THE IRISH CANCER Society has said it is “essential” that BreastCheck continues to be supported by Government after the service said appointments in their current screening round are delayed by up to a year.

The national screening programme said the delays are due to the impact of the Covid-19 pandemic, with the service now planning to screen women every three years instead of every two.

The screening service is for women who do not have symptoms and who are aged between 50-69.

It was paused for several months at the beginning of the pandemic in 2020, and again between January and March 2021, in order to “protect participants and staff by complying with social distancing guidelines to prevent the spread of COVID-19”.

This pause in screening meant that women had to wait longer for their appointments.

A spokesperson for BreastCheck said that while the service was paused, “we provided support to the symptomatic breast cancer service, assessing and treating women of all ages who were at high-risk of breast cancer and whose hospital appointments had been delayed due to COVID-19.”

“This meant that urgent patients who had symptoms were seen quicker, with the aim of improving the outcome of any diagnosis,” the spokesperson added.

“Appointments in our current screening round, where we normally invite women for screening once every two years, are delayed by up to a year.”

This means that if a woman was due to be screened in 2020, BreastCheck aimed to invite her in 2021; if she was due to be screened in 2021, BreastCheck will aim to invite her this year.

The spokesperson said the service is prioritising women “who were due screening longest and women who are new to screening”.

During this time, Ireland will be more in line with England, which screens women every three years. However, we aim to return to screening women every two years as soon as possible. This is dependent on the situation with COVID-19 and restrictions.

Some are concerned that this move will further delay breast cancer diagnoses in Ireland.

Director of advocacy at the Irish Cancer Society Rachel Morrogh told The Journal: “It is essential that the National Screening Service continues to be supported by Government with whatever it needs so it can continue to recover from the impact of the pandemic across all its programmes, including returning to a two-year programme for BreastCheck.”

“The pandemic has had a significant impact on all cancer services and this includes cancer screening. The European Cancer Organisation estimates that one million cancer screenings in Europe did not take place during the pandemic and experts have warned that this could lead to later stage diagnoses,” she said.

Morrogh said that many people have contacted the Irish Cancer Society nurses with questions about how interruptions to cancer screening might affect them.

While people are waiting to be called for their screening appointment, we urge the public to remain aware of their health and any changes in their body. Screening is not for people who have symptoms of cancer. It’s vital that anyone who has any unusual or persistent symptoms, such as a lump or unexplained bleeding, seeks medical advice from their GP, who will arrange follow-up care.

“The Irish Cancer Society strongly encourages people to attend their screening appointment when they’re invited.”

More than 3,600 women and around 37 men are diagnosed with breast cancer in Ireland each year. Of those, around 760 people die from the disease.

Breast awareness

CEO of cancer charity Breast Cancer Ireland Aisling Hurley told The Journal that while the move to screen women every three years is “startling”, women should regularly check their breasts themselves and arrange to see their GP if they notice any abnormalities. 

“What we’re trying to promote is the need for every woman, regardless of their age, just to be more breast aware, know their own signs and symptoms, know how to do a breast check themselves so that if they spot an abnormality, they go to their GP and they will be seen straight away,” she said.

“The clinics are all working still, so it’s about empowering women and men to take their own breast health more seriously. Don’t wait for the free mammogram to come their way.”

She said despite an initial low number of referrals during the height of the pandemic, the number of people attending breast clinics have steadily caught up.

“They’re seeing people every day. They’re triaged by a GP on a low risk, medium risk or high risk and in turn, when they get into the breast clinic, they’re triaged there, and anyone that’s high risk is seen within a week,” she said.

It’s about people knowing their own normals. So if it’s normal today, when I checked myself, if I check myself in a month’s time and I spot something slightly different, then I should go to my GP and have a consultation.

New research commissioned by Breast Cancer Ireland as part of their MakeTime2Check campaign suggests there is a need for ongoing education and awareness to women around checking their breasts.

According to the research, only 34% of the Irish women surveyed check their breasts once a month as advised. 44% check their breasts only when they remember to do so – and less regularly than once a month

30% of women who don’t check their own breasts are still ‘unsure as to what to look for’ with regards to the eight signs and symptoms of the disease.

Whilst 86% of women are aware of a lump being a sign of the disease, significantly less (68%) are aware that skin issues such as dimpling on the skin or a rash around the nipple (55%), are also cause for concern and should be investigated further.

19% of women who don’t check their own breasts are unsure as to how to properly perform a self-breast check, with 9% of these women believing that this is something that can/should only be conducted by a trained health professional.

Hurley said the statistics are “stark” and said there needs to be more education to help women to understand what they should be looking for. 

“So many women immediately associate breast cancer with having a lump. Instead, it can be pain, it can be inverted nipples, it can be discharge from the nipples, one breast can be slightly larger than the other, it can be swelling in the lymph node, it can be for all the world orange peel on the outside of the breast which is actually a tumour on the inside pulling on it.”

“So what we’re trying to say to people is, understand what the normal is, understand the signs and symptoms, know how to do a breast check yourself properly, and take your own breast health seriously and into your own hands.

Despite 50 being the age of eligibility for BreastCheck screening, 23% of women are diagnosed between the ages of 20-50 years.

Hurley says the eligibility age “absolutely” should be lowered. 

“It’s disgraceful. It does need to be lowered, but then the counter argument for that is it will cost money. You know, the government will say: ‘look, we provided for 50 to 69, we can’t bring it down to 40 and extend it out to 79 because there’s an economic cost involved’.

“So my thing is, yes, lower the age, of course. What I equally have to keep saying [to women] is be more aware themselves. Everybody has to take ownership for this.”