Delayed Access to Tests for Detecting Genetic Breast Cancer

Obviously, substantial attention has been paid to the issue of breast cancer genetics in recent days. I would like the Leader to bring to the attention of the Minister for Health the current circumstances that pertain with respect to genetic testing for patients in Ireland. Most breast cancers are not genetic. A small minority of breast cancer cases are caused by well recognised genes which can be diagnosed on the basis of a blood test. In a typical scenario, when a doctor takes a careful and detailed history from a patient with breast cancer, it will emerge that there is a substantial or suspicious history of breast or other cancers in the family which would indicate that the person in question might be an appropriate candidate for genetic testing. This has important health implications for the patient. Not only does she need treatment for the cancer she has, but she is also at substantial risk of developing new cancers which can be prevented by making appropriate, albeit difficult, decisions about preventive surgery.

As well as that, their close family, their sisters and daughters, have a 50% chance of inheriting the gene which causes breast cancer, if they have the gene. It is important to know this. It is not a tremendously common problem but it is an important one. If it is managed correctly, lives can be saved and the State can be spared costs.

Approximately one in 1,000 people carries the gene and approximately 5% of breast cancers are caused by these genes. The problem is as follows. There is a 12-month waiting list to get a genetic assessment and the only statutory unit in the country that is doing this for public patients is the one situated in Our Lady’s Hospital for Sick Children in Crumlin, run by an extremely gifted medical geneticist, Professor Andrew Green. Professor Green, with great vision, set up the service, not with health service money, but with money from research, and from that defaulted into running a clinical service which is, I would say, grotesquely underfunded.

I suspect there is “grotesque underfunding” fatigue when people hear me talk about the health service. Parenthetically, I do not believe it is in general underfunded as I believe it is mal-funded, but this is a case where it is clearly underfunded. However, lest I be seen as somebody else who is whinging and shroud-waving about a deficiency in a health service which is full of deficiencies, in a public service which is underfunded, in a country which is broke, I make the point that this decision is costing money.

What happens to the patients while they are on the waiting lists for a year? They are getting multiple expensive MRI scans, gynaecology tests, specialist ultrasounds of their ovaries and extra evaluations, but, not only that, their extended family may also be getting these while they are waiting that one year for the blood test. I have no doubt about this. The blood test has come down substantially in cost and it is now several hundred euro rather than €1,000 to get one test done. Clearly, part of the bottleneck is that the staff in Crumlin do not have national specialist unit funding and this is being absorbed in the general costs of that hospital which, as we know, has had its allocation cut in recent years despite its national status in so many areas.

I can understand how we all have to grit our teeth when we see deficiencies in the health services, but it makes no sense to impose a deficiency which is costing us money. I would ask that this be brought to the Minister’s attention. I understand the Taoiseach made reference to genetic testing in the Dáil yesterday. When the decisions are being made, I ask that it be taken into account that there are real cost savings to be made.

I am honoured to make this speech on the one-year anniversary of the death of a good friend and patient of mine, Geoff Prendergast, whose son, Joe Prendergast, at the age of ten and as part of his mourning process for losing his father so sadly, has just published several wonderful children’s books. The proceeds from these will be used for cancer research through the CCRT. I would like the record to reflect this brave young boy, Joe Prendergast, and his Dad.

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