Which Breast?

February 10, 2022
Dianah Walter

The Breastscreen Initiative (TBSI), a project founded by the Australian General Practitioners Network and the Australian Association of General Practitioners, offers a solution they believe will increase screening rates in Australia into the 90% range.

I support this initiative 100%! Right now the screening rates are akin to only screening one breast. Together, let's raise the rate.

This is the letter which is being sent to Members of Parliament -State & Federal, in an effort to raise the rate of breast screening.

We write to you with growing concern of Australia’s state’s and territories low breast screening rates for eligible women.

Since the states began their programs over 30 years ago, there has not been an annual screening rate beyond 59% we estimate leaving possibly 8,000 women diagnosed at a later rather than earlier stage of breast cancer. 

The 5 year survival rate for Stage 1 (early) breast cancer is on average 100% Stage 2 is 95% for locally advanced (Stage 3) 81% Metastatic Breast Cancer (stage 4) is is lower than 32%, as just these few statistics show it is crucial to obtain an early diagnosis to provide the best possible outcome for the patient. 

Low breast-screening rates are even more worrisome now with the growing Covid health crisis, over just the last few months we have seen sites closed for the foreseeable future, waiting lists for appointments, less patients able to be onsite at any one time due to social distancing, cleaning policies and the vulnerable in the community with less access due to not only state of emergency policies but their personal circumstances, now is the time to implement not only an immediate fix but a long term plan to increase screening rates into the 85% range and beyond. 

Considering the annual funding BreastScreen receives, over $300 million a year from the state and federal government ($319 million in 2019) and the money that is spent every year by them to determine where they need to focus marketing, resources for the participation rate to grow there has never been any growth in the overall participation rate. We believe 60% to be the natural ceiling for the BreastScreen model.

BreastScreen in each state is always at capacity so if the participation rate were to grow how would they screen more women?

Covid has shown us it is not possible for BreastScreen to handle a larger percentage of women wishing to have a breast screen, currently in Victoria there is a 6 month (minimum) waiting list and their sites are only taking bookings from women in the 50-74 age bracket. 

NSW is only taking bookings from women whose screenings were cancelled whilst their sites were closed, everyday this policy continues the system gets further behind, we do not see a way for screenings to be caught up or those now due to be screened able to access a breast screen via BreastScreen NSW within a reasonable timeframe, one could argue this is only due to Covid and under normal circumstances this would not occur, but it shows if the participation rate grew BreastScreen alone, without the support of private radiology would have waiting lists with age requirements as we are seeing now.

November 2021 the ABC 7.30 report aired a segment in regards to this matter, including an interview with Melissa Blythe from NSW who received a late diagnosis due to BreastScreen closures in Sydney, Professor Sue Evans during this segment stated 

“There is a risk that the undiagnosed cancers will present in a more advanced state” 

The Australian Institute of Health and Welfare report - 17/12/2020 reports on the period January - September 2020.
In April 2020 1,100 screening mammograms were performed compared to more than 74,000 in April 2018. There were 145;000 fewer screening mammograms performed via BreastScreen Australia in January - June 2020 compared with January - June 2018.

The report data ends as of September 2020, it does not take into account the closures to BreastScreen NSW sites that began in August 2021 or policies limiting appointments at many sites not only in NSW but other states and territories. 

As previously stated pre-Covid, 40% of the eligible population were not being screened by Breastscreen in their state, we assume 12-15% already have breast disease they are are not eligible for the program and are under the care of their doctor, leaving 25-28% either not being screened at all or being screened in private radiology, as there is no national register for breast screening neither General Practice nor BreastScreen know who any of these women are, or what group they belong to, a national register such as the one in place for vaccinations is much needed to solve this issue. 

There are many possibilities as to why women of eligible age are not using BreastScreen, we believe it to be a range of reasons such as, English as a second language, cultural taboos, anxiety, poor past experience with BreastScreen, convenience of private radiology, the list goes on. 

The advice given by the Cancer Council, State Health departments, and on the BreastScreen sites themselves is to speak to your GP if you have any concerns with your breast health, yet GPs are unsupported and not incentivised in regards to breast health. It has been particularly clear with the closures of BreastScreen in NSW, and other states having limited capacity due to social distancing and cleaning policies, waiting lists due to a backlog of unscreened women, that the responsibility for breast health and breast screening has been placed on General Practice. 

Australia has a functioning BreastScreen system but the reality is 59% is the best participation rate it has accomplished in 30 years, there have been multiple attempts and large amounts of funding used to develop programs to increase the participation rate, none have proven to be successful.

The Breastscreen Initiative (TBSI) a project founded by the Australian General Practitioners Network and the Australian Association of General Practitioners, offers a solution we believe will increase screening rates in Australia into the 90% range.

What needs to be implemented:

A GP Medicare item number for a yearly review of women over 40 and beyond to assess their risk of breast cancer and document their screening for a national breast screening register

A national data base of women screened to track screening by state breast screen in addition to those treated/screened by the Medicare rebated GP initiated  program

Improved referrals to and from general practice that integrates StateScreen and General Practice consultation and software

The ability for women to have a breast screen performed in a private radiology practice with no cost to themselves (Rebated Medicare for screening mammogram) 
Private radiology needs to be used to complement the existing breast screening program, a combination of public and private resources will be necessary for a larger percentage of women to be screened.

How many women are eligible to participate in BreastScreen within Australia, we estimate these numbers in each age bracket:

40-44 *803,250
45-49 *841,500
50-54 *828;750
54-59 *828;500
60-64 *573,750
65-69 *612;000
70-74 *540,600

In total 5,088,250 women, if only 59% are participating in BreastScreen, 2,035,300 women are not, every year, 2,035,300 women. 

Under our proposal eligible women would have the choice to remain with the BreastScreen program within their state/territory or be screened by private radiology on referral from their GP.
This not only lessening the current burden on the sites unable to operate as usual but giving an option to women who believe for many varied reasons some cultural or socio-economic, those with language barriers or general anxiety who have a valued , trusted relationship with their GP, and would prefer to discuss and have their screening options implemented via their general practice, all eligible women should have a choice. 

Change is difficult, accepting a rather average 59% as the normal is far easier, but given the results of the reforms to Australia’s childhood vaccination program in 1995 by including general practice have proven the model we propose works, in 1995 the participation rate for childhood vaccination was 55% by 2000 it was beyond 90%, why would we accept 59% is the best we can achieve for breast screening in Australia when there is undeniable evidence that by including general practice into the existing program the 90% and beyond participation rate is within reach.

Below is a link to media, The Breastscreen Initiative on ABC national news 27/11/2021, in the last few days we have filmed interviews with several media outlets, these interviews will screen in the coming weeks.

This matter is of the utmost urgency, we look forward to your response. 

Kind regards

Nicole Borzillo
Senior Project Manager
The Breast Screen Initiative
Australian Association of General Practice
Australian General Practice Network

Dr Rodney Pearce AM

Lead Physician
Director of AGPN
Chair of the Immunisation Coalition
Director of the Medical Benevolent Association SA
Medic Alert
Past Director Headspace, AGPAL ,RDNS, ACE Division of GP
Past Chair AMACGP, GP Supervisors Association
LMO committee (DVA)

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