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Mr Hession also said that the radiol- ogy staff in Limerick has agreed to take on extra work, when Clare wom- en are referred there from September ‘‘on the promise from the HSE that all this is going to get sorted out in terms of we get a proper breast centre”.
Mr Hession said that there would be no preferential treatment for women from Limerick and any woman pre- sented with a lump will be seen with- ht Wiere) ©
Meanwhile he is supporting Lim- erick as a centre of excellence. Mr Hession fears that there are a lot of misunderstandings about the service.
“Radiology is the diagnosis of breast cancer or the exclusion of breast can- cer after that our job is essentially done. The treatment is basically on- cology, surgery, radiotherapy,” he said.
He said that there are two differ- ent types of screening. The screen- ing breast service is the Breastcheck service, which has yet to be rolled out in the west offering mammograms to women in a certain age category.
“Tt is like going to the dentist with no symptoms,” said Mr Hession.
“What we are dealing with is sys- tematic breast disease. It is basically a woman either in between her invi- tations to Breastcheck or before she would even be asked, she developed symptoms be it pain or a lump or something like that. It is that group of patients that would be referred to the systematic breast service,’ he said.
Approximately 3,000 women a year go through the radiology department in Limerick, while 500 to 600 were receiving mammograms in Ennis every year.
Breastcheck will reduce both of
these numbers significantly accord- ing to Mr Hession.
“There is a significant waiting list for mammograms here as people are requesting screening mammograms, which GPs have a right to ask for. Un- fortunately we don’t have the slack in the system that we can facilitate them in the time scale they would want,’ he said.
‘“T am not speaking on behalf of the HSE, I am the person in charge of administration with the department of radiology and the advice we have been given is to make a systematic service work, a radiologist needs to be reading a thousand mammograms
a year. The technician doing them should be doing at least 20 a week.”
“The purpose of that is that these people get very experienced at what they are doing and very good at what they are doing. It also allows for the policing of results. So if a tumour is missed or it is a delayed diagnosis, it is all centralised and it is all open to analysis as to what happened and why did it happen. It 1s to put everything in one area, to pool the expertise, not just radiologists and breast surgeons. You are meant to have more than one surgeon as well, a pathologist, the doctor who looks at a specimen un- der a slide.
“The triple assessment clinic is Where a lot of women with lumps should go so they can be seen by a surgeon that day. That surgeon will refer them for imaging, which will be a mammogram or ultra sound, that depends on the woman. Cytolo- gist would be taken at that stage,” he said.
“The unit at Limerick 1s not a dig- ital system but the next system we hope to put in would be digital,” said Mr Hession.
“Technically it is very exact and it is policed and certainly no one is shy in breast screen washing laundry.”
“Unfortunately not all cancers are detectable. A mammography is not a clean bill of health,’ he said. “And they should not be taken as that. Cer- tainly if a woman has a mammogram and still feels a lump, and it is not rare, that still needs to be pursued. It does not mean it 1s missed, it just means it 1s invisible. Mammograms extenuates certain characteristics in a tumour but if that tumour does not have it or that lump does not have it, it is invisible.
“The real thrust of it is you are go- ing to a service that is designed by international best practice to deliver that service. It is not that we will have a little bit out in Nenagh and a little bit in Ennis. It 1s inconvenient, we were aware that it is less than conven- lent,’ he said.