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Dáil Éireann debate -
Wednesday, 4 Apr 2001

Vol. 534 No. 1

Priority Questions. - Cancer Screening Programme.

Gay Mitchell

Question:

32 Mr. G. Mitchell asked the Minister for Health and Children when he will ensure that a breast screening programme will be available for all women between the ages of 50 and 64. [10008/01]

The Deputy will be aware that in March 1997 the then Minister announced the introduction of a major action plan to implement the proposals contained in the National Cancer Strategy. Included in the plan were proposals for the introduction on a phased basis of a national breast screening programme.

BreastCheck, the national breast screening programme, commenced in February 2000. Phase one of the programme covers the Eastern Regional Health Authority Area, the North Eastern and Midland Health Boards areas. Special legislation was passed allowing BreastCheck to collate a register of eligible women and screening will be offered to well women, who have no symptoms, in a systematic way so that all eligible women can be screened routinely every two years. If a woman has symptoms she should consult her general practitioner. BreastCheck is strongly committed to reaching all women in the target age group 50 to 64 years as quickly as the campaign allows.

The decision to proceed on a phased basis is a reflection of the complexities involved in the screening process and my Department's key objective is to ensure that the Irish programme meets the necessary quality assurance criteria. It is for this reason that the Irish national breast screening programme must be driven by inter national quality assurance standards and best practice.

Specifically the phasing will take account of the following critical success factors: 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.

The service is being delivered by two central units, the Eccles Unit on the Mater Hospital campus and the Merrion Unit on St. Vincent's Hospital campus, with outreach to the community by means of three mobile clinics. The Eccles Unit is now fully commissioned and screening commenced there in February 2000. Limited screening is also in progress in St. Vincent's Hospital pending the construction of the new Merrion Unit. In addition, the first mobile screening commenced on 21 August 2000 in Longford.

Decisions in relation to subsequent phases of the programme will be guided by the experience gained from putting phase one of the programme in place. Phase two will involve the extension of the programme to the rest of the country. The steering committee has recommended that phase two of the programme should follow phase one as soon as is practicable.

I thank the Minister for his reply. Is the Minister aware that breast screening refers to the investigation by mammography of women who have no symptoms, that is, those who believe themselves to be free of disease, whereas symptomatic patients are women who have a breast complaint and fear they may have cancer? Does the Minister agree that a high quality screening programme should be matched by equally high quality arrangements for women with symptomatic breast disease? It is now 12 months since the report on symptomatic breast services was submitted. Some 13 specialist breast units were recommended, as the Minister has stated. Will the Minister indicate where these units will be, whether the locations have been specified and whether the hospitals have been informed and the resources allocated? If not, when will the announcement be made and funding be made available?

Is the Minister aware of recently published Danish research which suggests that for women between 30 and 50 years of age, breast cancer has a 50% higher prevalence among those who do night work? Has the Minister's attention been drawn to that research? Does he or his Department have any comment on it?

The question relates to the extension of the breast screening programme nation wide and to all women between the ages of 50 and 64 years. One of the reasons it has been introduced on a phased basis is the one put forward by the Deputy. It is essential that as one rolls out a national breast screening programme, that one has the follow up services for those who will be found to have symptoms of breast cancer and so forth. The back up facilities have to be put in place and the necessary protocols have to be adhered to in terms of the waiting times from the screening process right up to treatment and so on. That is why phase one covers the three health board areas and phase two follows on.

In terms of symptomatic breast disease, my predecessor, Deputy Cowen, asked the National Cancer Forum to bring forward a report on that, which it did. It sent it to me early last year and I appointed Niall O'Higgins to oversee the implementation of that across the country. In the Estimates announced before Christmas, I allocated more than £4 million to six health agencies to allow the commencement of the development of centres. I can give all the details to the Deputy, as I did at the time – it was a matter of public record. In terms of the areas, there are two in Dublin, one in the west, one in the south west, one in the south east and one in the midlands. We made allocations to those health boards which, to a certain extent, had their plans in place and were ready to absorb the funding in 2001. We envisage rolling out the other seven in the context of the Estimates for 2002.

There was a great deal of local angst in some areas about the subgroup's recommendations and so on. We have managed to convince many people of the efficacy of the process, of the importance of getting state of the art centres in every region and that the concentration should be on outcomes as opposed to geographic location. We are making progress on that front.

I take it the Minister has no information on night work and breast cancer. Perhaps he might communicate with me separately on that. Does he agree that to achieve and maintain standards, it is essential that an audit system is put in place? The report recommended that one of the specialist breast units be designated a reference unit to co-ordinate the audit of a specialist breast unit. Does the Minister agree that St. Vincent's Hospital, in which the first breast clinic in the country was established more than 20 years ago—

Time has expired. We must proceed to the next question.

I have sanctioned that unit. I have given the go-ahead at St. Vincent's Hospital.

The entire process is very unsatisfactory.

In accordance with Standing Orders I call Question No. 33.

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