I welcome the Minister of State, Deputy Murnane O'Connor. She is most welcome to Seanad Éireann.

I thank the Minister of State for being here. We know that aside from skin cancer, breast cancer is the most common form of cancer in Ireland. Approximately one in seven women will be diagnosed with it. The HSE provides a variety of treatment options for women with breast cancer depending on its stage, grade and severity. Among these options is a mastectomy, which is a procedure that removes the breast after which patients can have breast reconstruction surgery, a procedure that replaces the breast tissue previously removed.

Unfortunately, though, today, quite a number of women who have received mastectomies are experiencing excessive waiting times for reconstruction surgery. We know that women often have a choice to make between receiving breast reconstruction immediately after undergoing a mastectomy or waiting to have a reconstruction done in the future, which is what we call "delayed reconstruction".

Sometimes, a mastectomy is not recommended given a patient's circumstances and health. Quite often, for medical reasons, immediate reconstruction is not possible. For other women, there are myriad different reasons they cannot at that point have it. Indeed, one woman who spoke to me said she was given four days to make her mind up. She was just devastated at the impact of having a mastectomy and could not imagine spending several more hours undergoing that operation. People need to be mentally ready to have that type of surgery.

Many have been waiting for between four and seven years on public waiting lists. I know of some who had mastectomies in 2021 and are still waiting. In the case of one woman who came to me a number of weeks ago, sadly, the surgeon she had in St. Vincent's has passed away. At every subsequent meeting she has had for a check-up and examination, which was every three months initially, then every six months and is now a year, she has had a different surgeon every time. The delayed reconstruction was requested, but she discovered only two weeks ago that that was never acted on within her notes. Even though she has asked for it multiple times, her request was never acted on. It was referred to another hospital two years ago and is now at the bottom of its waiting list.

This situation has a huge impact on mental health and well-being. It causes prolonged distress, anxiety and frustration, impacts on confidence and self-esteem and leads to people avoiding things like swimming, holidays, social events and intimacy. There are, of course, restrictions on clothing and daily activities. There is an ongoing sense of being unfinished in recovery, and this is really the key thing I wish to ask about here. The recovery and treatment should cover everything up to the end of the reconstruction. I do want to acknowledge my party colleague Senator Teresa Costello, who has spoken about this quite a lot, including a few months ago. Delayed reconstruction is now categorised as non-urgent, despite substantial psychological consequences, and I am asking the Minister of State to have it classified as urgent.

I thank Senator O'Loughlin for raising this really important issue today. As she knows, I am taking this Commencement matter on behalf of the Minister, Deputy Jennifer Carroll MacNeill, who cannot be here. The Senator has highlighted a really important issue. The Government is committed to improving cancer care, ensuring better prevention and maintaining improvements in cancer survival rates and timely access to treatments.

As the Senator said, breast cancer is the most common cancer among women in Ireland. Almost 4,000 cases of breast cancer were diagnosed in Ireland in 2025. Fortunately, under the national cancer strategies, survival rates for breast cancer have greatly improved. The most recent figures show a five-year survival rate of 87.5% for people diagnosed between 2019 and 2022, which we all really welcome. The stage of the diagnosis has a significant impact on survival rates and earlier diagnosis often leads to better outcomes.

The Minister, the Department and the HSE recognise that breast reconstruction surgery following treatment for cancer is an important part of a patient's recovery and should be accessible to everyone who wants to have it.

There is a wide range of treatments for breast cancer. Surgical options are discussed through the consultant with the patients to see what they want. Where surgery involves a mastectomy, options for reconstruction surgery will also be discussed. The reconstruction is often done at the same time as the mastectomy surgery, but it can be done at a later date. The HSE's national cancer control programme, NCCP, reports that access to services is affected by several issues. The surgery is a stand-alone procedure. It must be scheduled within the overall surgical capacity of the hospital and can be affected by unscheduled care and demand for theatre access. Surgeries can be lengthy and complex depending on the type of reconstruction taking place. Significant clinical and nursing expertise can be needed.

The implementation of the NCCP's hereditary cancer model of care, which was published in 2023, means that women who have an identified genetic predisposition can be referred to the specialist services to discuss risk reduction strategies, including preventable double mastectomies, which can include breast reconstruction based on a patient's preference. In 2023, the NCCP carried out a survey of cancer centres that looked at waiting times for reconstruction surgeries. The NCCP worked with the HSE acute operations to facilitate access for hospitals to the National Treatment Purchase Fund, NTPF, as a short-term measure to help to speed up the reconstructive surgeries across the different cancer centres and reduce overall waiting times.

In 2025, the NCCP provided funding to Cork University Hospital to pilot a project for patients to receive their risk-reducing surgery in the South Infirmary Victoria University Hospital using elective theatre space. This pilot allows surgeries to be scheduled in a timely way suitable to the patients and does not compete with other cancer or unscheduled care demands. My thoughts go out to the patients still waiting for their surgery. The Government and I recognise the urgency of need for patients to receive their surgery so they can finish their treatment and move on with their lives. The Government remains committed to the implementation of the national cancer strategy and to continually build on improvements to service and better outcomes for patients.

I thank the Minister of State. In her response, she acknowledged that "breast reconstruction surgery following treatment is an important part of a patient's recovery and should be accessible to everybody". It is not just an important part; it should be an urgent part. It is not cosmetic. It is a recognised component of cancer recovery. At the moment, public patients are facing prolonged uncertain waits. It appears from the statistics that women's reconstructive surgery is consistently deprioritised within the elective care system. The delayed reconstruction effectively extends the cancer journey by several years. It undermines recovery, dignity and long-term well-being. There must be more that the Minister and the HSE can do. I acknowledge that the treatment abroad scheme is used, but that is not going to suit everybody. We need to get the data on the waiting list action plan 2025. Going forward, we need to look at surgeons promoting immediate surgery when it suits. There also needs to be an increased Government budget allowance.

What the Senator said is important for women waiting on this surgery. I assure her that the Department and HSE are working on reducing waiting times for this surgery. While immediate reconstruction can avoid a second hospital procedure - I think that is more important - delayed reconstruction allows for more time for decision making and can ensure that necessary cancer therapies are not delayed. Successive national cancer strategies have delivered a continued improvement in the outcomes for cancer patients. Since the beginning of the national cancer strategy in 2017, the Government has allocated €105 million to support cancer services and improve outcomes for patients. Under this investment, more patients are being seen in the specialist centre and more patients are being reviewed.

New drugs and therapies are being made available and patients are receiving better support with their cancer treatment.

I ask the Senator to give me the lady's details because her case is one that we need to look into, particularly as the Senator said that she has gone back down to the end of the waiting list. That is a worry for me. I assure the Senator that the HSE and the Department are working at getting those waiting times down. I thank her for raising this issue today. It is also important to mention Senator Costello who has been highlighting this issue too.