The number of mammograms carried out by the HSE’s BreastCheck screening service fell by more than two-thirds in 2020, leading to the detection of 600 fewer breast cancers.
Some 56,000 women had a full mammogram last year compared to more than 170,000 in 2019, a drop of 114,000, and mammogram numbers this year are expected to be behind again as BreastCheck operates a coronavirus-affected service.
The average number of cancers detected by BreastCheck each year is 1,050. Warning that delays will continue, the HSE said BreastCheck “does not aim to catch up on issuing outstanding invitations in the short term”.
The current delays will mean that many women will get a BreastCheck screening every three years, rather than the recommended two-yearly check.
When targets for 2020 are examined, the drop in mammograms is even higher than 114,000, since it had been planned to carry out 128,000 more mammograms last year than were actually possible to do.
Appointments ceased
“The pause in screening was put in place to protect participants and staff by complying with social distancing guidelines. When screening was paused, the arranging of appointments ceased,” said a HSE spokeswoman.
According to the HSE, a significant number of women attending BreastCheck are in a vulnerable age category for contracting the virus, as it caters for women aged 50-69. BreastCheck carries out mammograms on healthy women only.
Appointments for routine screening will resume when it is deemed safe to ask women to reattend, according to HSE clinical director of BreastCheck Prof Ann O’Doherty.
Acknowledging the impact of the virus, Prof O’Doherty said: “Most years we pick up six cancers in every 1,000 women we screen. We’ve screened much less so there are hundreds of women we haven’t diagnosed.
“We know that and we are desperate to get back screening,” she said, adding that women with breast cancer are still receiving treatment and anyone with symptoms should seek advice.
Women who require “further assessment” are being seen in follow-up clinics and the HSE has urged those undergoing follow-up treatment to attend their appointments.
Noting the pressures created by the virus on the State’s hospitals, she said: “The truth of the matter is we are not able to treat people in the normal way because hospitals are full of Covid patients.
“We don’t save lives by doing a mammogram. We save their lives by treating patients and getting them to hospital and operating. That is a huge problem in Covid times because hospitals are inundated with sick people.
“It’s very hard to get people in at the moment. We’re not ignoring screening but we have to do what is going to give the best outcome in Covid times,” she told The Irish Times.
Despite the problems, the health service was treating the same number of women for breast cancer as it had been at the end of 2019: “So that was good. People were very frightened at the start and didn’t come in.
“Then it stabilised and overall we don’t think that we had a lot of people not coming in,” she said, though it will be impossible fully to catch up with the screenings missed during the pandemic.
This is because of a lack of trained personnel required to ramp up screening, she said, adding that it takes 15 years to train a breast radiologist and seven years to train a radiographer.
Concerns
“It’s absolutely unrealistic to think that we are going to catch up. We’re going to keep going and get as many through the system as possible. We will probably have in the next year or two some women going out to three years, which would be the norm in the UK. We’d love to get everyone back at two years.
BreastCheck is a screening service for well women, and not a symptomatic service, so women with concerns should immediately contact their GP for referral on to hospital clinics that are still fully working.
However, women with symptoms of breast cancer have avoided presenting for investigation because of their fears about contracting the virus, according to a leading expert, Arnold Hill, professor of surgery and head of the medical school at the Royal College of Surgeons Ireland (RCSI).
“I think there are a number of people who are obviously concerned and are opting not to come. There is no question about that. It’s very hard in a Level 5 lockdown though, because people themselves are often not certain about what is normal and who can blame them,” he said.
“Understandably, patients have fears and concerns about attending hospital but we still want to see a woman with a possible lump to make sure they don’t have cancer and if they do, we’re here to treat them.
Despite the challenges, Beaumont Hospital, where Prof Hill works as a breast and endocrine surgeon, detected more cancers last year than the year before, making 380 diagnoses in 2019 and more than 400 in 2020.
When caught early, breast cancer, the second most common cancer in women in Ireland, has an 85 per cent survival rate after five years. About 700 women die from the disease every year. One in 10 will be diagnosed with it during their lifetime.
The chairman of the charity Breast Cancer Ireland (BCI), Prof Hill said new research has found an existing cancer drug, Dasatinib, can have a “helpful effect” in treating aggressive breast cancers, combined with chemotherapy.
Known as triple negative breast cancers, or TNBCs, they occur in younger women as well as those who are older, grow rapidly and are challenging to treat. Few young women treated for TNBCs later can have children.
The research was led by Dr Paul Mullan at Queen's University Belfast. Welcoming the development, the chief executive of BCI Aisling Hurley said it hopes one day to make breast cancer "a long-term treatable disease".
To mark World Cancer Day on Thursday the Irish Cancer Society is urging people to contact their doctor if they are concerned about symptoms that may indicate cancer.
Eight signs of breast cancer
The eight signs/symptoms to be aware of in self-examination are:
– Puckering of the skin of the breast
– Lump in breast or armpit
– Change in skin around nipple or nipple discharge
– Dimpling of the nipple or nipple retraction
– Unusual increase in the size of one breast
– One breast unusually lower than the other – nipples at different levels
– Enlargement of the glands
– Unusual swelling in the armpit
Regular updates to screening schedule changes are available at breastcheck.ie. Women can also contact Freephone 1800 45 45 55 or info@breastcheck.ie