The pioneering clinical-led model developed for the BreastCheck programme has been successful in minimising the risks associated with breast screening. The aim of BreastCheck is to detect breast cancer at the earliest possible stage. The programme is fully audited against a range of quality, client-centred criteria as set out in the BreastCheck women's charter, which is appended to the document circulated. We continually measure our performance against this charter to ensure the programme is performing at optimal level.
Governance of BreastCheck was transferred to the board of the National Cancer Screening Service, NCSS, on its establishment in January 2007. The establishment of the NCSS and its development is an integral element of the national cancer strategy and contributes to proof that a clinical-led, evidence-based approach to cancer screening can successfully reduce the incidence of and mortality from breast cancer in Ireland. BreastCheck has been extended to eight of the 13 counties in its expansion area and we have launched CervicalCheck, which is Ireland's first national cervical screening programme.
To date the BreastCheck programme has provided screening to more than 206,800 women with a quality-assured programme that is recognised as a world leader in the use of advanced digital mammography. The successful BreastCheck model has been used and adapted for CervicalCheck, the national cervical screening programme. CervicalCheck is Ireland's first free, quality-assured cervical screening programme. The overall aim of CervicalCheck is to reduce the incidence of and the death rate from cervical cancer in Ireland.
BreastCheck provides free mammograms to women aged between 50 and 64 years, sequentially, on an area-by-area basis in a two-yearly cycle. BreastCheck began offering free breast screening to women in that age range in the then Eastern Regional Health Authority and the North Eastern and Midland Health Board areas in February 2000. In 2003 approval was given for the extension of BreastCheck to counties Wexford, Kilkenny and Carlow. Screening commenced in Wexford in March 2004. Screening was extended to women in Carlow in 2005 and in Kilkenny in May 2006.
In December 2007, some ten months ago, construction was completed and screening began from two new screening units, namely, the BreastCheck western unit and BreastCheck southern unit in Cork to serve women in the southern and western regions. Screening commenced from both units in counties Cork and Galway in December 2007. These units, together with seven mobile digital units, will provide screening to in excess of 140,000 women in the south and west of the country. To date in the expansion area, the service has been extended to counties Roscommon, Galway, Mayo, Cork, Limerick, Waterford, Tipperary North, and in the coming weeks screening begins in Tipperary South. In addition, BreastCheck is currently, as of today, screening women in Monaghan, Meath, Cavan, Kilkenny, Kildare, Dublin, Wexford, Arklow, Tallaght, Gorey, Galway, Cork, Nenagh, Mayo, Dungarvan and Limerick.
On expansion, BreastCheck was clear that it would take in excess of 24 months to complete the first round of screening. Despite media and public reports to the contrary, I assure the committee that BreastCheck remains on schedule for the introduction of the programme to all women in the remaining counties. The BreastCheck programme is, and must remain, focused on quality assurance for the women we screen. The screening schedule is part of that quality assurance. It is this focus that has ensured that the women we screen can have confidence in the service they receive from BreastCheck.
BreastCheck will not, therefore, compromise on this quality remit to satisfy any political, with a small "p", or public demand for the introduction of the service. Our screening schedules are dictated by operational considerations alone and we will not be swayed in terms of sequencing.
I refer to some key statistics. The total number of mammogram examinations carried out from 2000 to the end of September 2008 is in excess of 442,000. This has resulted in the recall of some 16,390 women for further assessment. This has, in turn, resulted in the early diagnosis of breast cancer of some 2,717 women. The overall acceptance rate of women attending after invitation in that period is 78.8%.
In 2007 the target for timely admission to hospital, an important dimension of our programme since we cover primary treatment as well as diagnosis, was exceeded for the first time since with 94.4% of women diagnosed with breast cancer by BreastCheck admitted to hospital within 21 days or three weeks.
In its 2007 "Health at a Glance" survey, the OECD ranked BreastCheck fifth in the world for the percentage of women screened, ahead of long-established screening programmes in countries including the UK, USA, France and Australia. The Scandinavian countries came in ahead of Ireland in that survey.
In April 2008, state of the art digital imaging technology was introduced across the entire breast screening programme. BreastCheck is considered to be the first screening programme internationally to be converted entirely to digital mammography. BreastCheck developed a national radiographic training centre, known as Breastlmaging, to support mammography in both screening and symptomatic services. The first Breastlmaging students graduated in June 2008.
The NCSS has a remit to make particular efforts to encourage the uptake of screening by disadvantaged groups. Dublin's north inner city has been a traditionally challenging area for us. In the past, the average acceptance of invitation to screening was only 44%. Following an intensive, targeted screening promotion campaign in the area in 2007, the uptake rate for screening reached 71%, which is the highest acceptance rate achieved by BreastCheck in that area to date. This bodes very well for the future and is testament to the excellent work of our screening promotion team.
BreastCheck is currently preparing to complete expansion into the remaining counties in the west and south. Following the national expansion of the breast screening programme and in line with Government policy and the 2006 cancer control strategy, and subject to the provision of additional resources, the upper age limit for screening will be extended to 69 in accordance with the European Council's recommendation.
The board of the NCSS has commissioned an internal review to examine the evidence for reducing the lower screening age limit from 50 to 47 years. This proposal is under examination and no decision will be made until a thorough review is complete.
CervicalCheck, the national cervical screening programme will provide free smear tests to 1.1 million eligible women aged 25 to 60 living in Ireland. Over time, a successful national programme in Ireland has the potential to cut current mortality rates from cervical cancer by up to 80%. The programme will provide a free, complete, quality-assured programme of care. Women can choose a registered smear taker. Similarly to BreastCheck, the programme is auditable against a range of quality-led criteria as published in the CervicalCheck women's charter, which is appended to the notes provided to committee members.
The ultimate focus of the programme is on quality assurance and the NCSS was anxious to ensure a number of necessary elements were in place before embarking on a national programme. A national quality assurance group was established with specific sub-groups to address the following: quality standards in primary care and smear-taking; laboratory, cytology, histology; and colposcopy, gynae-oncology and primary treatment. As part of the preparation, new screening intervals were introduced, in line with international evidence. CervicalCheck will provide screening every three years for women aged 25 to 44 years and every five years for women aged 45 to 60 years. Prior to this, in the phase one programme, there was a single interval of five years.
An NCSS smear taker contract for medical practitioners was published following an extensive consultation period. Letters from a Member of the Oireachtas were published in newspapers today concerning this contract. I wish to make clear that the contract in question was not imposed on any party. The consultation period included the publishing of a draft contract, which produced significant feedback from potential smear takers and an extensive consultation process over several months with medical practitioners, key stakeholders and representative bodies.
Following an EU public procurement process, Quest Diagnostics Incorporated was named as the provider of cytology laboratory services to the CervicalCheck programme. Quest Diagnostics Incorporated operates to a range of quality-assured standards set by the NCSS. A review of colposcopy clinics in Ireland resulted in the establishment of a quality assurance structure for colposcopy. For the information of members, colposcopy is a secondary diagnostic tool which can provide a definitive diagnosis. The NCSS has identified 11 colposcopy clinics to initially support the programme. The NCSS is examining the feasibility of providing additional colposcopy services and is in the process of agreeing a further four locations to accept referrals from CervicalCheck. The NCSS has made significant investment in colposcopy services to ensure a standardised, quality-assured level of care is delivered, with timely access for all women, as specified in the charter.
A smear taker training unit was established to facilitate the accredited smear taker training programme that is delivered by the nursing division of the Royal College of Surgeons in Ireland, the Irish College of General Practitioners and National University of Ireland, Galway. A new brand identity was introduced and the programme was made available to women on 1 September 2008.
The governance of cytology services has been transferred from the HSE National Hospitals Office to the board of the NCSS. All smear test samples are examined twice by two separate cytotechnologists. Smear test results are being provided within ten days of receipt, with results available to women within four weeks of having their test taken. Approximately 2% to 5% of women screened will require access to a colposcopy service. Our aim is to guarantee that women with high-grade changes detected are provided with such access within four weeks and women with low-grade changes are guaranteed access within eight weeks.
It is important to remember that, on average, 180 new cases of cervical cancer are diagnosed in Ireland every year. Half of all new cases are in women aged under 46 years. On average, there are 73 deaths per year in Ireland and the average age at death from cervical cancer is 56.
CervicalCheck has now registered 3,842 smear takers in 1,416 locations throughout the State. While already substantial, that number can grow, if necessary. Since the programme commenced, 69,000 smear tests kits, including vials, brushes, transport boxes and so forth have been delivered to smear takers at their various locations. That will be an ongoing process.
The Minister for Health and Children has asked the board of the NCSS to explore a national colorectal cancer screening programme. One of the key advantages of a colorectal screening programme is that it can detect pre-cancerous adenomas and is therefore a preventative health measure. In April 2007, the NCSS established an expert group on colorectal screening to make recommendations on the development of a population-based colorectal screening programme in Ireland. This group, chaired by Professor Niall O'Higgins, has evaluated the clinical and operational requirements for the establishment of an effective, well organised and quality assured service. It has examined the population to be screened, the type of screening test required, the screening intervals and the potential impact on existing clinical services. The group presented its first interim report to the board of the NCSS in December 2007. An independent peer review of the report was sought from an international panel of experts on colorectal cancer screening and was completed in August 2008. This panel included Professor Wendy Atkin and Professor Robert Steele from the United Kingdom, Professor Jean Faivre from France and Professor Michael O'Brien, who is Irish but practises in the Unites States of America. The expert group took into account the recommendations of the validation panel and completed its second and final report in October 2008 which was been submitted to the board of NCSS last week. The expert group's clinical recommendations form the basis of a modern, best practice and quality-assured screening programme for colorectal cancer. The board of the NCSS is considering the report at the moment.
In response to a request from the NCSS, the Health Information and Quality Authority, HIQA, is currently undertaking a health technology assessment to examine the relative cost effectiveness and resource implications of different models of population-based colorectal cancer screening programmes. The board of the NCSS expects to publish its recommendations in the coming weeks.
Approximately 1,900 new cases of colorectal cancer are diagnosed in Ireland every year, with 900 deaths from colorectal cancer per annum. Ireland has the highest mortality for colorectal cancer in western Europe, the fourth highest mortality rate among men worldwide and the 15th highest mortality rate among women. England is currently introducing a population programme targeting 60 to 69 year old men and women, while Scotland is introducing a population programme targeting 50 to 74 year old people. Wales will introduce a population programme imminently, initially targeting 60 to 69 year old people and gradually extending to those aged 50 to 74. A national programme is being introduced in France, which is currently screening people aged between 50 and 74, while Finland offers screening to all those in the 50 to 74 year age range. Regional programmes are under way in Italy, Spain, Hungary, Bulgaria, Romania, Czech Republic and Australia. This brings us up to date on the three main remits of the NCSS.
I pay tribute to the board, management and staff of the National Cancer Screening Service. It is a testament to their efforts that a national cervical screening programme was launched to 1.1 million women in Ireland, within 21 months of the organisation being established and receiving its mandate. It is also significant that BreastCheck has become the first national screening service provider worldwide to offer a fully digital mammography service.
The National Cancer Screening Service has developed an organisation that is not subject to the traditional barriers and enmities that so often exist between clinicians and administrators and this is one of our key strengths. It contributes to the fact that the NCSS has never lost a day to industrial action and I firmly believe this is due to the cohesive working relationships fostered among staff regardless of discipline. Every member of the NCSS team is committed to our ultimate shared goal of reducing the incidence and mortality of cancer among women in Ireland and, we hope, among a large section of men.
Our organisation is one that can make a real difference and the commitment of our staff is what makes it work. We have had much success in our screening programmes to date and the model we have created clearly works. Everyone in the NCSS is committed to providing quality assured screening that women in Ireland can trust. The experience of what we have achieved forms a model for future screening and cancer care programmes. Quality assurance will continue to underpin every aspect of every programme undertaken by the National Cancer Screening Service.