Written Answers. - Breast Screening Programme.

John Bruton


63 Mr. J. Bruton asked the Minister for Health the nature of the work being undertaken in conjunction with other European countries to ascertain the effectiveness of mammographic screening in preventing breast cancer; and when results will be available from this research. [182/94]

Jim Mitchell


94 Mr. J. Mitchell asked the Minister for Health if his attention has been drawn to recent reports indicating the need for the implementation of a nationwide breast cancer screening programme, with particular reference to women in the over 50 age group; and if he will make a statement on the matter. [1012/94]

Máirín Quill


133 Miss Quill asked the Minister for Health the plans, if any, he has to introduce a national breast screening programme in the near future; and if he will make a statement on the matter. [926/94]

Johnny Fox


138 Mr. J. Fox asked the Minister for Health the plans, if any, he has to introduce a breast cancer screening service for all women, especially those in the high risk group in Ireland. [16/94]

Edward Nealon


154 Mr. Nealon asked the Minister for Health his views on whether the provision of a national breast cancer screening programme is conducive to earlier detection and successful treatment; the plans, if any, he has for introducing such a programme at an early date; and if he will make a statement on the matter. [1014/94]

Frances Fitzgerald


222 Ms F. Fitzgerald asked the Minister for Health his policy on mammography screening; if he intends to introduce national screening for women between the ages of 50 and 64; and the progress that has been made in introducing a mammograph screening service in this country. [254/94]

Charles Flanagan


229 Mr. Flanagan asked the Minister for Health when he will receive final results of a pilot project on the matter of breast cancer screening; and if he will make a statement on the matter. [719/94]

I propose to take Questions Nos. 63, 94, 133, 138, 154, 222 and 229 together.

As the causes of breast cancer remain to be clearly established, emphasis is placed on early detection at the pre-invasive stage, through mammography, and consequent early treatment. The yield from mammography is highly dependent upon the medical equipment being used and the expertise of the health professionals involved in the procedure.

At present in Ireland, mammography is used largely as a diagnostic tool for symptomatic or worried women on referral by their general practitioners. There are now diagnostic mammography units at 17 hospitals throughout the country and expertise has been growing in all aspects of the early detection of breast cancer and its treatment.

Some months ago I met representatives of the Irish Countrywomen's Association to discuss breast cancer services generally. As a result of our discussions, my Department's Health Promotion Unit together with the Irish Cancer Society are arranging a number of seminars on breast awareness over the coming months in order to increase public awareness of breast cancer and other aspects of women's health.

With regard to mammography in particular, there has been considerable debate and discussion internationally regarding the effectiveness of mammography screening in reducing mortality from breast cancer. Mammography screening involves the carrying out of mammography on a mass population basis to detect those women with unrecognised breast cancer.
It is important to mention also that mammography screening programmes tend to be directed at women aged between 50-65 years. Provisional figures show that, of a total number of 650 women who died from breast cancer in Ireland in 1992, 249 were aged between 45-64 years. Mammography screening programmes are not effective in reducing mortality in younger women and older women have proved reluctant to come forward for screening. There has been a good deal of controversy as to whether mammography screening programmes can be successful in reducing mortality in this age group. As a first step, it is essential, therefore, to establish whether a reduction in this mortality rate can be achieved in Ireland and most importantly, how this can be achieved.
For these reasons, my Department is supporting a major mammographic breast screening programme currently underway at the Mater Foundation. This programme, the Eccless Breast Screening Programme, is part of a network of seven pilot schemes on breast cancer screening being carried out within the European Community. The programme is being carried out in a defined catchment area, north Dublin and Cavan-Monaghan, representing both urban and rural populations. All women in the catchment area aged between 50-64 years are eligible to attend and will be included in two round of screening. Written invitations suggesting a date for screening were issued and these were followed with a second invitation in cases of no response. The age group to be screened complies with EU criteria for such programmes.
The objectives of the study are: to evaluate the impact of mammographic screening on mortality from breast cancer among Irish women, to compare the specificity, sensitivity and predictive value of the mammography screening programme with that reported internationally and to document compliance with a breast screening programme in Irish women.
The Eccles Breast Screening Programme commenced screening in 1990 and is expected to conclude shortly. I hope to have the report on the programme's finding by the end of this year. National policy on this area will be guided by the findings of this programme. This is the first study of its kind undertaken in this country and has established itself as one of the leading European pilot programmes. The key factors which have contributed to its success in this regard are that it is a centralised screening programme with strong clinical leadership and trained and dedicated radiological, epidemiological and radiographical support. Another important feature of the Eccles Breast Screening Programme is the emphasis on quality assurance mechanisms. As indicated in the National Health Strategy document which I published earlier this year, decisions on the national policy to be followed in this matter will be influenced by the results of the pilot study.