Léim ar aghaidh chuig an bpríomhábhar
Gnáthamharc

Dáil Éireann díospóireacht -
Thursday, 12 Feb 1998

Vol. 487 No. 2

Adjournment Debate. - National Breast Screening Service.

Last Friday I accepted an invitation to visit the breast clinic at St. Vincent's Hospital where there were 160 women. The only common link among them was a fear of cancer because they had been referred by their GPs. They received a tremendous service: a clinical examination, a mammogram, a biopsy, were met by a surgeon and an oncologist and have the care of a clinical nurse and the friendship and services of the Irish Cancer Society.

The service was excellent but the waiting was long. In modern hospitals where there may be up to 220 women waiting for a service on a particular day it shows the need to expand that clinic and clinics throughout the country.

Breast cancer is a disease from which 650 to 660 women in Ireland die each year. I hope the Minister can reassure us the new development at St. Vincent's Hospital will include a specialised clinic to assist women at all stages of breast cancer disease. One group which particularly needs attention are the high risk women who have a family history of cancer. They need special care and a day allocated to them rather than all women at different stages being referred by their GPs from all over the country to attend on a Friday. It shows the need for clinics throughout the country. Some 1,200 new cases of breast cancer are diagnosed each year. There is a tendency by all GPs to refer everybody to Dublin, thus creating a scare among women. If dealt with locally, the problem may not be as bad. When referred to Dublin women are more fearful.

The need for a national breast screening service has been debated previously. A number of factors lead to breast cancer but no real cause is known. This means we cannot prevent breast cancer but we can detect it. The most successful way of detecting it is by breast screening. The Eccles Breast Screening Programme found a detection rate of 7.9 per cent per 1,000 women. This is an extremely high rate, one of the highest in the EU. It has been proven that a national breast screening service for women aged between 50 and 64 can detect the cancer, therefore ensuring it can be treated.

I accept there is a problem with compliance, getting the women to take up the offer of a mammogram. The results of the study in 1996 showed that 61.5 per cent opted to avail of the service in the first round but this was increased to 85 per cent in the second round. This study asked about the feasibility of running a national programme. It needs to be phased in and women must comply. There is a need to get women to admit they are over 50 years of age and in need of the mammogram. Women need to accept that the test will not automatically show they have the disease. Early detection means that women can be properly looked after.

There is a need to provide a high quality service throughout the country. We will only accept the best when it comes to women's health. Now is the time to start testing women in the 50 to 64 age bracket. Will the Minister give a commitment that the clinic at St. Vincent's Hospital will be established as a specialised centre and that the first phase of the national breast screening programme will be implemented this year?

I am committed to providing a national breast screening service. The implementation of a national breast screening programme is a major undertaking which requires careful planning and organisation. From my Department's perspective, of particular concern is the need to achieve acceptable compliance levels and, at the same time, satisfy the necessary quality assurance criteria.

As the Deputy will be aware, in March 1997 the then Minister, Deputy Noonan, announced the introduction of a major action plan to implement the proposals contained in the national cancer strategy. Included in the plan were proposals for the introduction, on a phased basis, of a national breast cancer screening programme. The first phase, which is in preparation, will cover the Eastern, North-Eastern and Midland Health Board areas and target 120,000 women in the 50 to 64 age group, which represents 50 per cent of the national target population.

A major challenge was the need to establish a named population register which would comply with data protection requirements. However, following the passage of the Health Provision (No. 3) Act, 1997, and subsequent correspondence with the Data Protection Commissioner, we are in a position to proceed with the establishment of a population register for the programme. Work is well advanced and it is hoped to have the register in place by April or May.

Since the launch of the cancer action plan there have been a number of other important developments in relation to breast screening. These include the establishment of a national steering group chaired by Dr. Sheelah Ryan, chief executive officer, Western Health Board, to guide the implementation of the national breast cancer screening programme; the establishment of a national quality assurance committee chaired by Professor Ennis, consultant radiologist, Mater Hospital, as a sub-committee of the steering group and which is representative of experts from all the relevant clinical disciplines; and the decision to appoint Dr. Jane Buttimer, deputy chief medical officer in the Department of Health and Children, as project director for the programme. Dr. Buttimer will take up her duties shortly.

A key development in recent months was the decision by the breast screening steering committee on a model of delivery for phase one of the programme. It has been agreed that there will be two central units based at the Mater Hospital and St. Vincent's Hospital where the screening, assessment and treatment of women will be carried out using a multi-disciplinary team approach involving the relevant clinical disciplines, including the screening radiologist. There will be two mobile units to bring the screening services to women in more remote-rural areas within the three health board areas included in phase one. Each mobile unit will be linked with one of the central units. This should ensure uniformity of standards and continuity of care.

Taking into account the lead-in time involved in the development of IT systems, the establishment of a population register and the recruitment of consultant and support staff, I am advised that we should be in a position to commence the screening programme by September. I am committed to making the necessary resources available. Substantial funding has been made available to meet the start-up costs for the programme.

It is important to introduce the programme on a phased basis to ensure high quality and promote high uptake of the service. Decisions taken in relation to the timing of subsequent phases will be guided by the experience gained in implementing phase one of the programme.

Barr
Roinn