 per cent would be recognised as an adequate compliance level. This figure was achieved in the pilot scheme. Expertise is now available in the Mater Hospital as a result of the Eccles pilot breast screening programme which covered the Dublin and north east areas in the first instance. This pool of expertise will be availed of in screening 120,000 women in the age cohort 50-64 which represents half the national target population. On the question of structures, it will work from the Eccles programme in the Mater Hospital and have the co-operation of the three health boards concerned.
It will involve both mobile and static units but the detail of that is now being worked out between officials of my Department and the people who are running the programme in co-operation with the health boards. They have been given the go ahead to proceed immediately. We have the finances in place and the programme will work through 1996.
In looking at the areas into which we could extend, it was a question of ensuring that a proper programme would be put in place. It would be easy to announce a national screening programme and get some kind of political kudos for doing so but I was fearful, on account of international experience and what we have learned here on the pilot programme, that if we did not get a sufficient compliance rate, if we could not get sufficient standardisation to ensure quality and if we could not rule out false positives and false negatives in so far as we can through having the proper expertise, we could spend a lot of money on an ineffective programme and raise false hopes among the target population that we were doing something effective when, in fact, we were not. I am sure the Deputy is aware of the conflicting views in this debate internationally. Taking all things into account, it was proper for me to move prudently on a standardised high-quality basis rather than opting for a national scheme in the first instance.
The Minister has, on a number of occasions, taken the opportunity to pay tribute to the work being done in the National Breast Cancer Research Institute located at University College Hospital, Galway, and I am not being parochial when I mention that institute. It is the only one of its kind in the country. Would the Minister accept that an enormous amount of clinical and medical expertise has been built up, both within the institute and within the hospital, where the institution has been located and how soon will he be in a position to extend the screening programme to such an institute? Obviously, the Minister would not have any concerns in that instance in relation to a proper programme being put in place, as he puts it. Second, how soon realistically does the Minister expect to have nationwide availability to breast cancer screening?
(Limerick East): Some of those questions I can answer and some I cannot. First, I know the Deputy is not being parochial because we all must look at this Question in the national context. From a parochial or constituency perspective, it would have suited me to have this programme in the Mid-Western Health Board functional area as, indeed, it would have suited the Deputy to have it in the Western Health board area. In looking at the evidence which was presented to me, it was absolutely persuasive that the way to proceed was to develop the screening programme in the area where the pilot programme was operating and we included half the target population.
Yes, there is a pool of expertise in Galway. There is a pool of expertise available in Cork, too, where the national cancer database operates at the moment. I hope, in the context of the report on cancer services in the country which will be available to me shortly, I will have more to say about what expertise is available.
In terms of a screening programme, the expertise which had actually worked a screening programme for a targeted population was attached to the Mater Hospital project, and it is no reflection on the quality of expertise available around the country that we would allow them to continue the work they started. I am not sure yet as to the phasing in of the scheme because the outcome of anything we do in the health service from now on must be measured as well as undertaking the service. If the results are good as we go through 1996 and 1997, I would hope, some time in early 1997 to be in a position to announce further extensions. In terms of the target population rather than the geography, 50 per cent of the national target population is being taken in now. If we were to extend it, for example, to the Western Health Board and the North-Western Health Board and, let us say, that part of the Mid-Western Health Board which is north of the Shannon, I think we would take in about one third of the remainder. I think the number is about 41,000 but I can check that figure for the Deputy. There would be in the neighbourhood of 80,000 in the rest of Munster, let us say, the Southern Health Board and the Limerick-Tipperary part of the Mid-Western Health Board. It might be possible to do the next 50 per cent together. At the moment, the people who are organising the programme are looking at an extension in two tranches along the lines I have indicated.
