Dáil Éireann - Volume 525 - 07 November, 2000

Written Answers. - Cancer Screening Programme.

133. Mr. Stagg asked the Minister for Health and Children the steps being taken to ensure that the national breast cancer screening service is available to all women on a country wide basis; and if he will make a statement on the matter. [24539/00]

Minister for Health and Children (Mr. Martin): The Deputy will be aware that in March 1997, the then Minister announced the introduction of a major action plan to implement the proposals contained in the national cancer strategy. Included in the plan were proposals for the introduction on a phased basis of a national breast screening programme. Phase I will cover the Eastern, North Eastern and Midland Health Board areas and will target 136,000 women in the age cohort 50 to 64, which represents approximately 50% of the national target population.

The decision to proceed on a phased basis is a reflection of the complexities involved in the screening process rather than the costs involved and my Department's key objective is to ensure that the programme meets the necessary quality assurance criteria. For this reason the national breast screening programme must be driven by [366] international quality assurance standards and best practice.

Specifically the phasing will take account of the following critical success factors: the achievement of acceptable compliance levels among the target population; ongoing evaluation of the programme from a quality assurance perspective; and availability of the necessary clinical expertise to conduct the programme.

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

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

I am conscious of the importance of early access to symptomatic mammography services and of the provision of an equivalent standard of excellence in both symptomatic and screening mammography services. A review of symptomatic breast cancer services was carried out by a sub-group of the national cancer forum at the request of my predecessor, Deputy Cowen. This review commenced in 1999 and I received its report in April this year.

Having considered the report entitled Development of Services for Symptomatic Breast Disease, I accept the broad thrust of its recommendations. This report is essentially about the development of centres of excellence for the specialist treatment of breast disease. The report refers to the strong evidence which exists that women with breast cancer are at a lower risk of relapse and have a better opportunity of long-term survival if they are treated in a multidisciplinary setting. This means that surgeons, radiologists, pathologists, medical oncologists, radiotherapists, plastic surgeons, nurses, counsellors and others all bring expertise together to provide the best care for each patient. The report is recommending the establishment of these specialist units. It is in this context that I emphasise the importance of prioritising women's health over and above geopolitical considerations.

Having considered the report, I established an expert advisory group to assist and liaise with health boards in formulating the health boards implementation plans for the development of specialist breast units. This advisory group under the chairmanship of Professor Niall O'Higgins has met with all health boards recently. The health boards are now formulating their plans for [367] the development of the services in their own regions and I await the submission of these plans.