Breast Cancer Awareness Month: Statements

I am pleased to mark breast cancer awareness month and to discuss this important topic. At the outset, I wish to acknowledge the great commitment of those working in cancer services in hospitals, screening services, community services and the charitable and voluntary sectors. This has enabled the continued provision of quality care to individuals during the Covid-19 pandemic and following the cyberattack in May.

Cancer prevention is a cornerstone of the National Cancer Strategy 2017-2026. Prevention aims to improve the overall health of our population and offers the most cost-effective, long-term approach for cancer control. The proportion of the incidence of cancer attributable to modifiable lifestyles and environmental factors is estimated to be in the 30% to 40% range. Modifiable lifestyles or environmental risks exist for many cancers. Of these, smoking is the most important. Others include excess body weight, physical inactivity, alcohol consumption and sun exposure.

Prevention measures are promoted by the Government as part of the overall health and well-being initiatives under the Healthy Ireland programme. Initiatives such as breast cancer awareness month bring a renewed and targeted emphasis on prevention. It presents opportunities for us all to promote breast awareness and spurs us on in our efforts to promote the message across the population that people can impact significantly on their own risk of developing cancer.

Breast cancer is the most commonly diagnosed invasive cancer among women in Ireland. It affects approximately 3,500 women every year as well as a very small number of men. Breast cancer is the second leading cause of cancer deaths among women in Ireland. However, survival rates are improving significantly. The latest breast cancer statistics from the National Cancer Registry show that five-year net survival for breast cancer patients improved from an average of 70% for a diagnosis in the period 1994 to 1999, to 85% in 2011 to 2015. This represents an approximate halving of the five-year mortality risk over that time. As these figures predate the introduction of the current national cancer strategy and the improvements made in recent years, it is expected that the next set of figures will show a further substantial improvement.

The vision of Ireland's national cancer strategy is that we will strive together to prevent cancer and work to improve the treatment, health and well-being, and experiences and outcomes of those living with and beyond cancer. It is about preventing cancer across our population, diagnosing it early, providing optimal care to people and maximising their quality of life.

Each year, approximately one third of all breast cancers diagnosed in Ireland are detected through BreastCheck. I am happy to report that routine screening appointments in BreastCheck are returning to normal despite the impact of Covid-19 and the recent cyberattack. Approximately 86,000 women were screened between January and September of this year. Unfortunately, due to nearly a year of screening time being lost because of the impact of Covid-19, it will take longer to get through the current screening round, that is, approximately three years when it normally takes two. However, this is still within international norms, as Ireland screens more frequently than many other countries. People who have been waiting the longest will generally be invited first. The National Screening Service is working hard to return breast screening to two-year screening and to doing so in a safe manner. It should be noted that, even when screening was paused, the programme continued to operate follow-up clinics, providing support to the symptomatic breast cancer services.

Additional funding of €10 million was provided for cancer screening in 2021. This is helping to increase capacity. This investment includes two new mobile screening units for BreastCheck, located in Donegal and Dublin, with a third mobile unit coming on stream in 2022. In line with commitments in the programme for Government, BreastCheck is currently implementing an age extension project that will see all women between 50 and 69 years of age being invited for routine breast screening. As with all of our national screening services, BreastCheck delivers its services in line with international criteria for population-based screening programmes that are kept under constant review.

As part of breast cancer awareness month, the National Screening Service and the HSE have launched an extensive national media campaign to highlight key details about symptom awareness, breast cancer prevention and screening during Covid-19. BreastCheck provides a great deal of information on its website, breastcheck.ie. This includes educational materials to encourage people to be aware of general breast health and information on the common symptoms for which they should seek medical advice.

All individuals are encouraged to attend for their BreastCheck appointments when they are called. Sometimes, people may be a little apprehensive or put it off for whatever reason, but it is important that they take up their appointments when they are offered. Early intervention is key.

BreastCheck has launched a campaign that aims to inform the public about any delay in appointments and to highlight the Covid-19 protective measures that are in place at screening locations. Before an appointment, a text message from BreastCheck is sent to confirm the appointment details. In this way, someone can rearrange an appointment if necessary and BreastCheck can offer the initial appointment to another person in the community.

Diagnosing cancer at its earliest possible stage is a critical first step in achieving higher survival rates, reducing treatment severity and improving patients' quality of life.

Patients who recognise suspicious symptoms and seek early medical intervention are generally more likely to have less advanced disease, less severe treatment and better outcomes. When cancers are diagnosed at stages 1 and 2, longer-term survival prospects are considerably better than for patients diagnosed at stages 3 and 4 of the disease. The five-year survival rate is 94% for people diagnosed with stage 1 disease and 19% for people diagnosed at stage 4.

Each of the eight designated cancer centres in the State has a symptomatic breast disease clinic, with a ninth clinic operating in Letterkenny University Hospital as a satellite of the service in University Hospital Galway. Approximately 42,000 new patients attend these clinics every year, having been referred by their GP. Between January and September this year, GP e-referrals for breast cancer were at 130% of the 2019, pre-Covid, rate.

The national cancer control programme continues to monitor closely trends in numbers coming forward to diagnostic services and the level of attendances for appointments for treatment, with a particular focus on urgent cases. The total number of new patients seen across symptomatic breast disease clinics between January and August 2021 was 98% of the figure for the corresponding period in 2019. Patients are triaged as urgent and non-urgent. Attendances at urgent symptomatic breast disease clinics from January to August 2021 were at 115% of 2019 levels, while attendances at non-urgent clinics were at 82% of 2019 levels. Furthermore, the total number of new cancers diagnosed in symptomatic breast disease clinics from January to August 2021 was 104.6% of figure for the corresponding period in 2019. All the statistics, as we can see, are going in one direction.

The national cancer control programme is currently developing a model of care for hereditary cancer, covering the identification and assessment of those with possible hereditary cancer risk, referral for counselling and testing when indicated, and co-ordinated surveillance when required. Increased staffing has been provided to the hereditary cancer service in St. James's Hospital, including a consultant in cancer genetics. In November last year, the hospital commenced a trial of a remote genetics testing provider, with the aim of improving turnaround times for testing during the Covid-19 period.

As previously indicated, breast cancer has very good survival rates. In fact, people with a diagnosis of breast cancer account for almost a quarter of all those living with and beyond cancer in Ireland. An extra €1.91 million is being used this year to continue the development of survivorship services, including psycho-oncology services, to improve the quality of life of those living with and beyond cancer. An additional €20 million was allocated for the continued implementation of the national cancer strategy this year, with €1.8 million allocated specifically for breast cancer services. This funding will drive improvements across all stages of the cancer continuum. In addition, there is funding of €12 million for the restoration of cancer services to 95% of 2019, pre-Covid, levels. This funding is being used to support hospitals in addressing backlogs, extending clinic times, providing additional clinics, increasing diagnostic capacity and providing locum and temporary support. I am delighted that the commitment of the Government to the implementation of the national cancer strategy is further emphasised by the allocation of an additional €20 million in budget 2022.

I take this opportunity, in breast cancer awareness month, to encourage people to attend for their BreastCheck appointments. If anybody, of any age, has concerns about cancer, I urge them to go to their GP, who will arrange appropriate follow-up care. As somebody who was called for a BreastCheck appointment a couple of years ago when I turned 50, I was apprehensive going for my first scan. We are all conscious of undressing in front of healthcare staff, but I was met by a lovely nurse. It is very important to go for the scan and it is such a relief when you get the results. Of course, some people do not get the result they want but, fortunately, early intervention is key. We all have friends and relatives who have had results that were not as good as they should have been but who have been able to get the treatment they need. I encourage everyone to go to screening appointments. I know all my colleagues in the House will encourage anyone who receives a BreastCheck appointment to go and have the check done. It only takes a few minutes and people will be glad when they have it over and done with.

The message I really want to give today is that our cancer diagnostic and treatment services are open and our healthcare staff will provide people with the care they need. I give way to my colleague, Deputy Murnane O'Connor, for the few minutes remaining in this slot.

I thank the Minister of State for sharing time. Every October, we receive a wealth of information about breast cancer, with people dressed in pink engaged in fundraising and celebrities speaking about their breast cancer experience, but we still see women arriving at clinics not knowing much at all about the disease. One in seven women in Ireland will be diagnosed with breast cancer. Due to Covid-19 measures, the screening programme is nearly a year behind. This is a devastating situation and we must do something about it. I welcome the Minister of State's commitment in this area, against the background of the major disruption that has taken place during the Covid crisis.

Awareness surrounding breast cancer is incredibly important because early detection, often through screening, can catch the disease when it is most treatable. If that early screening is not available, we have a massive problem. Breast cancer is the third most common cancer in Ireland. Sadly, between 2015 and 2017, an average of 719 women and five men died of breast cancer in this country. In terms of survival, National Cancer Registry data show that the probability of women diagnosed with breast cancer surviving for five years was more than 82% in the period from 2010 to 2014. International comparisons show Ireland has improved its ranking over time in terms of survival rates for a number of cancers but, as I understand it, this is not so much the case for breast cancer.

BreastCheck, the screening programme for breast cancer, is only open to women aged 50 to 69. Every year, approximately one third of all breast cancer cases diagnosed are detected through the programme. The onset of the Covid-19 pandemic resulted in invitations for BreastCheck screening being suspended in March 2020. While all symptomatic breast disease clinics remained open and accepted referrals, they are operating with a reduced capacity. BreastCheck services resumed in October 2020 with reduced capacity due to Covid measures and there was a 69.6% reduction against expected activity. Fewer mammograms have been carried out in 2021 than would otherwise be the case. This is a concern, but I am delighted the Minister of State has given a commitment on funding, which will, we hope, see a return to a situation where as many mammograms as possible are carried out.

The national screening service has highlighted that we have lost nearly a year of screening, which I know the Minister of State has undertaken to rectify. We must enhance the BreastCheck service and encourage patients who have been afraid to ask about worrying symptoms to come forward for screening at a symptomatic breast disease clinic. In June this year, representatives of the Irish Medical Organisation, IMO, told the Joint Oireachtas Committee on Health that there is a growing backlog of patients waiting for urgent, time-critical diagnosis services and treatment services while, for reasons connected to the pandemic, life-saving screening services are falling below the annual targets. The full impact of the Covid-19 crisis on cancer care may be years away but we can do something now. We can increase investment in this area, which will enable us to have a meaningful awareness discussion.

I am one of the women aged over 50 who has been screened for breast cancer under the BreastCheck programme. It is a relief to be checked and it is important that all eligible persons who are called for screening avail of it. As the Minister of State said, there is always a fear around going for the scan. Like her, I encourage everyone who is called for BreastCheck screening to attend. In the long term, early intervention is key.

We are nearing the end of October, which is breast cancer awareness month. Breast cancer is one of the most common cancers in women, with almost 3,500 women diagnosed every year in Ireland. It is important to highlight, as the Minister of State has done, that men can also be affected by breast cancer.

Being breast aware and understanding how to check your breasts effectively each month is crucial to spotting the early signs of cancer. Thanks to the work done to increase awareness of the early signs and symptoms, as well as improved treatment options, breast cancer now has a five-year survival rate of 83%. It is a disgrace, however, that most of this work is carried out by charities, which have to fundraise for the majority of their income because of the failure of Government to provide vital services.

There are currently almost 28,000 women in Ireland who have survived breast cancer. Since 1987 the number of women who have died from breast cancer has decreased by almost one third and in women under 50 it has dropped by almost a half. That is very good news and we are all delighted by it. However, despite clinical advances, breast cancer stories are still often rooted in the diagnosis and treatment of the disease. Much of the ground that had been gained pre-Covid has now been lost. Fewer than 100,000 people were checked under the State's three cancer screening programmes in the first half of last year due to Covid-19 restrictions. This compares 500,000 people who were screened in 2019 and suggests that we are significantly behind in our screening for bowel, cervical and breast cancers. Covid-19 has had a significant and negative impact on cancer services, causing many patients to present late or avoid appointments. Screening services were down for much of the pandemic and missed annual targets by 44% to 70% while chemotherapy and radiotherapy services operated at 80% to 90% of 2019 levels. It is difficult to know how many people did not present to GPs in 2020 when they should have but it is estimated from surveys to be anywhere from 15% to 25%. We need a massive screening catch-up programme. Early diagnosis is crucial to a better outcome and everyone who is diagnosed with cancer should be given a medical card.

A lady came to my office last month who had found a lump. She was told she would have to wait for up to four months to have it removed. Luckily she was referred to a plastic surgeon and was told she would only have to wait for six weeks. Imagine the worry and the sleepless nights she suffered, trying to keep her household going while coping with such a diagnosis. On top of this, she fell through the cracks because of a communication issue between her consultants. It was not until I wrote to the Minister of State, Deputy Butler, that the fire was put under everyone and everything was sorted. Her operation was carried out this week. I would like to wish her well and to thank the Minister of State for her intervention. However, people with cancer should not have to contact their local Deputy, who follows their case up with a Minister of State at the Department of Health, in order to get the treatment that they really need.

The system is broken and it is an absolute disgrace, in a modern democracy, that we have such a broken system. Urgent investment is needed in cancer screening, diagnostics and treatment to catch up on delayed and missed diagnoses. Sinn Féin in government will step up investment in the National Cancer Strategy by €20 million to provide funding support for cancer prevention and early diagnosis, surgical and medical oncology, physiotherapy oncology, rapid access clinics, radiotherapy, survivorship and investment in genetics research, diagnostics and treatments. We will also invest a further €10 million in cancer screening services which are currently operating at full capacity. They cannot catch up on missed screenings over the last 18 months without additional capacity. Oncology consultant posts must be prioritised when filling the 600 new consultant posts funded in the last budget. It is about time the Government gave this issue the funding and attention it deserves. Lives depend on it. Like the Minister of State, I am in my 50s and have attended BreastCheck clinics a few times and it is vital that we encourage everyone to do that.

For the last few years I have requested Cavan County Council to light the courthouse in pink for the month of October to highlight breast cancer awareness. The council has always obliged and I am thankful it for that. It was not my initiative but that of a woman with stage-four breast cancer. She is an excellent advocate for breast cancer awareness and is very focused on making women aware of the signs of breast cancer and of the importance of checking their breasts regularly. She has spent years undergoing treatment and is still doing so but is always good humoured, positive and thinking of others. I want to pay tribute to her for all the work that she does.

She has also advocated for the extension of BreastCheck and feels strongly that it should be expanded to those aged 40 and over. She points out that if this had been the case, she would have been diagnosed earlier and would not have had to go through all of the treatment she has endured. There are also potentially major savings to the State from early diagnoses and I hope that additional investment in screening programmes will be provided. Women must be screened and if the HSE is not willing to provide mammograms, it could provide ultrasounds which can be just as effective. From the age of 40 onwards hormonal changes are happening in the body and it vitally important that women are screened while these changes are happening. A high volume of breast cancer cases are estrogen driven and a mammogram will pick this up. For women aged 25 to 40, an ultrasound is effective and non-invasive. For women over 69, an ultrasound can pick up changes in the breast tissue. According to Breast Cancer Ireland nearly one quarter or 23% of women diagnosed with breast cancer are between the ages of 20 and 50 while approximately 36% of women diagnosed with breast cancer are over the age of 70. In that context, all women need to be checked and screened regularly. GPs could play a bigger role in this area. Some GPs, no matter what one attends for, will offer to do a breast check. It would be good for all GPs to consider doing that if possible.

I am also concerned about a potentially high number of undiagnosed cases due to BreastCheck being suspended during Covid. It is alarming that disruptions to cancer screening programmes caused by the pandemic may lead to people presenting for treatment at much later stages of the disease. A year has been lost as a result of Covid-19 and that will take years to address. The pandemic and the HSE cyberattack have both had a negative impact on screening and, indeed, are still having an impact. That said, capacity issues have existed for a number of years so it is not accurate to blame all delays on Covid or the cyberattack.

A major effort must be made to make screening accessible to all women. I have spoken to many disabled women who often find that when they present for screening they cannot be accommodated and have to wait for another appointment. Nobody should have to wait. There is also concern about the lack of medical oncologists. I understand that there are only 41 such specialists when it is estimated that 100 will be needed by 2028. There are also shortages of radiation and surgical oncologists and haematologists. Serious efforts must be made to address this problem.

I also wish to acknowledge that breast cancer is not just a women's problem. Men are also affected, with one in every 200 cases of breast cancer in a man. This form of cancer can effect one in 1,000 men. I understand that cannabis use is a common cause of breast cancer in men and awareness of this must be increased.

October is breast awareness month. This is a very positive initiative in terms of promoting awareness and ensuring that everybody is breast aware. Early detection is absolutely vital when it comes to breast cancer because it saves lives. It is very important that everybody knows how and how often to check their breasts, what changes to look out for and what to do if one notices a change. In 2020, 3,704 cases of breast cancer were diagnosed in Ireland. Breast cancer is the most common invasive cancer in women. One in seven women in Ireland will receive a breast cancer diagnosis in their lifetime. On a more positive note, the mortality rate has fallen by 2% each year between 1994 and 2016. Behind every case number is a woman, or in rarer cases, a man, their family, friends and community. Prevention strategies around looking after our general health and early detection through self-checks and screening are vital. We must invest in preventative healthcare, awareness, early diagnosis, screening, community supports and treatment services.

Sinn Féin recently launched a health policy document in which we pledged an additional €20 million for the National Cancer Strategy to ensure continued improvements in cancer prevention, diagnosis and treatment. We also pledged an additional €22 million for cancer screening services to improve access and capacity. Screening is absolutely central to responding to breast cancer. Earlier this week the Oireachtas Joint Committee on Health heard that cancer services are facing significant challenges arising from the pandemic, the HSE cyberattack in May and historic capacity issues which were flagged as far back as 2018. The committee also heard that there is anecdotal evidence that people are presenting in the more advanced stages of the disease as a result. While screening rates are back to pre-pandemic levels, the fact remains that restrictions had a devastating effect on screening services, with Professor Fidelma Flanagan, lead clinical director for BreastCheck, saying that the service lost a year and that it will take years to recover.

We need to consider expanding the ages at which we screen.

At the moment, only women aged between 50 and 69 undergo screening, as this is when women are at the highest risk of developing breast cancer. The cases reported for women under 50 and over the age of 69 are lower than for those in the screening age group but they are still significant. We need to be mindful of breast cancer at different stages of life and we need to review the screening ages in line with the incidence rate.

At a meeting of the Joint Committee on Health this week, Professor Fidelma Flanagan said that because cancer incidence is low in the under-45 age group screening is not advised but that BreastCheck is considering expanding screening to those aged under 50 and over 70. I hope this can be done and the Government invests in the service to allow it to happen.

In other European countries, the approach to preventative care involves people being given an appointment for a breast check and other vital check-ups. Anyone who does not attend a first appointment receives a second appointment notice in the post and failure to attend that appointment means a third appointment must be paid for. This acts as an incentive to avail of preventative measures from an early age.

Long before Covid 19, crucial targets in the national cancer strategy were missed relating to timely access to diagnostics, surgery, radiotherapy and screening. We are in the middle of the State's third national cancer strategy and services are still under-resourced, including breast cancer services.

This month, as it is breast cancer awareness month, it would have been prudent, moral and entirely possible to announce a budget allocation for the restoration of many cancer services, including expenditure ring-fenced for additional screening to ease the anxiety experienced by so many women over the past 19 months. However, the budget did not do that. The Irish Cancer Society's justified ask of €45 million was abjectly ignored and just €30 million in additional funding was given. This is not just for the national cancer strategy but is to be spread across the development of myriad national health strategies. This is massively missing the mark. Sinn Féin's alternative budget would have allocated €42 million directly for cancer services. Early detection is indisputably important, as is timely access to treatment.

At a meeting of the Joint Committee on Health this week, BreastCheck representatives told us that screening was back on track. A quick visit to the commentary under BreastCheck social media posts shows dozens upon dozens of testimonies from women who are not so confident in the resumption of services. They include a testimony from a woman who has been waiting for seven months, having been referred by a GP after presenting symptomatically. Women are feeling ignored and dejected, and are frustrated by the situation.

I will mention one woman in particular in Clare. Ms Margaret O'Connor has been brave and patient and has ultimately been let down by the handling of screening services. I have submitted parliamentary questions on her behalf to try to get some form of accountability about how this situation has arisen. Ms O'Connor does not understand why she was not informed that screening had stopped. She has attended her mammogram every year. However, the service just stopped and she did not have access to a mammogram for 18 months. Worse still, she was not notified, there was no consultation or communication and no information was inputted on the website. Ms O'Connor would have gone for a private screening but instead was left in the dark battling rising anxiety. She knew something was wrong and eventually, a ball of nerves, she went to her doctor. Unfortunately, she had aggressive breast cancer. By the time comprehensive screening took place, it had unfortunately spread to her lung and liver. Ms O'Connor has said that the last year of her life has been a living nightmare. The registry is currently 12 months behind, which means that if a woman has not had a screening over the Covid period, she may have to wait another year, which will be three years in total without screening. Investment now in upscaling early detection measures is far more economically viable, as well as being better for our people.

I thank the Whip for allowing this matter to be added to the clár this week. I am on the Business Committee but we all know who ultimately sorts out the schedule for the week, so I thank the Whip.

I welcome the opportunity to speak about and mark breast cancer awareness month. Unfortunately, breast cancer has touched the lives of many of us in this House and people throughout the country. It has had a devastating effect on lives and anything we can do, as the Parliament, to raise awareness is important. What is ever more important is that we use our powers as legislators to ensure that Ireland offers best-in-class healthcare, including access to screening and diagnosis.

While today we may focus on discussing the many issues women face in getting diagnosed and having treatment, we need to ensure that coming out of the pandemic we take another look at healthcare in the country. For too long, women’s health and well-being have come second in Irish healthcare. While breast cancer has had so much investment that outcomes are positive for many, we need to ensure equal access to good cancer care for anyone who gets the devastating news of a cancer diagnosis.

We know that early detection is vital in the battle against all cancers. Screening is an essential, and sometimes life-saving service. However, we need to ensure that our screening programmes are properly resourced. BreastCheck screenings fell by two thirds in 2020 due to the pandemic and we are told it could take up to three years to clear the backlog that has built up. The Government needs to commit to providing additional resources to clear this backlog and seek to reverse the recent extension of the screening interval to three years, bringing it back to the recommended two years. We need to make clear that this backlog does not involve people waiting for a statutory document, such as a driving licence or passport. These backlogs are about people's lives and ultimately a backlog like this that is not addressed speedily will end up with people becoming very ill and, unfortunately, dying. This is absolutely urgent and should be a priority.

Without routine screening there is a risk of delayed diagnosis for women. Women will have delayed diagnoses that could have been treated sooner. Women who will be diagnosed at a later date may need to have a more aggressive form of treatment because of the suspension of testing. We cannot have this happen and I urge the Government to consider investing in our BreastCheck capacity. It is of vital importance that, as we get our health services back and running, we ensure that what is preventable is prevented.

Breast examinations are highly important, as are mammograms. Many charities do extraordinary work in raising awareness about the signs and symptoms of breast cancer and encourage regular self-examination. However, the Government must do more to assure women that if they feel they may have symptoms, they will be treated in a quick and timely manner. I say this because of the very sad testimony of the late Sarah Harding who gave us her experience of discovering she had breast cancer. The world was left shocked earlier this year when the former Girls Aloud singer Sarah Harding died from breast cancer in September at only 39 years of age. In a newspaper interview before her death, she said that due to the pandemic she put off going to the doctor when she first suspected she had symptoms. We need to ensure that no woman ever feels this way. Sarah Harding's untimely death has shone a light on the importance of making women of all ages more breast aware and ensuring they all have access.

The Government should look at working with social media influencers on the signs and symptoms of breast cancer to encourage young women to attend their doctor if they are in any way concerned. The waiting lists these young women are likely to experience must be dealt with as an urgent priority. While younger women are less likely to be struck by breast cancer, we know that 23% of diagnoses occur in women under 50 years. This has been raised by previous speakers. In recognition of this, we should look to extend the BreastCheck service to younger women to encourage and embed a culture of prevention within our health service. We have seen from the free at the point of access operation of PCR testing across the country that if we provide services that can accommodate the numbers required and remove the financial barrier, more and more people are likely to avail of them. It gives people confidence and allows us to capture more cases within all age groups as early as possible.

I will touch an one other point today that has been raised by Alcohol Action Ireland which reiterated today that the provisions in the Alcohol Act 2018 would help to inform consumers of the link between alcohol and all cancers, including breast cancer. Alcohol is responsible for one in eight cases of breast cancer. Approximately 12% of all breast cancers, or 300 cases per year, are associated with alcohol consumption. We can come to the House and make statements but there is legislation that would directly impact these statistics. It has passed this House but has been left in limbo. Why can the Government not implement this legislation as soon as possible? What is holding us back from bringing it forward? We speak often in this House about projects and legislation that will have impacts years down the line but we have in this legislation something that can make a difference right now.

We have had far too many cases of poor treatment and poor service in women's healthcare in Ireland. We need to deliver progressive and proactive actions so that in years to come we do not look back and regret that when we had the opportunity to make real tangible change in healthcare for the women of Ireland, we did not deliver. If we continue in this vein, we will continue to have horrible stories of late detection and missed diagnoses, and we will have condemned another generation of Irish women to a service that falls far below par. Women across Ireland deserve so much better than what our health service has delivered for generations to date.

I am glad to have an opportunity to speak on this subject at this time because it serves to remind us all of the importance of early detection and treatment, and of the availability of the appropriate services.

I am not sure whether my colleague is returning. I had two minutes or something.

At this point, the Deputy has 11 minutes.

Well, I have been-----

I believe the Deputy will rise to the challenge.

We dealt with this subject in committee just two days ago. It was a timely visit to the subject. I compliment the Minister and Ministers of State on their work in this area, particularly at that this time and coming as it does in the wake of the difficulties with the reliability of screening and the reviews of screening that did not work out to the benefit of quite a number of women. In those circumstances, we have learned lessons. At least I hope we have.

One or two points come to mind. Almost invariably as public representatives, we get telephone calls from constituents who have sad tales of diagnosis to tell. It is an appalling time for a woman. It is a time when her breath is taken away by what lies ahead. That is why it is important, now more than ever and in the wake of Covid and what has transpired over screening, to have a dramatic response and to recognise that the women's cases are important, notwithstanding all the competing demands. In the eyes of those affected, the demand is the most serious they will face in their lifetimes. They know that. They feel talking to somebody is a help because the burden is shared. They are quite right.

Scientifically, we have learned a lot over the years. The medical world has learned a lot very quickly about Covid. There is a good case to be made for treating all forms of cancer, particularly breast cancer, in the same way as Covid because, to deal with threats of their magnitude, it will be necessary to concentrate on the necessary research as and from now. I have no doubt that if an adequate investment is made in the research, it will yield dividends in a short time. Again, this relates to Covid and the experience we had of it. One normally expects ten years to go by before a response of the kind made to Covid can be made, but that did not happen; there was a concentration, and it brought results. The same applies to breast cancer. It is timely to remind ourselves about the work being done and the experiences we have had, and also to recognise that, by the end of the second quarter next year, the health services will have caught up with the Covid backlog. I ask the Ministers to do everything they can to ensure there is no diminution of the struggle or battle against the disease in the intervening period.

My colleague has returned to the House. She might tell me when to stop.

Whenever the Deputy wants.

I will continue for a couple of minutes, with the permission of the Leas-Cheann Comhairle.

It is important that we mark this occasion. It is important that we learn from what has happened in the past. It is equally important that we spend money strategically and redouble our efforts to deal with the issue from here on in. We must encourage investment to deal with it.

Cancer care is being given by many in constituencies up and down the country. Very many of the services are voluntary. In some such cases, as in my constituency, volunteers have fallen victim to the disease, which makes it even more poignant. Notwithstanding their efforts to help others, they found they had become victims themselves.

I recognise the efforts the Minister and Ministers of State have made and with which they need to continue. They should try to ensure that as we face the problems associated with the usual winter illnesses, such as overcrowding in accident and emergency departments and hospital bed shortages, the BreastCheck system will not be allowed to falter or diminish in any way. The service should be delivered in such a way as to give the best possible results to the women who rely on it.

I thank Deputy Durkan for sharing time.

Members will have to bear with me because I am breathless. I ran across from a committee vote but I am really glad I made it because this is such an important topic to discuss. I am thankful for the opportunity.

The pandemic has posed many challenges in delivering breast cancer services. Receiving a diagnosis of breast cancer has to be one of the most unthinkable results but regrettably the pandemic, coupled with the HSE cyberattack, made detecting it and administering care and treatment even more difficult. I commend BreastCheck on the welcome news that it has returned to pre-pandemic levels of assessment but it is important to acknowledge just how difficult the past 18 months have been for those living with cancer. As we heard yesterday at the Oireachtas health committee, breast cancer remains the most common cancer among women in Ireland. It is the third most common cancer in Ireland after skin and prostate cancers. Sadly, one in seven women will be diagnosed with breast cancer in their lifetimes.

We are all aware that breast cancer also affects men. Some 37 men are diagnosed with breast cancer every year in Ireland. Last year there were 600 fewer breast cancer detections, but not for the right reasons. It was not because breast cancer rates are reducing but because there was less screening and detection because of Covid-19. That is really frightening when one thinks about it.

As we know, early detection and prevention are vital in the treatment of breast cancer. Amazingly, BreastCheck is responsible for a 9% reduction in mortality from breast cancer overall. That is why I welcome that screening services have now returned to normal.

Beyond healthcare, many of those currently going through treatment heavily rely on community networks and support groups to keep them going, both emotionally and mentally. I recently joined members of the Lucan Women's Network in Corkagh Park to mark breast cancer awareness month and raise funds for the Marie Keating Foundation. Lucan Women's Network is a superb local group supporting equally superb national organisations but unfortunately organisations such as the Marie Keating Foundation, the Irish Cancer Society and Breast Cancer Ireland have been devastated by the pandemic. They could not continue at the same capacity with their boots-on-the-ground fundraisers, such as Daffodil Day and the Great Pink Run, but just like many of the breast cancer patients they support, they showed their resilience. They ploughed on with virtual and socially distanced fundraisers. However, limited fundraising led to limited funding, and that means capacity has become limited also.

In budget 2022 an extra €20 million was earmarked for the national cancer strategy. While I am aware that this has been broadly welcomed by many cancer organisations and charities, I join the Irish Cancer Society's calls for clarity on the additional funding that will be made available to help to eliminate waiting lists for cancer services. As we heard at yesterday's health committee meeting, these waiting lists are the nub of the problem. They feature across much of the health service. Having a streamlined system for assessing and treating patients has to be of the utmost importance to all of us.

The personal financial cost of having breast cancer is not talked about enough. The Irish Cancer Society has conducted research into the financial impact of having cancer and has found it is twofold. The financial factors include additional costs and, in many cases, a reduction in income. Regarding the additional costs associated with having cancer, the Irish Cancer Society's report of 2019, The Real Cost of Cancer, concludes that the average additional cost is €756 per month, with many patients facing outgoings of up to €1,000 per month. The report notes that, on average, a cancer patient faces an income loss of over €1,500 per month as a result of having to leave a job, work for fewer hours or, as is sometimes the case, close his or her own business.

I welcome the extension to the drugs payment scheme in the budget, which will help those going through treatment for breast cancer. I support further extension of the financial supports available to those going through cancer. I was very pleased that a grant of €500 was announced to go towards the cost of wigs for women who lose their hair as a result of chemotherapy. Practical supports such as that can make a real difference.

The most important message we can get across today to all women is to, please, attend their screening appointments and be breast aware. They should know the signs to look out for and check themselves regularly because, as we know, early detection is key. If you do not know what you are looking for, you should take five minutes to check the HSE website, and make a habit of it. Thankfully, the mortality rates of breast cancer are decreasing, but early detection is the key. The more awareness there is among women and men about what to look out for, the better the outcomes will be for everyone. Breast cancer awareness is an important tool in early detection and I welcome the focus that breast cancer awareness month is creating here in the Chamber and outside it in communities. I congratulate all of the organisations that are doing so much to promote cancer awareness and to support people through cancer diagnoses.

I am conscious that although this disease predominantly affects women, it also affects men and we should not intentionally or otherwise exclude those men who are diagnosed every year with breast cancer. I do not believe there is anyone in the House who does not support the screening programme. I certainly support it. I have had cause to use a BreastCheck clinic outside scheduled appointments and a plan. I remember the fear and anxiety in the pit of my stomach in that time between the visit to the GP and the visit to the centre, the staff of which were absolutely remarkable and I give them full credit for that.

Although great progress has been made in raising awareness, particularly in the area of self-examination, early detection, diagnosis and treatment are vital. However, people only have control over one of those factors, that is, being breast aware, as Members speak about consistently. They have no control over diagnosis or treatment. It strikes me as inherently cruel and cold that people, predominately women, are told that they need to take responsibility and take these actions, and that we will show them how to do so and educate them, but, as Deputy Wynne stated, they are then told to wait three years. That strikes to the bone. While the onus is put on women and the information is provided, there simply is not the support needed at the other end to make it a speedy process and ensure the waiting times for a mammogram, ultrasound or anything else are appropriate.

There are 5,568 people awaiting outpatient appointments for breast surgery. Those are real people with real lives and families who are not only in physical need, but are dealing with the emotional impact that comes with such a diagnosis. Although BreastCheck may be back on track, the lack of capacity in the service was flagged as far back as 2018 and that has nothing to do with Covid or the cyberattack. Of course, these waiting lists do not exist for those who happen to have means or private health insurance. The doors open much quicker for them. Again, that strikes me as cruel and cold. We need to sort out the waiting list system. There needs to be a strategic plan to deal with that current backlog, predominantly of women, because this cannot be allowed to continue.

I am grateful for the opportunity to speak on this topic, October being breast check awareness month. We are grateful for the success of the BreastCheck programme and it is important to mention that it has been very successful and saved thousands of lives. So many women and families are grateful for that success - that they were checked in time, got adequate treatment and their lives were saved. If there had been delays, that would not have happened. The Minister of State, Deputy Butler, referred to the difference between getting in early at stage 1 or 2, compared with stage 4. The difference is day and night. That reality is something of which so many people are aware, yet people have to wait so long for treatment. That is one issue that needs to be dealt with urgently. We must ensure people are dealt with quickly.

Yesterday evening, the House heard statements on gender equality. Nothing goes to the core of gender equality more than the issue of women's health. Nature lets us men off very lightly. That is the reality and we are conscious of that. I refer to the age category for whom this screening is carried out. It is targeted at women aged over 50, who may be going through menopause, but the truth is that almost a quarter of cases occur before that age. That needs to be recognised. There is also the issue that breast cancer can be a hereditary disease. It is certainly the case that members of certain families have a great tendency to develop breast cancer and need to be checked. There is a need to put a programme in place in that regard. I understand there is a programme in place but many women, and even many GPs, are not aware of it. Many GPs do not know that when one member of a family has been diagnosed with breast cancer, they need to refer the other women in the family to that programme so that they can be checked early. A circular needs to be sent to GPs in that regard to ensure they are aware of the programme and know what they are doing.

The Minister of State referred to lifestyle issues, which are something of which we must be conscious. I am sure every woman is conscious of them. However, there are lifestyle issues over which women have no control, such as those relating to poverty or stress levels, and which also have an impact on their health. For many women who are struggling to make ends meet and pay the mortgage and do not have enough money to get schoolbooks for their children, those stresses in their lives mean their mind is crowded and they do not have the time, energy or focus to be able to look after their own health. That needs to be acknowledged.

I very much welcome these statements and the opportunity to mark breast cancer awareness month and raise issues of concern, but also to give credit where it is due. There is no doubt that the breast cancer services are very good and improving all the time, notwithstanding the difficulties in the past couple of years. It is an element of the overall cancer strategy which, again, has taken very much the right kind of approach. It is not perfect by any means but, notwithstanding the issues relating to inadequate funding that need to be addressed, the approach that was taken some years ago in setting up this strategy, identifying centres of excellence and making the case very strongly for the need to have a clear strategy in place and following it is the right one overall. It was certainly encouraging that representatives of BreastCheck and the national cancer control programme appeared before the Oireachtas committee on Tuesday and, in the main, notwithstanding what has been happening in the past couple of years, the news from both of those organisations was good.

We all know that breast cancer is a significant cancer. It is a significant thing for all women in terms of concerns regarding their own health. It is very much up there as one of the main areas of concern for women. It is a concern for most of women's lives. As Members know, the risk of developing breast cancer very much increases with age. There is also the hereditary factor. It is something that can dominate people's lives. All of us - women in particular - are conscious of that, its danger and its implications. It is something about which we are all very sensitive, and understandably so, because it is the most common cause of invasive cancers among women in this country. One in seven women in Ireland will be diagnosed with breast cancer at some stage in their lives. That is a very high figure. There are approximately 3,500 new cases each year and the national cancer strategy predicts that figure will rise through the next 20 years or so. The indications are that the figure will rise to more than 4,500 cases per year in that timeframe. That has significant implications in terms of resources, location of services and all those kinds of things.

It is not good enough to set up services and keep funding them the way they were funded the previous year. Obviously, funding has to take account of growth in population and increases in prevalence. We can never afford to sit on our laurels in relation to that.

The incidence of breast cancer has increased over time, which is a matter of concern. It increased by 2% per year between 1994 and 2008. The incidence rate has levelled off since 2008. That is partially due to improved detection rates, which have been very good. BreastCheck is an essential element of that. Mortality rates decreased by 2% each year between 1994 and 2016. The reason for that is earlier diagnosis, improvements in treatment and a general raising of awareness in relation to the issues around breast cancer.

The Oireachtas Joint Committee on Health discussed the issue earlier this week. We had representatives from the national cancer control programme in with us. They made the point that approximately one quarter of breast cancers may be preventable through modifiable behaviours and environments. That is something that has only recently come to be realised by people. The representatives made the point that the first line of defence against breast cancer is a more healthy lifestyle. That underlines the need to place a greater emphasis on encouraging health awareness and promotion. Thankfully, a good bit of that is happening through Healthy Ireland, but we need to do more in that respect.

Obviously, smoking has an impact in relation to incidence rates of breast cancer, as does maintaining a healthy weight. As a country, we are really struggling with obesity levels and many people are overweight. There needs to be a far greater focus on this area. There is also a link between alcohol consumption and breast cancer. I asked one of the representatives attending the committee meeting a few days ago to quantify the increased risk associated with even the moderate consumption of alcohol. The additional risk of developing breast cancer is put at between 10% and 12% as a result of the connection between alcohol consumption and the development of breast cancer. While self-examination, awareness and all of that is really important, and that point must be stressed, maintaining a healthy lifestyle, a healthy weight, in particular, and reducing our consumption of alcohol are also important.

There are many issues to discuss in relation to breast cancer. We must address the issue of the time lost as a result of the Covid pandemic and the cyberattack. We must also ensure that younger people are dealt with as early as possible where there is evidence of the presence of hereditary factors.

When we speak of cancers in this House, we hear that they come to nearly every home. It was breast cancer that came to our house. While my mam tried to stay very strong while she was dealing with it herself, I will probably never forget the kick in the stomach that many of us felt in the house, and also the huge sense of relief when five years had passed following her treatment. That is a story or journey that not every woman gets to make. However, breast cancer is a very treatable cancer, and it is a journey that screening really helps to prevent.

Being able to mark it here in the House is most important because we should not forget the huge success that BreastCheck has been. It is true that we are ranked 16th out of 24 EU countries and we can still do better, but it has been a success and it links into the success of the national cancer screening programme. It was a very difficult political decision to take, and often the Government had to outline the concept of a centre of excellence and set out why it would help outcomes. I know the Taoiseach, in fairness, played a strong part in that when he was Minister for Health at the time, as did others in medical leadership. I think the presence of medical leadership around that debate helped persuade many people that it was the right way to make progress.

Today is about marking the success of that and encouraging as many people as possible to participate in the screening process. We must also look at the lessons that can be learned from the breast cancer screening programme and how we can apply that to other screening programmes. Screening is incredibly beneficial for some cancers and some diseases, because we know there are two sides of the screening process. It is not always the case that it should be applied to every cancer or to every illness, and that is a clinical call. The work being done by the national cervical cancer screening programme is equally important, as is the work being done on prostate cancers.

We need to look at the learnings. One of the issues in the current programme is encouraging as many people as possible to avail of an appointment if one is made. There are many stories out there and there are women who can tell their stories of how the screening programme has been really beneficial to them. All I can do is encourage people to take up the offer of an appointment if it is made. There have been delays as a result of Covid, and as we played our part in many different ways, attending your appointment is the best way of helping others who are waiting on an appointment.

I will not labour the point as the bells have started ringing for a committee and I have to run and attend it. I apologise. However, I wish to take the opportunity to thank all the staff in the national cancer screening programme. It is an incredibly beneficial programme. We should do anything we can in this House to support it, including increasing the funding, which was done in the previous budget.

I am pleasantly surprised to find that I have a lot more than just five minutes of a speaking slot. I am not sure I will need all of it, which will probably be good news to the Minister of State.

I wish to start by echoing the thoughts of many in the Chamber on the success of BreastCheck and the screening programme. I acknowledge the hard work done by the staff of BreastCheck, the positive impact that has had on homes across the country and the lives that have been saved by it. Indeed, Deputy McAuliffe made the point that cancer can come to any home. However, we also need to look at the issue of delays, and the time lost due to the Covid pandemic and the cyberattack, as Deputy Shortall mentioned. Delays in screening lead to delays in diagnosis, which leads to delays in treatment and can lead to more significant time lost. It is time lost that loved ones and families can have together. It is incumbent on the Government to continue to take the steps that we have been taking to support the services to deal with this backlog and get back on top, so that the success that BreastCheck has had can continue to grow. We must deal with the backlog and deal with the time lost to ensure that no family loses a loved one.

Many of the constituents I have spoken to in relation to breast cancer view the issue through the same lens that they view women's healthcare in general. I am conscious of the protesters who were outside Leinster House in recent weeks, protesting about the restrictions on maternity care. Thankfully, we are seeing a lifting of these restrictions and development in that area. As a result, I am not sure the complaints I wanted to make in that area are still valid, but the changes that are happening are happening slowly.

We need to look at ensuring that all women have safe and reliable access to all aspects of healthcare, whether it is maternity care, BreastCheck or abortion services, which we will be looking at in the upcoming legislative review. It is very important to ensure safe and consistent access.

I am also conscious that, as we speak, representatives from the All-Island Cancer Research Institute are appearing before the Joint Committee on the Implementation of the Good Friday Agreement. This highlights the areas where we can work closely with others to fight back against cancer. Just as I ask the Ministers of State to ensure not just BreastCheck but other screening programmes get the funding they need to catch up on the Covid backlog, I also ask that valued institutes, such as the All-Island Cancer Research Institute, do not suffer because of Covid, Brexit or anything else and that the good work they do can still be supported and can still contribute to fighting cancer.

I will leave it there. I thank the Ministers of State. I also hank my fellow Deputies for all of the extra time.

This October marks the 36th annual breast cancer awareness month. Like previous speakers, I acknowledge all of the staff who work in the cancer screening programmes. They carry out their work with huge empathy, care and professionalism and I acknowledge this. When breast cancer awareness month was first launched, the message was simply to promote breast screening throughout the population as one of the most effective weapons in the fight against breast cancer. Screening has proven to be instrumental in the early detection of breast cancer. It has also been proven to lower the numbers of women dying from breast cancer. Each year, approximately 3,500 cases of breast cancer are diagnosed. One in nine women will develop breast cancer during their lifetime. This is a stark and concerning statistic. It is something that highlights the need to carry out the screening programme and breast cancer treatment.

A total of 1 million cancer screenings have not taken place across Europe since March 2020. Screening not taking place can lead to later stage diagnosis which most likely will have worse outcomes. The challenge is to increase the number of screenings. Thanks to increased awareness of breast screening, survival rates are on the rise and mortality rates are decreasing. It is important to acknowledge this. There are many amazing charities, such as the Marie Keating Foundation and Breast Cancer Ireland, that do incredible work in promoting awareness of breast screening and providing support for those receiving treatment.

Recently, a close friend of mine, Gemma Devoy from Leo Fitzgerald House, began treatment for breast cancer. Gemma is just 35 years of age. I know there is science around it, but for me this highlights that the screening age needs to be lowered. On hearing of the financial difficulties faced by women receiving treatment, Gemma set herself the task of raising €1,500 for the Marie Keating Foundation to help other women like herself getting treatment. As a true reflection of the strong inner-city community she comes from, the community rallied behind her and her cause. There were events such as bingo and more than €20,000 was raised. While it is a stressful time, there are also many positives that can come out of it.

As the Minister of State knows, there are few families in Ireland that have not been affected by breast cancer. As Deputy Andrews said, it affects one in nine women. This is an enormous proportion of the population when we think about it, particularly if we were to put all of those women in one place. We must also remember that one in 1,000 men will be diagnosed with breast cancer in their lifetime. It is incredibly important during breast cancer awareness month to raise awareness of the importance of being breast aware and for people to get themselves checked if they notice any change.

The reduction in screening during the course of the pandemic is concerning for this reason. Only 56,000 women were screened in 2020 compared with 170,000 in 2019. We urgently need to arrest this decline. There was a significant reduction in breast cancer diagnosis last year. That is not because breast cancer has gone away; it is very likely because women have not been able to access screening. A year without accessing screening could be a year living with an undetected problem and a lot of worry and stress. Some women have felt discouraged from going to get themselves checked because of the pandemic.

People might have seen in The Irish Times an article in which Niamh O'Donoghue from my locality in Cork sharing her story and encouraging women to trust their gut and go to the doctor when they feel something is not right. Niamh discovered a lump. She said she felt healthy and initially put off seeking medical attention. When she did go for testing in the early summer, she was diagnosed with breast cancer at the age of 29. She has been incredibly courageous in sharing her story publicly in the hopes of raising awareness and encouraging other women to go and get checked. This is what I expect these statements are about. Our objective is to ensure people take the opportunity.

We are also urging the HSE to make sure that there is no step-back in provision and that everything is followed up and there are as many appointments as necessary. We have an excellent BreastCheck facility in Cork on the Infirmary Road. I encourage everyone to get checked. I wish Niamh the best of recovery and I hope her treatment goes well. As she has said, it does not matter what age someone is or how healthy they feel. If people are feeling healthy and well and something does not feel right they should go and get checked. It is an issue of gender equality and equal equality to appropriate healthcare. Women need assurances from the Government that the resources are being put in place to ensure their health needs are met.

It is very apt that we are having this discussion on breast cancer awareness month. This is an issue close to the hearts of many people. I do not think there is anybody in the Chamber or the country who has not been affected by a loved one, friend or family member being touched by breast cancer. The world was touched by the ravages of breast cancer when Sarah Harding died seven or eight weeks ago. She was only 39. It was a terrible loss for her family and the world.

Yesterday, at a meeting of the Joint Committee on Health, the national cancer control programme gave details on an overall strategy on breast cancer. I found it very informative. Anybody who listens to it will have found it very informative. Breast cancer is very pervasive in this country.

I am slightly disappointed with something that was missing from the statement made by the Minister of State. This is with regard to the age of screening. I know it has been extended upwards to 69 but there is real merit to lowering it from 50. In Sweden and other countries in the European Union, it has been lowered to 40. Because it has been lowered to 40, particularly in Sweden, death rates have decreased by 26%. There is merit to lowering the age of screening. The Minister of State may come back on this.

The good news is that the chances of survival of those women and some men who are diagnosed with breast cancer are extremely high because of diagnosis and treatment. Over the next 20 years, breast cancer will increase by 25%. This sounds alarming but it is because of better detection and diagnostics. It is welcome. I have been speaking to many women under the screening age who are quite concerned about it. They want it to be lowered. At present, one quarter of all cases of breast cancer in Ireland are under the age of 50. They are under the radar of screening. This has to be addressed very quickly.

In March, People Before Profit submitted a motion on this with five points. These included lowering the age of screening to 40, diagnostics for younger women, triple assessment which is very important and keeps emerging, revision of the criteria for the BReast CAncer gene, BRCA, testing, which is also very important, and an education programme in schools on breast examination.

Earlier detection gives better outcomes for everybody.

The screening programme is good. It has obviously been disturbed because of the pandemic and everything has been thrown up in the air. I appeal to the Minister of State on the screening issue. Even the experts who appeared before the Joint Committee on Health on Tuesday said there is definite merit to this and gave another critique as to why the check is at 50 years of age, which I understand. There is definitely merit, however, in lowering these checks to 40 years of age. If that is the case, we can prevent the spreading of the disease and help in the saving of women’s lives.

I thank the Minister of State, Deputy Butler, for her attendance and for her opening remarks on breast cancer awareness month. I welcome the opportunity for all the Deputies in the House to join with many other colleagues to discuss this very important issue. Breast cancer remains one of the most common causes of invasive cancer in women in Ireland, after lung cancer, and is the second most common cause of cancer deaths among women.

It is estimated that approximately a quarter of breast cancers may be preventable through modifiable risk and environmental factors. The first line of defence against most disease, including cancer, is prevention through a healthy lifestyle. Breast cancer awareness is an important tool in the early detection of cancer. The focus that breast cancer awareness places on this is very welcome. Approximately 3,500 new cases of breast cancer are diagnosed each year and the National Cancer Registry predicts that it will rise to 4,650 by 2045. One woman in seven in Ireland will be diagnosed with breast cancer in her lifetime. For each of these women, her diagnosis brings with it a worrying and uncertain time for her and her family.

I thank the Minister of State, Deputy Butler, again, for the earlier update, including that the national screening service and the HSE have an extensive media campaign planned to highlight key details about screening during Covid-19, breast cancer prevention and symptom awareness.

Breast screening is one of the key strategic tools we have and breast cancer was the first of the cancer services to be centralised by the national cancer control programme when it was established. Breast screening provides an opportunity to detect breast cancer at an early stage and thereby diagnosing mortality and stage of disease at diagnosis. Screening targets those people most at risk of disease based on best scientific evidence and international expertise. BreastCheck invites well people for screening, which is a non-urgent service. Each year, approximately one third of all cancers diagnosed in Ireland are detected through BreastCheck.

I recall when I was a member of the regional health authority that there was a concern in BreastCheck that people who were being invited were not showing up to their screening. I use this opportunity today to say to women that if they are being invited, they should please use that invitation because it is important.

BreastCheck, along with the other cancer screening programmes, was temporarily paused last year due to the impact of the pandemic. The capacity of BreastCheck was also impacted by the cyberattack on the HSE. The programme has done a significant amount of work to support the safe resumption of breast screening and the focus of resumption includes the management of capacity across the whole of the screening pathways, which includes a follow-up assessment and treatments.

Routine screening appointments are now returning to normal with approximately 59,000 women being screened between January and July this year. The programme exceeded the target of 49,000 women and more than 10,000 participants were screened in August alone, which is very welcome. However, as Professor Flanagan, BreastCheck’s lead clinician, told the Oireachtas Committee on Health, interruptions caused to the screening programme by Covid-19 may result in some cancers going undetected. I reiterate it is critical that women take up their appointments.

I welcome the expansion of the screening that is included in the programme for Government that will see all women aged 50 to 69 years of age invited for routine screening. This and other commitments in the programme for Government to improve health services for women and the general population are very welcome.

I thank the Minister of State for her presentation today and for dealing with and highlighting this issue by having this debate during breast cancer awareness month.

The BreastCheck screening programme plays an important part in improving outcomes for breast cancer under the national cancer control programme. It is important that we acknowledge the dedication, commitment and hard work of all those involved in this programme but also the work of the doctors, nurses and administrative staff within our hospital system who provide the care and treatment.

Over 3,500 cases are identified each year. This is going to continue to rise in the coming years and, in particular, there is a change in demographics in that we will have a greater number of women over the age of 50. It is therefore important that we continue to give the necessary support for this service.

It is interesting to see the change in these figures. In 2000, there were 973,700 people over 50 years of age. This figure is now 1,629,400. If one takes it that the breakdown between men and women in these figures is 50% each, that is a growth from 486,000 in 2000 to 814,000 in 2021, which is a very significant change. It is therefore important that we continue to increase the funding each year in this area because the number of people that require the care will continue to increase.

I greatly welcome the decision by the Minister of State and the Department to make an additional €21 million available for the programme in 2021. It is important to note that one in seven women in Ireland will be diagnosed with breast cancer. That is the reason why at all times that adequate funding must be made available and that the appropriate services are in place both in respect of the screening programme but also in the treatment that is required.

Over 40,000 women are referred to breast clinics by their GPs. Of those referred, approximately 3,000 will receive a diagnosis of breast cancer. Of those who are identified with breast cancer, approximately 85% will require surgery and 70% will require radiotherapy. It is important then that there are no delays in access to the treatment that they require.

I note that there have been challenges, in particular over the past two years, as a result of Covid-19 and the cyberattack. This placed major strains on the service both in the screening programme and in the care plan for patients. As outlined earlier, there will be an increase in the number of women over 50 years of age and it is important, therefore, that we have an adequate number of staff to deal with the screening programme and the follow-on treatment that is required at all times for those who are identified with cancer.

There is a challenge in recruiting sufficient numbers of radiologists and this is an issue which requires priority. How can it be made more attractive for people to train and work in this area? There needs to be an engagement with all sections of the healthcare sector. This is not just a problem in Ireland but is one throughout the world. It is important therefore that we continue to review the services that are available and make whatever changes are required to deliver the full national cancer strategy.

I will now deal with the issue of Covid-19. It was interesting to read in a recent article that approximately one person in five has been adversely affected by Covid-19 and the Covid lockdown. In particular, in the case of a family where the mother or partner is identified with breast cancer, that is another added difficulty and there is a need to give not only support to the person requiring the treatment but also to the family. We must keep this in mind when dealing with this issue.

It is also important to highlight that breast cancer can affect men and I understand that an average of approximately 37 men per annum are identified with cancer. Is important that we get information out on that issue also.

As to people not being able to turn up for the BreastCheck appointment, I welcome what the Minister is doing in respect of the importance of turning up for the appointment and if one cannot turn up, of notifying the service. There is nothing worse than a service being available and people not availing of it because there is then a waste of time, in that the people who should be there are not there. I understand from the presentation during the week at the health committee that of the people who did not turn up, approximately 30% turned up subsequently. The importance of this service needs to be highlighted and that we need to get the information out there. We should also highlight the issue that breast cancer can also occur in a younger age group and therefore affects women in all age groups. A major campaign to get this information out there should also be carried out. I thank the Minister of State and the Department and all of the people involved in the programme.

It is important that, as the numbers identified with cancer continue to increase, the services be there to meet the demand.

I welcome the opportunity to speak on this important issue. As numerous Deputies have said, there is barely a household breast cancer has not affected, not to mention their extended families. I worked in cancer diagnostics for years. There is no screening programme for many cancers but there is one for breast cancer because we have a very good diagnostic tool and an effective treatment in many cases. That provides us with a great opportunity and we must make the most of that opportunity. Numerous Deputies spoke about Covid, the cyberattack and the impact that has had. It is really important that we get back on track and, in fact, go beyond. Participation rates in the national cancer programme, the centres of excellence and the various screening programmes have fluctuated. Some of that relates to resources while some relates to capacity. We need to strive to continue to improve and I am sure the Minister of State will want to do likewise.

A number of Deputies spoke about raising awareness, as we are doing with this debate, and reiterating the call to people to attend their appointments for screening. We also need to understand why people are not attending and whether there are patterns within that. That would be of benefit. We also need to consider extending the scheme to younger age cohorts.

I am grateful for the opportunity to address the House as part of breast cancer awareness month. The key message I wish to convey relates to the importance of availing of the screening programme when the offer is made to individual women but also to the need to act on any suspected symptoms or concerns. As Deputy Martin Kenny said, the screening age should be reduced to 40. I recall attending a meeting where that was one request that really came across from the women in attendance.

Covid-19 has, of course, impacted on the range of services available in the health service, especially during 2020. The commitment, however, of those involved in the national cancer control programme saw a change in direction during those months. The programme targeted those most of risk as well as those presenting with symptoms or suspected symptoms. Thankfully, since then, the rate of screening has seen some improvement, and last month, the BreastCheck screening service returned to pre-pandemic levels. Even so, the fact remains it will take some time to address the backlog left by Covid. That has been confirmed by a number of the agencies involved that appeared before the Joint Committee on Health earlier this week.

As in other areas in the health service, it is important that supports and funding be put in place to deal with the backlog experienced in this area. Timely intervention is needed and that requires investment in staffing, but right now it is important that anyone who either is offered screening or has concerns because of symptoms or suspected symptoms not hold back or delay. We all need support when faced with certain issues. Anyone who is apprehensive about accepting or making an appointment should look to family and friends for that support. They should not try to deal with it alone.

Breast cancer was discussed this week at a very insightful meeting of the health committee and I take this opportunity to highlight some of the key messages that were given. Breast cancer is the most common and pervasive cancer among women. Each year, 3,500 new cases are diagnosed, although the National Cancer Registry estimates that by 2045, that will have increased to somewhere in the region of 4,650. Incidence rates increased by 2% each year between 1994 and 2008, due in part to improved levels of detection. The increase has largely levelled off since 2008, which is good to hear. The majority of breast cancers are diagnosed through symptomatic breast clinics, to which about 42,000 women are referred each year by their GP. Roughly half of these are triaged as urgent referrals. The rate of cancer among those triaged as urgent is 10%, as opposed to 1% of triaged as non-urgent.

With all these figures in mind, I reiterate breast screening is one of the most effective ways to detect breast cancer at an early stage before symptoms develop. If someone has symptoms, they should not wait for an invitation but seek a referral from their GP to symptomatic services.

Breast cancer awareness month is an opportunity for everyone to reflect on the impact of cancer, not only on our immediate lives but also on the wider general public. While researching in preparation for this debate, I was disappointed by our response to breast cancer during the Covid pandemic. The bottom line is we are now one year behind in the screening process. I shudder to think how many lives will be lost as a result. Breast cancer is the third most common cancer in Ireland, after skin and prostate cancer. Each year, more than 3,500 people are diagnosed with breast cancer, and the National Cancer Registry predicts this will figure will have increased to 4,650 by 2045.

Breast cancer is predominantly a female disease, and one in seven women will be diagnosed with breast cancer in her lifetime. It should be noted men can also get breast cancer, but it is much rarer. In fact, just over 35 men in Ireland are diagnosed with breast cancer each year. It is estimated that in the period 2015 to 2017, 724 people died of breast cancer in Ireland, of whom five were men.

Survival rates, as in the case of other cancers, are greatly increased with early detection. National Cancer Registry data show that the probability that a woman who has been diagnosed with breast cancer will survive the following five years is more than 80%. Our record in survival rates from breast cancer is one of the worst in Europe. In fact, we are ranked 16th of 24 EU countries in this regard. This is not acceptable and the Government must do more to improve it.

BreastCheck is the Irish screening programme for breast cancer. Breast screening helps find cancer at an early stage, and early detection makes cancer easier to treat and gives a much better chance of a successful outcome. To put this into perspective, up to the end of 2020, BreastCheck had delivered almost 2,000 mammograms and detected more than 14,400 cancers. Each year, one third of all breast cancers diagnosed in Ireland occur through the BreastCheck scheme. In light of these statistics, it is clear how important this programme is to women's health.

The Covid pandemic has caused great damage to Ireland but I fear even more damage is coming. Due to Covid, BreastCheck screening was suspended in March 2020. Services only resumed in October of that year, and even then, they were with greatly reduced capacity. At the time, I did not agree with this for I feared we were only creating more problems for ourselves down the road. The HSE's annual report of 2020 stated that only 56,270 women had received a complete mammogram, representing a massive fall of almost 70% when compared with previous years. That is shocking.

Why was this allowed to happen? Surely this programme was an essential service. Certain types of businesses were allowed to remain open, yet one of the most important screening programmes in the country was suspended. We need an explanation for this. We have been told screenings are about one year behind. What plans have been put in place to bring the screening programme up to date? As has been stated, early detection of breast cancer can be the difference between life and death. How can we get early detection when the programme is running a year behind schedule?

Full capacity was restored in September 2021 but this is not good enough. We need to increase the programme's capacity as a matter of urgency to reduce the backlog. The Minister, Deputy Donnelly, has stated, "In the light of Covid, clinical priority was given to referrals triaged as urgent." This is not good enough. The whole point of cancer screening is early detection. Even more worrying were the comments of Dr. Clive Kilgallen, chair of the consultant committee of the Irish Medical Organisation, who told the Joint Committee on Health that Covid-19 has had a significant negative impact on cancer services. He also stated there is a growing backlog of patients waiting for urgent, critical diagnostic services and treatment services.

I am grateful for the opportunity to speak during this debate and raise awareness of the backlog in breast cancer screening. Both the Government and the HSE need to ensure these screening services are brought back up to date in order that there can again be early detection of breast cancer. The message is that if you are in doubt, get it checked and please attend your appointments.

It is shocking that during the time of this debate so far about ten people in the State will have been diagnosed with cancer. It shows the prevalence of the illness and the damage it does annually in this country. I was one of those statistics about a year ago. Thank God, I am back to full health at present. I was both lucky and unlucky. My diagnosis was delayed because of Covid, but I have a brother who works in the sector. He is a professor in cell biology and when restrictions lifted he noticed the lesion and urged me to go to a doctor, which could well have saved my life.

Breast Cancer Awareness Month is an integral part of our war on cancer. The message for every man and woman in the country has to be that if he or she notices a lump, strange spots, a mole or things that have changed, he or she must not waste time and get checked absolutely immediately. Timely diagnosis and treatment are radically important. There has been great frustration throughout the country that, in many ways, diagnosis and treatment have been significantly delayed even though cancer is the biggest killer in the country. Some of the statistics I have looked at recently are quite startling. The statistics of the national cancer registry dating back to 2019 found that Ireland's five-year survival rate for breast cancer is 82%. This is poor by European standards. If one is diagnosed with breast cancer in Sweden, one is 7% more likely to survive for five years than if one is diagnosed in Ireland. If one is diagnosed in Britain, one is 5% more likely to survive for five years than if one is diagnosed in Ireland. We have much work to do to reach the European standards.

The divide is not just geographical in this regard. There is also an economic divide in our country. Last week, I tabled a question for the Minister for Health, Deputy Stephen Donnelly. In his reply he indicated that currently in the State there is a differential of a whopping 12% in the five-year survival rate for breast cancer in respect of whether one has been diagnosed and treated in a private hospital or a public hospital. That is a startling fact. There is a radical two-tier practical effect on one's ability to survive cancer depending on where one's diagnosis happens and whether it is a private or public hospital. Women diagnosed with breast cancer in a designated cancer centre have an 85% chance of survival for five years while those diagnosed in what is termed as an "other public hospital" have an 81% chance of survival for the first five years but those diagnosed in a private hospital have a 93% chance of survival. These statistics go back to 2019.

In certain hospitals, for example, when a woman is going for a biopsy they reassure her before diagnosis by scheduling chemotherapy sessions for the following day. The woman has an appointment to hear the results of the biopsy and she also has an appointment to get chemotherapy the following day, just in case, even before she has had a diagnosis. This gives the strong impression that the health service is on the ball, is super efficient and is doing everything it can to make sure treatment starts soon. However, I have spoken to women who are in a different situation. One woman I spoke to got the bad news and presented for the appointment the next day only to find out it was a consultation and no treatment would be administered. She had to wait six weeks before the first session of chemotherapy started. I know of many other people who were waiting longer for chemotherapy and treatment to start for serious cancers.

I have just left a meeting of the Oireachtas Committee on the Implementation of the Good Friday Agreement at which representatives of the all-Ireland cancer research organisations gave very valuable information. They said that one of the key things that hampers their ability to research is the lack of a digital identifier for patients in the South. They are dealing with paper documents and they are unable to find out exactly what is happening to individuals with regard to their cancer treatments.

I thank the Ministers of State who are present today to hear these statements and comments. I am a member of the Oireachtas Committee on Health and this week, as part of Breast Cancer Awareness Month, we were fortunate enough to meet experts from the breast screening services and the national cancer control programme. They included Professor Fidelma Flanagan, Ms Fiona Murphy, chief executive of the national screening service, Professor Arnold Hill and Dr. Martin O'Sullivan. If anybody wishes to listen to that meeting of the health committee last Tuesday, it was a very fine interaction between Members of the Oireachtas and the experts. Most of the questions asked by the public representatives were answered. Not all of them were answered so I have a few I would like to follow up on with the Minister of State. The guests did commit to forward papers to the committee on some issues, and I look forward to receiving them.

There is some good news before I ask the questions. It was the Taoiseach who, in his role as Minister for Health a number of governments ago, introduced the national cancer strategy. We have that to thank for the fact that statistics demonstrate that while breast cancer incidence is expected to increase, as the committee heard and as other colleagues have mentioned here, mortality rates have been dropping consistently year-on-year by 2%. Obviously, we need to do more and would like that to be greater, but from 1994 to 2016 that trend has been downward by 2% per year. It is small but at least it is downward.

A couple of the key messages, and some of them have been referred to by other Members and were also referenced by the experts before the health committee, are the messages of prevention and awareness. Approximately 25% of breast cancers are preventable through modifiable risks. There is also the message that the three previous speakers mentioned about taking up one's appointment when one gets it. Over 20% of people not taking up their appointment is quite dramatic, notwithstanding the excellent efforts that the health specialists are making to ensure people are reminded through text messages and so forth of the fact that they have an appointment. I reiterate the message from my colleagues on all sides of the House that when women receive the text or notification with their appointment date and time, they should take it up. However, there are modifiable risk factors and environmental factors, the usual ones, that heighten the risk of a woman developing breast cancer.

The committee also discussed the age cohorts that are enabled to access the breast screening programme, because there are many questions about that among the community. Some colleagues at both Oireachtas and council levels have raised them with me. They are quite mainstream questions and they are the questions to which we did not get granular answers. I will list them explicitly. There are those who might say that every young woman should be entitled to access the BreastCheck screening programme. Very reasonable answers were given to that suggestion. There are issues to do with the age cohort of women who generally are more vulnerable. From the menopause age onwards was one of the indications given. It was also said that adopting a national universal screening programme could cause more anxiety among the female population and do more harm than intended when set against the improvements it was wants to do, the service it wants to provide and the alerts it wants to provide to people. The answers and the interaction we had with the experts on that were very meaningful and useful to the public.

We were told there are international standards and principles at play in respect of all ranges of cancer screening, not just breast cancer, and Ireland does its best to adopt and meet those international standards. Some queries were raised. We screen the 50 years to 70 years age group, but some countries do it for women under 50 years old and some do it for women under 45 years old. Almost no country in the European Union screens women under 40 years old. I understand that the European Union recommendation is that 45 years upwards would be the ideal. Hopefully, the Minister of State might be able to respond on when Ireland might hope to achieve that.

I understand the incidence of breast cancer in women under 30 is one in 200. For every 200 cases of breast cancer, only one is a woman aged under 30. However, there is anecdotal evidence indicating that may not tally. While we had the mortality rates, they were not broken down by age group. It would be very useful to have the information in tabular form for how many women, very regrettably, passed away in recent years aged from 20 to 30; 30 to 40; 40 to 50; 50 to 60; 60 to 70; and over 70. There seems to be difficulty in accessing that information. I have tabled a number of parliamentary questions on that. The people involved and advocates have found it well-nigh impossible to access that information. That information needs to be made public, not to alarm people but hopefully to reassure them.

I was very heartened by the answer I got to a parliamentary question on widening the age cohorts for breast cancer screening. I was informed that the national screening advisory committee, NSAC, is having its first annual call later this year and that will open up applications for proposals for new population-based screening programmes and modifications to existing programmes, such as a reduction in the age of those eligible for screening. According to the NSAC, applications along those lines will be welcomed from the public as well as from the HSE, health professions and other professional bodies. The Minister of State might be able to inform us as to when that will be launched. That would be very interesting given that it is a first call. It will allow those advocates, who have concerns about women of a particular age not being able to access breast screening programmes, to put forward their views and their anxieties along with their on-the-ground experience of dealing with women, particularly young women, who are diagnosed with breast cancer.

Before I ask my questions, I pay tribute to the professionals who have kept the screening programme going. Clearly, it had to close during the Covid restrictions, meaning that only three months of screening was done in 2020. As it is a very intimate procedure, that was necessary to protect both patients and front-line medics. As a result, even though they have gone full throttle this year and I think 15,000 breast screenings were completed in September alone, it is behind by 120,000 breast screening procedures. It will be 2023 before we catch up on those breast screenings. If a woman was due a breast screening procedure a year ago and it has been delayed, we are all concerned over the impact of that delay on her health and her mental health. I appreciate the major efforts being made to catch up.

The health committee also discussed the impact of the cyberattack. The diagnostics and the radiological procedure are technology based. The cyberattack had almost as big an impact on the breast screening programme as the Covid pandemic had. It was important that those issues were made public.

While I understand that the Minister of State might not be able to give answers to these today, I would like answers subsequently. Of the approximately 690 deaths annually from breast cancer, how does that break down by age group, particularly those aged 49 and younger? It seems very difficult to get that information.

Of those women eligible for the BreastCheck programme at the age of 50, what percentage need to wait to get their appointment? What is the maximum waiting time? What is the minimum waiting time? I would like tabulated information on the average time from a woman making appointment to when she is called. What is the maximum waiting time for a first breast check? For example, could a woman be waiting until she is 52 or 53 before getting called?

How is the GP education being rolled out? The high-risk screening unit at St. James's Hospital is an excellent facility. How many such clinics are operating in Ireland? We need to ensure that GPs know to refer a woman presenting with symptoms of breast cancer on for further assessment even if they present in their 20s or 30s. Anecdotal evidence would suggest that because many of these women are very young, they sometimes felt dismissed by their general practitioner when they raised concerns after following the normal kinds of personal procedures they are advised to follow of checking whether they have lumps.

I am delighted to get the opportunity to speak on the 36th annual breast cancer awareness month. It is a major issue throughout the country. Many people have spoken today about the breast screening programme falling behind. I feel there is always a way around these things if we make the effort. As early detection is of such importance, one way of speeding this up might be to consider a 24-hour service, seven days a week to see if we can catch up and clear the backlog.

I commend the very good cancer services we have. Today we are talking about the importance of early detection of breast cancer and the importance of people not missing their appointments thereby leaving themselves vulnerable. I commend the doctors, nurses and staff in hospitals. Sometimes in the most terrible situations of palliative care we forget those people who do so much for people.

One thing that we have not looked at here today is people who end up getting cancer. It is a terrible shock and horror. No home in Ireland has not been affected by it. My mother died of cancer more than 20 years ago, aged 54. Even today it affects me personally. It affects everybody else because it is a major blow to a family.

People often come to my constituency office looking for a medical card. The word "cancer" should trigger something in the medical card section. A person with cancer should be allowed to have a medical card at least for the time he or she is going through the illness and, please God, comes out the right side of it. In many cases that could be 12 months. A hard-working couple might have had two incomes in the home. If one of them needs breast cancer or any cancer treatment, it gives rise to major costs but they still do not get a medical card. The extra cost is a terrible blow and a terrible infliction, particularly in cases where there are young children at home. There is a worry about the cost of medication and other costs. I commend the services. I do not want to be looking at anything here in a negative sense. If the State is to be seen as caring, we should seriously look at giving a medical card to everyone who is diagnosed with cancer for that period.

I would like to mention the supports and services that are available. I thank the CEO, David O'Brien, and the chairman, Neilie O'Leary, of Local Link Cork for their Cancer Connect service. I am also involved in it. Cancer Connect volunteers collect cancer patients every day from Castletownbere, Drimoleague, Dunmanway, Bandon, on the other side of the Mizen Head down into the Skibbereen and Clonakilty and bring them all the way to Cork. It is part of the Cork Local Link but it has a Cancer Connect service. Other car drivers volunteer to take patients who need one-to-one treatment for cancer to Cork University Hospital. They do brilliant work so that patients are in and out and not held up. I commend that fabulous service.

Today I have swapped my Limerick mask for "Granagh Backs Amanda". Amanda is a woman in her early 30s in the parish I am from, Granagh. This weekend, on 24 October, the vintage clubs and community around Limerick and where Amanda is originally from, in Newtown in Cork, have joined for a fundraiser for her. Amanda has been receiving breast cancer treatment and has four children along with her husband, Daniel. Amanda's children have special needs. I have four children too and we all know how hard it is when there are two healthy parents to rear four children. When the mother of children with special needs is going through treatment, it brings out the best in everyone in trying to help.

I am involved with several vintage clubs, including those in Greybridge, Charleville and west Limerick, and we are a family. There are many more, including in Ballylanders and Kilmeedy. We join together when there is a fundraiser for somebody in need. This Sunday, 24 October, that is what we are doing. My mask was made by local people to back Amanda. Anybody might have cancer detected and go through treatment. I thank the front-line services for everything they do for such people. The shortfall is when people come home and need help. That is what we are seeking to improve as a community. I cannot thank the people in counties Limerick and Cork enough for what they have done for Amanda and what we will do on Sunday. We are only a small community but such effort is mirrored across the country. Communities are great. The campaign is "Granagh Backs Amanda". The parish has lifted behind her and she knows the whole community is with her. She knows she has help in getting supports for her family.

I have been involved with many charity runs for people who have not survived and there are too many of those to mention. Many of them wanted to get their affairs in order but were not able to do so because of financial issues. Many runs and much community effort were expended to help. I would like something put in place for families bereaved through cancer. There should be something to help the financial position of families immediately afterwards. There should be something in place to help. Communities do this already, and they do absolutely fantastic work. I thank every volunteer in Ireland for what they do in the community around them. I emphasise what it means to people when they know their friends, family, relations and community are helping them. It gives them a massive lift.

I thank the Ceann Comhairle for the opportunity to speak to this very important issue. Being the third most common cancer in Ireland, it is likely that we will all have had mothers, grandmothers, aunts, spouses, sisters or daughters affected by breast cancer at some point in our lives. This is a disease that affects us all and one that has taken too many too soon. I take a moment to acknowledge all those diagnosed with breast cancer, all those undergoing treatment, the family members and friends of those affected, breast cancer survivors and doctors and nurses who do such a great job to assist those affected, especially over the course of the pandemic.

The Covid-19 pandemic has been a difficult time for many but especially for those affected by cancer. It is incredibly alarming that due to Covid-19, the screening programme for breast cancer is almost a year behind schedule. It has been said time and again that early detection of cancer is extremely important to ensure a better chance of survival and more treatment options. Women whose breast cancer is detected at an early stage have a 93% or higher survival rate in the first five years.

Why, then, are we not ramping up the funding of BreastCheck, especially now that the screening programme is so far behind? Significant funding must be provided urgently to deal with this backlog and if we are to properly ensure early detection, the screening programme must be expanded to include those under 50 as well as those over 70. This proposal is being considered by the Joint Committee on Health and I encourage every Deputy to support it in any way possible.

In my constituency of Donegal, the number of women waiting for breast cancer screening has risen to 6,800 according to new figures from the Health Service Executive. This is an absolutely shocking figure. The BreastCheck service is facing major backlogs due to Covid-19 and although screenings resumed in Donegal last October, they were suspended again in early 2021 due to high levels of virus in the community and did not resume until August. This backlog must be addressed immediately.

The fact that women must travel long journeys across the county for these checks must also be addressed. There were incidents lately of women from Inishowen being sent to Donegal town for BreastCheck appointments. For those who do not know the geography of Donegal, that is a journey of over an hour and a half. It might be easier to be sent to Belfast than Donegal town from Inishowen. In this case, a woman would travel for at least three hours for the BreastCheck appointment. That is for those with cars because there are no bus services or alternative transport available. I take this opportunity to thank Ms Betty Holmes, chair of Donegal Action for Cancer Care, for raising and helping to rectify this matter.

When BreastCheck was being rolled out initially, we in Donegal had been left to the back of the queue as usual. When the first check had been rolled out for Donegal women, women in the east of the country were already getting their second and in some cases their third cycle of the check. Women went ahead and organised a bus from Donegal to Belfast to get checked and at least three cancers were detected at that time. They were dismissed by the head of BreastCheck for taking action themselves but if they had waited for the health service to recognise Donegal, some of those women would have died, sadly. The women of Donegal have been completely left behind once again. In order to address this, I call on the Minister for Agriculture, Food and the Marine, Deputy McConalogue, to stay true to his word and ensure the Government puts a BreastCheck unit into Buncrana.

I would love to see a national roll-out start in Donegal for once and then we might get fair treatment, once and for all. If the women of Dublin had to wait four to five years to see the roll-out reach them, it would be the last time it would be done in that way. I also call on the HSE to keep the BreastCheck unit in Donegal town permanently. We need a number of locations for such checks because of the county's size.

There is no doubt BreastCheck services save lives and this breast cancer awareness month, I urge the Government to do all it can to prioritise breast cancer services. I know the Minister of State is doing this but we must ensure the backlog is cleared quickly. We cannot wait until 2023 or whenever it is for the backlog to be cleared. Clearing the backlog immediately will mean people will survive when they might not do so otherwise. It is vital and I know the Minister of State will do his best to make it happen. We need support from all of the Government to bring this about and ensure a roll-out happens leading to women getting the service they deserve.

I thank the Deputies for their contributions on the very important topic of breast cancer awareness. October is breast cancer awareness month but our commitment and alertness to any indicators of breast cancer should extend year-round.

As Minister of State with responsibility for public health, well-being and the national drugs strategy, I encourage all to be aware of what they can do to reduce their risk of cancer and other diseases through a healthy lifestyle, as many Deputies have said. As stated earlier by the Minister of State, Deputy Mary Butler, the proportion of cancer incidence attributable to modifiable lifestyle and environmental factors is estimated to be in the 30% to 40% range.

Smoking is by far the most significant risk factor. The HSE Quit service provides personalised free support by phone, email, text message and live chat to people who want to quit smoking. Our efforts to reduce smoking levels will continue through information sharing, as well as through taxation and legislative measures.

The link between alcohol consumption and cancer has been well established. National Cancer Registry Ireland data indicate 7.5% of breast cancer is attributable to alcohol intake. The evidence is also clear that reducing alcohol consumption will reduce the incidence of cancer. The aim of the Public Health (Alcohol) Act 2018, which has been mentioned, is to achieve a significant reduction in the consumption of alcohol in Ireland and, therefore, in the associated incidence of cancers and other alcohol-related harms.

Overweight and obesity are associated with multiple health issues, including breast cancer. The obesity policy and action plan aims to reverse obesity trends, prevent health complications and reduce the overall burden for individuals, families, the health system, wider society and the economy. Additionally, Ireland's national physical activity plan aims to promote increased physical activity levels across the population. Physical activity confers multiple health benefits and can significantly reduce the risk of a range of diseases, including cancer. Exercise continues to be important for patients throughout the cancer continuum. Through the healthy Ireland programme, we are supporting people to stop smoking, moderate their alcohol intake, lose weight, eat healthily and take more exercise so that they can live healthier and more fulfilling lives.

I am happy to report that routine screening appointments are now returning to normal in BreastCheck, despite the massive disruptions caused by Covid-19 and the ransomware attack on the health services. Approximately 86,000 women were screened between January and September this year, well in excess of the original target of 63,000. September's BreastCheck attendance figure of 16,000 is in line with the throughput in September 2019, before the onset of Covid.

As outlined earlier, the Government invested a further €10 million in the national screening service this year. This funding will support the development and opening of new BreastCheck units and the recruitment of more staff to enhance capacity across the service. An extra €20 million was allocated for the continued implementation of the national cancer strategy this year, with €1.8 million allocated specifically for breast cancer services. Funding of €12 million was allocated this year for the restoration of cancer services in the context of Covid-19. This is being used to support hospitals in addressing backlogs, such as running extra evening and weekend clinics, extended working days, virtual clinics, increasing diagnostic capacity and providing locum-temporary support. Symptomatic breast disease clinics are among the main beneficiaries of this funding.

The continuation of cancer services throughout the Covid-19 pandemic is testament to the great commitment shown by dedicated hard-working healthcare staff who have continued to give expert compassionate care to our loved ones with cancer, with invaluable guidance provided by the HSE's national cancer control programme. I also acknowledge the vital role played by community and voluntary sector organisations in supporting cancer patients and their families through the Covid period. Such organisations being readily accessible can have a positive impact on patients' quality of life, especially as their cancer journeys do not stop when they complete their main treatment. On a broader level, I note the close co-operation between the Irish Cancer Society and the national cancer control programme which is to the benefit of patients.

As indicated, cancer services continued to operate, although at reduced capacity due to the need for appropriate physical distancing and infection control measures, throughout the Covid period. At all times, there was a particular focus on urgent and time-sensitive cases. In the earlier period, there was a major emphasis on encouraging patients who had concerns to access cancer diagnostic services and to attend appointments. Thankfully, patients are now coming forward, and, indeed, attendances at urgent symptomatic breast disease clinics from January to August of this year were at 115% of the 2019 level.

The Government is committed to the implementation of the national cancer strategy to the benefit of patients. This is again illustrated by the allocation of a further €20 million in budget 2022. An important message to everyone is that BreastCheck screening and our symptomatic cancer diagnostic and treatment services are open and our healthcare staff will provide the care people need.

In breast cancer awareness month, I encourage all women to be empowered when it comes to their breast health by regularly checking their breasts for changes and attending BreastCheck screening appointments when called. All Deputies who spoke noted the importance of early diagnosis. I ask people not to put this off. Also, irrespective of age, if people have any concerns about cancer, I ask that they go to their GP who will arrange appropriate onward referral and follow-up care.

I thank Deputies Murnane-O'Connor, Patricia Ryan, Tully, Munster, Wynne, Duncan Smith, Durkan, Higgins, Clarke, Martin Kenny, Shortall, McAuliffe, Costello, Andrews, Ó Laoghaire, Gino Kenny, Devlin, Colm Burke, Darren O'Rourke, Martin Browne, Fitzpatrick, Tóibín, Lahart, Michael Collins, O'Donoghue and Pringle. I do not have enough time to go through all the points raised. I thank my colleague, the Minister of State, Deputy Mary Butler, for all the work she has done. Most people recommend that if in doubt, get it checked out.

Deputy Gino Kenny highlighted how, in Sweden, people from the age of 40 years are screened and, resulting in a 20% decline in death rates. That is an interesting statistic and I thank him for raising it. Deputy Pringle raised the issue of people having to travel for an hour and a half from Malin to Donegal town because they do not have access to a service. That issue needs to be addressed and I thank him for raising it.

Deputy Ó Laoghaire raised the case of Niamh O'Donoghue. Deputy Richard O'Donoghue spoke about Amanda who has four children and all the great work done by fundraisers. We need these support services. They are provided not only by the HSE and the Government but also by family, friends and the community. At times like this, it is important to thank members of the community for the support, love and time they give people, especially women who are diagnosed with breast cancer. It is a great assurance to people. I thank the Minister of State, Deputy Mary Butler, for the work she has done. This debate has been important in getting so much information on to the floor of the Dáil.

That concludes statements on breast cancer awareness month. I thank the Ministers of State and the Deputies who partook in what was an interesting and, no doubt, very important debate.