There has been worldwide coverage and publicity given to the decision by the actress Angelina Jolie to have a bilateral mastectomy because she has a mutation in the BRCA1 gene. Her decision to go public is a very brave one and will undoubtedly save the lives of many women across the world. It has also stimulated debate here and elsewhere on the adequacy of DNA screening programmes.

Ireland has a nationwide mammogram screening service for women over 50, which has been very effective and successful, but we do not have a DNA screening programme for BRCA1 and BRCA2 gene mutations. At the moment, women who have a family history of breast cancer are generally referred to their GPs for advice and may be referred on to one of the eight cancer centres of excellence in the country or be referred to a private centre, where the costs are prohibitive. The Irish Cancer Society has confirmed that there are approximately 360 Irish women who have the relevant mutation in their BRCA genes. The waiting time for such tests to be carried out, at up to 18 months, is excessive due to a shortage of funding. This situation is unacceptable, particularly because any woman who receives a positive test result is in a position to make a decision to have surgery which could dramatically reduce her risk of developing cancer. The risk of developing breast cancer can be reduced from 87% to 5% and the risk for ovarian cancer can be reduced by up to 50%.

A month ago, the Health Information and Quality Authority, HIQA, published a report, undertaken at the request of the National Cancer Control Programme, NCCP, which recommended DNA screening for women aged between 30 and 49. Such screening could reduce the number of deaths and would be cost-effective. I ask the Taoiseach to confirm that this DNA screening programme, as recommended by HIQA, will go ahead. Does the Taoiseach accept that the waiting time for testing for BRCA mutations, at an average of 18 months, is totally unacceptable? Will the Taoiseach confirm today that urgent action will be taken to enable this test to be made available within weeks to the women concerned?

I, like millions of others, read the story of the actress Angelina Jolie and her decision to have a mastectomy, as well as her statement to her children that their mammy would always be the same. She made her decision based on the risk of death, as her mother had died of ovarian cancer. This is of particular interest to a cohort of women in this country and around the world.

The demand for counselling and testing for diagnosis of hereditary genetic mutations in the BRCA1 and BRCA2 genes for patients diagnosed with breast or ovarian cancer who have a strong family history of similar cancers occurring in relatives younger than 50 years has increased. The NCCP has established a hereditary cancer programme in collaboration with the National Centre for Medical Genetics at Crumlin Hospital to improve access to assessment and genetic testing for those patients whose cancer may have a hereditary component. There are outpatient clinics with genetic cancer expertise at St. James's Hospital and the Mater hospital, with a similar service planned for Cork University Hospital shortly. That programme is primarily focused on patients who have hereditary breast, ovarian or bowel cancer. A working group has been established to agree appropriate structures and best practice in the identification and management of those with hereditary cancer mutations.

Deputy Martin is correct that at the request of the HSE, HIQA recently completed a health technology assessment of surveillance of women aged less than 50 who are at elevated risk of breast cancer. The Deputy will be aware that the programme for Government contains a commitment to extend the breast cancer screening programme to those aged between 65 and 70. HIQA examined the potential of a standardised surveillance programme as well as the resources required to support such a programme. The report found that surveillance for these women can reduce the number of deaths when compared to a situation where there is no surveillance programme in place, which seems to be quite logical. Women at high risk tend to have far more aggressive tumours, so early detection in these cases is absolutely critical. For those women who have been identified as being carriers of certain genetic mutations, HIQA concluded that surveillance from ages 30 to 49 using annual MRI tests would be cost-effective, and for those aged between 40 and 49, the addition of an annual mammogram should be considered. In another small cohort of women who have a high probability of developing breast cancer before 30 - that is, those who are carriers of a mutated TP53 gene - annual MRI surveillance from age 20 to 49 is the optimal strategy recommended by HIQA.

For women with a high familial risk but no identified genetic mutations and for those at moderate risk the HIQA report found that surveillance is not cost-effective compared to offering no surveillance.

However, HIQA concluded that if the goal is to maximise health gains using existing resources and taking account of current international best practice then annual surveillance using mammograms for those aged 40 to 49 years is better than the current arrangements. For persons who have a high risk or who have a family history in these kinds of cases the reported waiting list is not as long. In cases where there is no history doctors have recommended that a test is not absolutely necessary. The HSE national cancer control programme and the report specifically identify the at-risk categories and the strategy and structure for that is being put in place now by the working group. I hope it will save lives.

The fundamental question is will the Government extend the screening programme and will the resources be made available to extend the surveillance programme, as recommended by HIQA? That is the first question on which I seek absolute clarity and confirmation. The establishment of a working group does not mean a great deal. It can mean something but it would have to be followed up by a clear commitment to adequately resource the provision of any programme or service. That would take funding but the numbers involved are not significant in terms of those with a genetic mutation that would create a higher risk of developing breast cancer and ovarian cancer. Let us consider the numbers at issue. I understand approximately 4,200 women are known to have familial risks but only one in 15 of these actually have a genetic mutation. The costs cannot be insurmountable in this case although I realise there will be logistical issues and so on.

That is the position in terms of surveillance and screening. Equally important, is it acceptable that if one wants to have the DNA test done one must pay approximately €1,400 or else wait 18 months? I call on the Taoiseach, the Government and the Minister for Health to focus on that specific area and issue. At the moment the tests are going to Birmingham. The Taoiseach mentioned the national centre in Crumlin. The spokespeople at the national centre maintain that their equipment is hopelessly outdated, that they require new equipment and that extra capital resources to provide the equipment necessary to do the testing here are required. That has been well commented on by many of the experts involved in the aftermath of this issue getting the attention it is getting today.

Is the Taoiseach confirming that the surveillance programme as recommended by HIQA is going ahead and that resources will be provided to enable it? Will the Taoiseach take urgent action to enable women who need DNA testing to get it as a matter of necessity? Will he ensure that the availability and accessibility will be enhanced dramatically from the current waiting time of 18 months, a period which, I imagine the Taoiseach would agree, is unacceptable? The numbers are not vast. Lives can be saved. We are discussing reducing the risk of getting specific cancers from 87% to 5% and reducing the risk of ovarian cancer by 15%. There are gains to be made.

The working group has a function. I have no wish for it to be like working groups in the past, which did not do anything other than make a report.

We did the breast screening.

As Deputy Martin is aware, this issue concerns the lives of women here. It is also true to say that if a general practitioner anywhere in the country has a concern about someone in his surgery who may be in this category, he will not say to her that he is sorry and that she will have to wait 18 months because of his concern that she cannot be screened. If the GP has a genuine concern that a person in his surgery has a family history of this and that there is a real risk, then obviously in such a case because it is in that category it has to receive priority and the patient must be given a screening.

They do not get it. I am referring to the genetic mutation tests not the mammograms.

The Taoiseach, without interruption.

We are all interested in this. We need to understand and assess the numbers waiting for 18 months for assessment. Are they all for this particular category? Am I to understand that if a GP has a person in his surgery this morning, he must say that he is sorry and that they cannot do anything for the patient for 18 months despite the fact that she may have a serious possibility or probability of being caught in this particular function?

Patients must go private to get the DNA testing done or else wait 18 months.

He is mixing it up.

That is what the GPs are saying.

I ask the Taoiseach to conclude.

I do not have all the details of all these to hand this morning. However, I assume the working group-----

Will a GP refer someone?

Yes, a GP can refer someone.

Only to the private sphere because that is the only way one can get the treatment.

We have had cases-----

If a patient is on the public waiting list, she must wait 18 months.

Listen to the Taoiseach.

Please, Deputy Martin.

Does Deputy Martin want to get an answer or does he just want to interrupt?

Deputy Martin is aware that the breast screening system which operates here is one of the most effective of its kind.

That is for mammograms.

Cases have come to my clinic involving those covered in the private sector who were advised to go through the public hospitals and actually got treatment there very quickly.

That is for mammograms.

That is for cases of immediate risk.

It is a different programme.

People who are at immediate risk can be referred by their GPs for immediate screening where there is a risk and a probability that they may well be in this category. I assume that the working group will assess all of these figures and realities. At the moment, if a GP has someone about whom he has a genuine concern to the effect that she may be in danger of being caught by this type of cancer, then she can be referred for priority screening.