Front page todayArticle from: The AustralianTENS of thousands of...

Front page today

Article from: The Australian

TENS of thousands of women aged under 45 and over 75 would be denied free mammograms under a contentious plan to stop those not considered at greatest danger of breast cancer from overloading the screening program.

A landmark evaluation of BreastScreen Australia, the nation's world-renowned breast-screening program, has condemned authorities for allowing the program to become overstretched and fail to reach its crucial screening target. It made the bold recommendation to restrict access to free mammograms in a bid to save more lives.

When BreastScreen Australia was established in 1991, it was set a target of screening 70 per cent of women aged 50-69, the group considered most at risk and more likely to benefit from early diagnosis of breast cancer.

Despite a considerable increase in mammograms conducted by BreastScreen Australia, the participation rate in the key age group has now plateaued at 56.2 per cent.

Part of the problem has been the number of younger women using the service, particularly after actress Belinda Emmett and pop star Kylie Minogue were diagnosed with breast cancer. Emmett, wife of TV personality Rove McManus, died in 2006.

The BreastScreen report says the Minogue and Emmett cases caused a significant jump in women in their 40s seeking mammograms and confused public understanding of the risk factors for breast cancer and the key age group at risk.

Publicity of Emmett's diagnosis in May 1998 saw bilateral mammogram services for the 40- to 49-year age group increase by 10,000 in the following three months, while Minogue's diagnosis in May 2005 was followed by an increase of 6000 in the following quarter.

Capacity constraints have caused BreastScreen Australia to fail to meet the accreditation standards for timeliness, with worrying delays for women who need to be recalled to assess a screen-detected abnormality or simply to be screened again within the recommended two-year timeframe.

With an ageing population and workforce shortages, the problems are going to get worse, even with the efficiency gains that arise with the introduction of digital mammography.

Given that almost a quarter of the program's capacity is currently taken up by women outside the 50-69 age group, the evaluation advisory committee, which relied on expert analysis to compile its 296-page report, has now made the tough decision to recommend BreastScreen Australia focus on the age group where more lives can be saved.

The report recommends BreastScreen Australia refuse to give mammograms to women aged 40-44 years, those aged 75 and over, and those with symptoms of breast cancer or a known higher risk, such as a significant family history of the disease, who would need to get specialist help elsewhere. The specially convened committee of Australian and overseas health experts behind the report is chaired by Helen Zorbas, director of the National Breast and Ovarian Cancer Centre, based in Sydney.

The report found that in 2004-05, 92,658 women who used BreastScreen Australia were aged 40-44, and a further 61,479 were aged over 75. About 232,036 women reported a family history of the disease and 64,834 reported symptoms.

"For women aged 40-44 years, there is limited evidence of benefit for mammographic screening in relation to mortality reduction," the report states. "There is evidence of harm associated with screening in this age group, with a higher rate of invasive investigation without cancer present compared with women aged 45 years and over. For women aged 75 years and over, there is limited evidence of benefit in relation to mortality reduction associated with screening."

While Medicare rebates are available for diagnostic mammography where breast cancer is suspected, no rebate is available for general screening, meaning women have to pay to be screened outside the program run by BreastScreen Australia.

The report says the taxpayer-funded program should continue - it has reduced treatment-related deaths in the target age group by 21 to 28 per cent and is cost-effective - but not without reforms.

Given that about 2700 Australian women a year die from breast cancer, reaching the 70 per cent target in the key age group could save hundreds more lives and improve the outcomes for survivors.

"Breast cancers detected through BreastScreen Australia are significantly more likely to be smaller than those diagnosed outside the program, and a higher proportion of breast cancers detected by BreastScreen Australia are treated by breast-conserving surgery," the report states.

Participation rates are lowest among indigenous and migrant women, women in remote areas, and, surprisingly, women living in major cities.

Governments are urged to find a way to replicate the success of the ads of the 1990s featuring the late Sara Henderson. The report recommends "a range of social marketing, communication and service-delivery strategies", partly to counter public misconceptions about risk factors and the key age group that arose with the Minogue and Emmett cases.

The report recommends extending the target age group to provide biennial screening for women aged 70-74, annual screening for women aged 45-49, or biennial screening for women aged 45-49.

Inconsistent state policy settings should be corrected, governance, management and accreditation improved, and new staffing and co-location models examined in an effort to improve efficiency.

Health ministers met on Friday and agreed to release the report today, as governments consider its recommendations.