The Irish health watchdog is set to undertake a comprehensive assessment to determine whether “breast density” should be incorporated into the national cancer screening program. The Health Information and Quality Authority (HIQA) has announced it will investigate the feasibility of measuring, informing, and offering supplementary screening to women participating in BreastCheck, based on their individual breast density.
This significant review also encompasses the potential expansion of the national screening service to encompass younger and older age demographics, aiming to cast a wider net in the early detection of breast cancer.
Understanding Breast Density and Its Implications
Women with dense breasts face a statistically higher risk of developing breast cancer. Furthermore, standard digital mammography alone can present challenges in accurately screening these individuals, potentially leading to missed diagnoses. To address this, women with dense breasts could be offered additional screening modalities. These might include:
- Digital breast tomosynthesis: Often referred to as a “3D mammogram,” this technology takes multiple images of the breast from different angles, creating a more detailed, layered view.
- Magnetic Resonance Imaging (MRI): This imaging technique uses magnetic fields and radio waves to create detailed images of organs and tissues.
- Contrast-enhanced mammography: This involves injecting a contrast dye into the bloodstream to make abnormalities more visible on a mammogram.
- Ultrasound: This uses sound waves to create images of breast tissue, often used in conjunction with mammography.
The Landscape of Breast Cancer in Ireland
Breast cancer remains a significant health concern in Ireland. Between 2020 and 2022, it was the most commonly diagnosed invasive cancer among women and the second leading cause of cancer-related mortality. Annually, approximately 3,500 cases of breast cancer are diagnosed across the country.
Currently, the BreastCheck program offers free mammograms every two years to women aged 50 to 69. This national population-based breast screening program is a cornerstone of early detection efforts.
A Step Forward for Breast Cancer Outcomes
The announcement from HIQA has been met with enthusiasm, particularly from those with lived experience of the disease. Fianna Fáil senator Teresa Costello, a breast cancer survivor herself, has hailed the development as a crucial advancement.
“Today’s announcement from HIQA is positive in improving breast cancer outcomes for women in Ireland,” she stated, underscoring the potential benefits of a more nuanced approach to screening.
Senator Costello also expressed her support for a separate review considering the extension of BreastCheck eligibility. This assessment will explore lowering the age range to include women aged 45 to 49 and extending it to those aged 70 to 74.
This push for expanded age eligibility is not new. Senator Costello, alongside Fianna Fáil TDs Erin McGreehan and John Lahart, previously submitted a proposal to the National Screening Advisory Committee in 2021, advocating for the BreastCheck age to be lowered to 40. Their reasoning stems from the fact that a substantial proportion of breast cancer diagnoses in Ireland – nearly 25% – occur in women under the age of 50.
Addressing Gaps in the System
While improvements to the BreastCheck program are welcomed, Senator Costello has raised important concerns about women who present with symptoms outside the established screening age. She cautioned that focusing solely on screening improvements must not inadvertently overshadow the challenges faced by those attending symptomatic breast clinics, particularly younger women who do not meet the current age criteria for routine screening.
Senator Costello’s personal journey highlights the critical nature of timely diagnosis. She was diagnosed with stage-three breast cancer at the age of 36. “I believe the reason I’m still here today is because the day I went to the symptomatic breast clinic, I was given a triple assessment,” she recounted. “I wasn’t sent out of that clinic and told, ‘We’re going to make an appointment for you’, and I wasn’t left waiting six months.”
These concerns about diagnostic delays are echoed by Aisling Hurley, CEO of Breast Cancer Ireland. She has spoken out about the potentially devastating consequences of prolonged waiting times for patients.
“We know people who have had their physical exam, they’ve had their mammogram, they’ve been told to wait for their ultrasound, and they got a seven-month wait, only then to be diagnosed with stage four terminal, incurable cancer,” Hurley stated, painting a stark picture of the impact of systemic delays.
The urgency for these reviews is further underscored by recent performance figures. Last August, it was confirmed that BreastCheck had failed to meet its screening targets for two consecutive years. In 2024, the target was to screen 195,000 women and others; however, the service only managed to conduct 137,134 checks.
HIQA has indicated that the outcome of the new assessment could lead to further investigations into the economic and organisational implications of integrating breast density considerations into the BreastCheck program. Dr Máirín Ryan, HIQA’s deputy chief executive, confirmed the scope of the review: “Our assessment will review the available international evidence to help inform a recommendation by the National Screening Advisory Committee to the Minister for Health.” This thorough examination aims to ensure that Ireland’s breast cancer screening strategy is as effective and equitable as possible.
