The Minister of State is most welcome to Seanad Éireann. The first Commencement matter is by Senator Cosgrove. She has four minutes.

Cuirim fáilte roimh an Aire Stáit. I have spoken to her before about this issue. At the beginning of September, RTÉ's "Liveline" programme spent three days discussing the matter of dense breast material. The Minister of State might have heard it because it got huge coverage. It is something I have raised before in this Chamber, not only as a woman but as a representative of Sligo. I first became aware even of the existence of dense breasts with the tragic death of a Sligo woman named Marian Lovett. To give an outline of how the system failed Marian, in 2022, she received a clear mammogram. Less than 12 months later, she received a diagnosis of stage 4 terminal breast cancer. Sadly, she passed away then one year later. Marian's cancer was missed because her breasts contained more fibrous and glandular material than fatty material. The Minister of State will be aware that dense breast material appears white on a standard mammogram and cancerous materials also appear as white, so it makes it difficult to spot. Several of the callers to "Liveline", and fair play to Kieran Cuddihy for raising this so well on the programme, noted that the chances of finding cancerous material on a mammogram is akin to finding a snowball in a snowstorm. As a result of the campaign that was brought forward by Lobular Ireland, Siobhán Freeney and Marian's daughter, Martha Lovett Cullen, who brought this to my attention, we heard the women's stories. They were very brave when they came on and spoke about this and how they want the information made available to them that the HSE is receiving. I acknowledge HIQA is involved in looking at the issue.

I am going to give the example of Evan, who I heard speak about this. She got a private mammogram in her late 40s because she had a family history of breast cancer. At the private mammogram, she was told by the radiographer that she had extremely dense breasts and needed to be aware of this and that she would require additional screening. The additional screening was required because her breasts showed up as white on the standard mammogram, as would the cancer. Evan requested an ultrasound and a biopsy due to her family history and two weeks later, she was found to have stage 1 lobular cancer. She was lucky that her cancer was identified early. The point is that if she was just getting a standard breast check for cancer, people are not told with that mammogram.

I went for my first breast check during the summer. I was called back. The reason I was called back was because there was an unclear reading. However, I was not told either that I had dense breast tissue. I queried it. I asked, "Why am I being called back? Is it because I have dense breasts?" However, the clinicians were not able to give me that information. To me, it seems that if a woman can get a private mammogram and be told she has dense breasts and can make an informed decision to look for a biopsy and a second mammogram, why should everyone not do so?

This is not a failure of BreastCheck. All the women said that. They all said that it is a fantastic service, but we should be told. We should be entitled to the information the HSE is getting. If the clinicians are not able to read it on the mammogram, the equipment or whatever is needed to update the software needs to be put in place.

HIQA is involved, but that is going to be 2027 and the results of that might not be put into play until 2028. In the meantime, can people be told the information the HSE has access to that their own GPs can have access to? Why can people not be told that they have dense breast tissue so that they are able to make an informed choice themselves? It is not that long ago that CervicalCheck was under discussion. I hate bringing that up but it is not that long ago that it also happened that women were not being told. Their information is there and they should be given the information if the HSE has it.

I thank Senator Cosgrove for the opportunity to discuss this important matter of breast density notification. I have just come from the Dáil Chamber where I took a Topical Issue matter in relation to the important matter of breast screening. I am taking both on behalf of the Minister, Deputy Carroll MacNeill.

The first thing I want to mention, and the Senator said it as well, is the importance of breast screening. Unfortunately, only 70% of people take up their appointment; one out of every three does not. Any time we are speaking about women's health, and we are all unified in this, the more people who go for screening, the better. That is the first piece. One third of all breast cancers of the 3,500 every year are identified through BreastCheck. That is the first point I want to make. We are all in agreement about how important it is.

To move on to the matter of breast density notification, which is a really important thing, depending on a woman's body shape, as to whether breast density can be identified. It is common; around half of all women have dense breasts. It is a normal variation in breast tissue. Breast density is one of several factors that can influence breast cancer risk. It is very important to say, however, that having dense breasts does not mean someone will develop breast cancer. High levels of breast density can make mammograms more difficult to interpret in some women. However, breast density alone does not automatically mean that further imaging is required. Decisions about additional imaging are made on an individual basis by the clinical team as part of a women's assessment and diagnosis.

BreastCheck mammograms remain the best screening test available for population breast screening for women aged 50 to 69 years of age. It can save lives by finding many cancers early, often before symptoms develop. It is important to know that mammography detects the majority of breast cancers, including in women with dense breasts.

Consideration of any changes in Ireland's screening programmes is facilitated through established, evidence-driven protocols. The national screening advisory committee is an independent expert group that advises the Minister for Health on any proposed changes to Ireland's screening programmes. As Senator Cosgrove noted, at the request of the committee, the Health Information and Quality Authority, HIQA, has commenced a health technology assessment, HTA, to consider proposals for expansion of the BreastCheck programme. This is democracy in action. This is women with lived experience bringing their concerns forward through a committee, with recommendation made to the Minister and that recommendation has now gone to HIQA.

This review will comprise of three distinct components. First is the proposed extension of the age range eligibility to those aged 45 to 49, which I agree with. Second is the extension of age range to those aged 70 to 74. Again, I think that is really important. Third is the potential introduction of a standardised breast density notification. That is what the Senator is talking about. She talked about someone who went privately. I am not sure if it is across all private or if it was just that individual case. It is an interesting point. I do think the potential introduction of a standardised breast density notification would be really important to support women.

The HTA facilitates the assessment of relevant evidence on the effects and consequences of healthcare technologies or programmes. They seek to guide decisions regarding the appropriate use of technology and efficient allocation of resources. They involve a multidisciplinary assessment of clinical, economic, ethical, legal and societal perspectives that may be impacted by the introduction of a new technology or programme.

The Minister for Health wants to be in a position to develop services that are clinically effective and have positive health outcomes. She needs to be informed by the experts in order to do this. I will certainly discuss this with the Minister. She is not available today as there are a lot of budget talks going on. It is something I have heard about from my own friends, from colleagues and from Senator Cosgrove, who is such an advocate for women's health, and I compliment her on that. I have no problem coming into the Seanad any time to discuss women's health.

I thank the Minister of State for being so responsive. No one is disputing this, and we are totally in favour of extending the BreastCheck to both sides of the existing age range. It is a wonderful service and it is picking up many cancers. If someone has dense breast tissue it does not appear often as a lump. It is like a spider web and women are not feeling it. They have been encouraged to check their own breasts. If they have dense breast tissue, it is not showing up as a lump. At the moment we are not even looking at a second mammogram or ultrasound being referred. It is about women being told the information in order that they can decide if they want to do it privately themselves. I can see what the HIQA report will hopefully recommend, that is, that if dense breast tissue is showing up, women are to be referred for a second mammogram or ultrasound or biopsy; whatever is appropriate.

In my experience, when I was referred, it was really quick. Unfortunately, it was not in Sligo, and I had to go to Galway but it was really fast. I had a second mammogram and I had an ultrasound. I did not need to get a biopsy. What we are looking for in the interim before the HIQA report is concluded is that women are given the information so they can see that maybe they do need to pay for a second mammogram or maybe they need to look for an ultrasound. It is just so they have access to their own information.

I thank Senator Cosgrove. I assure her I will bring her views on this important matter back to the Minister for Health. It is important for me to clarify for the House that the BreastCheck programme does not currently collect, record or report on breast density scores. Determining the merits or otherwise of introducing such a notification is precisely the purpose of the HTA process, which should be allowed run its course. It is under way. Population-based screening programmes are intended for individuals without symptoms. It is really important that we recognise it is for people without symptoms. If somebody has any concerns or symptoms related to their breasts, they should not attend screening but instead should contact a medical professional for appropriate advice, that is, their GP. That is important.

I actually got notified yesterday. My husband told me on the phone that I got a notification from BreastCheck to attend. I think this is my fourth time going. It is a very good service. It really is. Unfortunately, only two out of three appointments are taken up. It falls more in the summer. People are busy. They might be working. It might not be easy to get off work. However, it is important to contact them, and they will reschedule. That is the most important thing to say. It is very important that every woman is breast-aware, which means knowing what is normal for them so that if any unusual change occurs, they will recognise it. Further information is available on the HSE website and on breastcheck.ie.

To return to Senator Cosgrove's point, the Minister has said she has to allow the process to take place before she can make that decision, which is the Senator's request, that the person should be notified. That would mean training and everything. The sooner we get this done by HIQA, the better, and hopefully we will have a positive outcome. I do support what the Senator is trying to achieve.

Gabhaim buíochas leis an Aire Stáit. I thank her for always being so available to the Seanad Chamber. It is lovely to see her here this morning.

While we are waiting for our next Commencement matter, I wish to welcome a special guest to the Visitors Gallery. We have Robert Watson, friend of Deputy Aindrias Moynihan. Good morning to them both. It is lovely to see them in the Chamber, and I hope they enjoy the proceedings.