Roadmap for Optimising Screening in Australia - Breast

A project to build evidence and consensus to improve early detection of breast cancer.

Early detection services for women without breast cancer symptoms include population screening through BreastScreen Australia as well as risk-based surveillance services outside the screening program, such as Medicare-subsidised breast imaging for women with specific risk factors, and services provided through family cancer centres. 

Cancer Council Australia has been funded by the Australian Government to explore options for more risk-based, personalised approaches to early detection of asymptomatic breast cancer in Australia, through a project named the Roadmap for Optimising Screening in Australia – Breast Cancer (‘ROSA Breast’ or ‘The ROSA project’).

The ROSA Breast project is the first initiative in Australia to combine evidence reviews, data analysis, population modelling, health service provider surveys, policy analysis and stakeholder engagement to systematically investigate options for risk-based screening in Australian health policy and practice.

The first Roadmap

Starting in 2018, the project established and consulted a panel of expert advisors to identify key questions and methodologies, then commenced a set of targeted evidence reviews, stakeholder mapping, surveys and engagement, and an overview of clinical services and policies and how people access those services.  In 2019, the project produced its first 4–5-year Roadmap  towards risk-based population screening to improve early detection of breast cancer in Australia.

Technical reports

Aligning with the 2019 Roadmap, over 2019-2022 the ROSA Breast project submitted eight comprehensive technical reports to the Australian Government Department of Health and Aged Care (formerly Australian Government Department of Health), including additional reports generated in response to the COVID-19 pandemic. These reports included:

• Clinical and health economics modelling to evaluate the likely benefits, harms and costs of various risk-based population screening protocols, with input from various stakeholders on identification of priority protocols to include in the evaluation. 
• A critical appraisal of international population-level trials of risk-based screening in terms of evidence about the benefits and harms for different risk groups and their potential translation to the Australian health setting.
• Systematic reviews that critically reviewed and compared available tools for breast cancer risk assessment and measurement of mammographic density.
• Information on BreastScreen Australia jurisdiction-level risk-based screening practices and policies.
• A protocol, developed in collaboration with the Australian Institute of Health and Welfare (AIHW) and relevant stakeholders, for enhanced routine BreastScreen Australia data collection and reporting to prepare for and support risk-based breast screening.
• Additional analyses of linked breast cancer screening, cancer registry and mortality data, in collaboration with the AIHW. 
• A special report on how the project findings and plans related to the COVID pandemic and its impact on Australian population breast cancer screening and related health services. 

Over 2022 the project synthesised these technical reports and summarised key evidence and evidence gaps related to consideration of risk-based breast screening in Australia.

Recommendations and Roadmap

In early 2023 after additional stakeholder consultation the project submitted a final set of recommended actions and an updated 5-year Roadmap designed to guide Australia towards risk-based breast cancer screening.

These recommendations and Roadmap draw on key findings from the ROSA technical work combined with the advice of an independent multidisciplinary Expert Advisory Group, an extensive network of co-opted experts, and input from senior BreastScreen state and territory personnel.

The recommendations and Roadmap are presently under consideration by the Australian Government Department of Health and Aged Care.

Publications

In addition to the various detailed technical reports provided to the Australian Government, the ROSA project has led or contributed to the recent peer-reviewed publications below:

1. Velentzis LS, Freeman V, Campbell D, Hughes S, Luo Q, Steinberg J, Egger S, Mann GB, Nickson C. Breast Cancer Risk Assessment Tools for Stratifying Women into Risk Groups: A Systematic Review. Cancers (Basel). 2023 Feb 9;15(4):1124.
2. Bulliard JL, Beau AB, Njor S, Wu WY, Procopio P, Nickson C, Lynge E. Breast cancer screening and overdiagnosis. Int J Cancer. 2021 Apr 19. Epub ahead of print. PMID: 33872390.
3. Feletto E, Grogan P, Nickson C, Smith M, Canfell K. How has COVID-19 impacted cancer screening? Adaptation of services and the future outlook in Australia. Public Health Res Pract. 2020 Dec 9;30(4):3042026.
4. Saxby K, Nickson C, Mann GB, Park A, Bromley H, Velentzis L, Procopio P, Canfell K, Petrie D. Moving beyond the stage: how characteristics at diagnosis dictate treatment and treatment-related quality of life year losses for women with early stage invasive breast cancer. Expert Rev Pharmacoecon Outcomes Res. 2021 Aug;21(4):847-857. Epub 2021 Jan 27.
5. Saxby K, Nickson C, Mann GB, Velentzis L, Bromley HL, Procopio P, Canfell K, Petrie D. The financial impact of a breast cancer detected within and outside of screening: lessons from the Australian Lifepool cohort. Aust N Z J Public Health. 2020 Jun;44(3):219-226. Epub 2020 Apr 20.
6. Lew JB, Feletto E, Wade S, Caruana M, Kang YJ, Nickson C, Simms KT, Procopio P, Taylor N, Worthington J, Smith D, Canfell K. Benefits, harms and cost-effectiveness of cancer screening in Australia: an overview of modelling estimates. Public Health Res Pract. 2019 Jul 31;29(2):29121913.
7. Nickson C, Velentzis LS, Brennan P, Mann GB, Houssami N. Improving breast cancer screening in Australia: a public health perspective. Public Health Res Pract. 2019 Jul 31;29(2):2921911

Project team 

The project is led by Associate Professor Carolyn Nickson, supported by a Project Coordination Group.  

In 2018 the project established an Expert Management Group (EMG) of 30 members, who helped establish the range of evidence to be collected, reviewed the interim findings, and helped identify priority activities for the next stage of work. The current program of work is now guided by a smaller Expert Advisory Group of independent, multidisciplinary experts.

Project Coordination Group

Associate Professor Carolyn Nickson - Project lead 

Lead, Breast Cancer Policy and Evaluation, the Daffodil Centre

Professor Karen Canfell – Executive Lead  

Director, The Daffodil Centre

Professor Bruce Mann – Co-Chair - Expert Advisory Group  

Professor of Surgery, The University of Melbourne 

Director of Breast Tumour Stream, Victoria Comprehensive Cancer Centre

Director of Research, Breast Cancer Trials, Royal Melbourne & Women’s Hospital

Paul Vardon - Co-Chair Expert Advisory Group 

Director, Cancer Screening Branch, Queensland Heath 

Megan Varlow - Stakeholder Engagement, Strategy 

Director, Cancer Control Policy, Cancer Council Australia 

Paul Grogan - Project Adviser

Senior Strategic Adviser, The Daffodil Centre

 

Mailing list

View a video presentation on the ROSA project

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Expert Advisory Group (as of December 2022)

Member	Affiliation/s
Prof Bruce Mann (Chair)	Professor of Surgery, University of Melbourne  Director of Breast Tumour Stream, Victoria Comprehensive Cancer Centre
Mr Paul Vardon (Chair)	Director Cancer Screening Unit, Queensland Health Chair, BreastScreen Australia Program Management Group
Ms Alison Lang	Acting Director, Screening Policy Section, Cancer Policy and Services Branch, Australian Government Department of Health and Aged Care
Ms Harj Bariana	Director Clinical Services and BreastScreen Operations, Westmead Breast Cancer Institute, BreastScreen NSW Sydney West Service
Dr Jill Evans	Clinical Director and Chief Radiologist, Monash BreastScreen
Ms Anny Friis	Consumer Representative, Cancer Voices Australia (until June 2022)
Ms Leslie Gilham	Consumer Representative, Breast Cancer Network of Australia
Dr Mandy Henningham	First Nations Fellow, Cancer Council Australia and Postdoctoral Research Fellow in Indigenous Social Sciences, University of Sydney.
Ms Sarah McGill	Director – Screening and Prevention, Cancer Institute NSW
Associate Professor Vivienne Milch	Director Cancer Care, Cancer Australia   Medical Advisor to the Department of Health and Aged Care on cancer screening policy
Associate Professor Michelle Reintals	Head of RANZCR Breast Imaging Group, Clinical Director, BreastScreen South Australia.
Prof David Roder	Chair, Cancer Epidemiology and Population Health, School of Health Sciences, University of South Australia Principal Research Fellow, SA Health and Medical Research Institute
Prof Christobel Saunders	James Stewart Chair of Surgery Royal Melbourne Hospital University Department of Surgery | School of Medicine

To receive updates regarding the project, please contact rosabreast@nswcc.org.au