The scale of the problem is especially worrying, writes Dr Muiris Houston, Medical Correspondent
Question marks over the treatment of at least 10 women with breast disease at Barringtons' Hospital in Limerick within the past four years have yet again raised concerns about the quality of cancer services in the Republic.
The unprecedented move by the Department of Health to ask a hospital in the State to cease providing breast cancer services, while welcome, will do little to reassure other women throughout the State who have recently been given the all-clear following a breast cancer scare.
With a review of breast disease assessments carried out since 2003 now under way at Barringtons', hundreds of women who attended the hospital must now wait for their cases to be re-examined. Inevitably, some will require further clinical evaluation and perhaps repeat investigations.
The scale of the latest problem is especially worrying, as it suggests a major systems failure in the health service rather than an isolated mistake.
We must now ask: is this problem confined to a single hospital or could it be an issue for other institutions, both public and private? And what does it mean for individual patients and their doctors?
It would be a mistake to see this as a purely private hospital problem. But it does highlight the Department of Health's error in excluding the private health sector from the regulatory remit of the recently established Health Information and Quality Authority.
The core issue is one of people and processes, rather than specific hospital locations.
As outlined by the National Quality Assurance Group for Symptomatic Breast Disease Services, centres offering these services must meet a set of minimum quality indicators.
Individual consultant surgeons must treat at least 50 new patients with breast cancer each year, while breast pathology reports must contain a minimum set of data.
Radiologists reporting mammograms should not work in isolation.
But perhaps the group's most important recommendation is that all women who develop a breast lump should undergo a triple assessment at a specialist centre. Such a centre should be staffed by at least two consultant breast surgeons, two specialist radiologists and at least two experts in breast pathology, and patients should be routinely assessed by a multidisciplinary team working to a set of quality assurance standards.
Research has shown that a woman's chances of survival following a diagnosis of breast cancer increase by 20 to 30 per cent as a result of attending an accredited specialist centre.
With breast cancer the most common fatal cancer in women and figures from the National Cancer Registry showing that some 2,700 women on the island of Ireland are diagnosed with the disease each year, it is unacceptable that the Health Service Executive has yet to select the locations for all specialist breast centres in the Republic. Only when this network is fully operational can we ensure that all women who present with symptomatic breast disease will be uniformly assessed.
However, no system can guarantee perfection. Even in conditions of best practice, up to one in 20 women may be told that they do not have breast cancer following a fine-needle biopsy, even though in reality they have the disease. Misdiagnoses can be minimised, but never eliminated.
But it does mean that if women with suspected breast cancer are assessed by doctors who are not seeing a high volume of cases, and who do not operate in an environment where joint decision-making at weekly conferences is the norm, then the results of such assessments are of questionable quality.
If you are a woman who has had a breast lump investigated recently, should you be concerned?
There is no reason to worry if you were referred to a recognised breast clinic in a major public hospital.
You will almost certainly have undergone a triple assessment by a multidisciplinary team and will have benefited from a full discussion of your case at the centre's weekly case conference.
However, if you had your assessment for a breast problem at a smaller hospital, either private or public, in the last two years, then you should consider contacting your GP to discuss the nature of the assessment.
In many cases, there will be no cause for alarm, but your doctor may advise further investigation at a dedicated breast clinic.
The advice for a woman who develops breast symptoms that require investigation in the future is clearcut: do not be tempted by the convenience of a small facility. Do not assume that private care is always better than public.
Instead, ask your GP for a referral to a specialist breast clinic where you will be seen by a multidisciplinary team of health professionals offering you the best chance of an accurate diagnosis and, should you need it, treatment of the highest quality.