As any woman who has had a mammogram will attest, it is an extremely intimate examination. It involves close contact between the woman and the radiographer as breast tissue is manipulated, sensitively nudged and pressed into providing a picture of what's going on beneath the skin.
But as we have all discovered over the last few months, close contact is a highly problematic thing during the Covid-19 pandemic.
With this in mind, BreastCheck, the National Screening Service's programme for women aged 50 to 68, took the decision in March to pause breast screening.
"We simply could not bring women who are presumed well into a clinical environment which could expose them to Covid-19," says Professor Ann O'Doherty, clinical director of BreastCheck.
By the end of March the National Screening Service had paused all its screening programmes, BreastCheck, CervicalCheck, Diabetic RetinaScreen and BowelScreen. Ireland joined other nations such as Scotland, Wales and New Zealand, in announcing an hiatus in screening.
The move was made to protect patients and staff by complying with social distancing guidelines, and also allowed the HSE to temporarily redirect staff and resources, where available, to the response to Covid-19. We also understand some of our programme participants are in the vulnerable groups.
As the Government this week moves to relax restrictions, indications are that we have "flattened the curve" of Covid-19 - for now. How the health service moves forward into the "new normal" of containing Covid-19 until a vaccination is achieved is an important issue.
As with other arms of the HSE in which services have been paused, we in screening are working on a roadmap for restarting services safely, while continuing to protect patients and staff from Covid-19.
The focus of the health service, the country and the world is on containing the potential devastation of Covid-19.
Yet there remains the fear that with screenings stopped, we could be missing our chance to catch many diseases early when they are treatable and curable.
Screening's ability to detect pre-symptomatic disease in patients is undoubtedly effective and desirable due to the long-term health benefits it offers. However, part of the rationale for this pause is that screening is an early disease detection measure used to identify those people at risk prior to symptoms.
"As such it is, a non-essential clinical activity in a time of crisis," says Professor David Keegan, clinical director of Diabetic RetinaScreen. "We can prioritise those who need screening and/or treatment more urgently once we recommence."
According to Dr Mary Short, primary care adviser for HPV Implementation with CervicalCheck, Covid-19 has impacted general practice, and this is also a consideration for screening. Many consultations are now taking place over the phone or video call. There have been concerns expressed to GPs that cervical screening has been paused.
"It is reassuring to know that in the majority of cases, the time lag between developing cell changes in the cervix and developing cervical cancer is between 10 and 15 years," Dr Short says.
"Cervical screening ascertains if there is a risk of a woman developing cervical cancer. Rarely does screening pick up cervical cancer itself (only in 0.3pc of cases)."
In some instances of cervical screening, a woman will need further treatment in a hospital colposcopy service. A safe pathway to recommence routine colposcopy, in common with other hospital services, will be a focus as the cervical screening programme is recommenced.
Prof Padraic MacMathuna, clinical director of BowelScreen, acknowledges that some cancers will go undetected if screening is suspended for six months.
"Could we do anything to prevent this?" he says. "Unfortunately in the current crisis, the answer will be 'no'. However, it is anticipated that any cancers detected will be treatable by surgery, with or without chemo-radiotherapy."
BowelScreen's programme relies on women and men aged 60-69 returning their home testing kits for analysis. After this, people are contacted by the service if they require intervention by way of a colonoscopy in a hospital unit.
According to Prof MacMathuna, this pathway has not been generally open to the programme and therefore a pause in screening has been necessary.
"That is why it is so important to communicate to all people who engage with the screening service, if you develop symptoms, you must go to your GP who can refer you to hospital for the appropriate management," he says.
"Screening is there to reduce the amount of disease in a community. It is not an individual diagnostic test. That message cannot be ignored."
The National Screening Service fully understands how difficult this pause in its programmes may be for the Irish people. However, the balance of risk supports this approach.
We continue to encourage anyone who detects any of the symptoms we screen for to contact their GP immediately. We look forward to inviting people for screening again in the very near future.
Fiona Ness is communications manager with the National Screening Service