Optimising early detection of breast cancer in Australia
Cancer Council Australia’s roadmap to evaluate, and potentially implement, more risk-based, personalised approaches to breast cancer detection and screening.
Background
Cancer Council Australia developed a draft roadmap in August 2019 outlining an evidence-based approach to evaluate, and potentially implement, more risk-based, personalised approaches to breast cancer detection and screening.
The roadmap aim is to build consensus on optimal clinical pathways for risk assessment and early detection of breast cancer for women at all levels of breast cancer risk.
Roadmap activities will draw on a wide range of expertise including the project Expert Advisory Group.
Cancer Council Australia’s roadmap to evaluate, and potentially implement, more risk-based, personalised approaches to breast cancer detection and screening.
Topic 1. Evidence to guide decision making about risk-based breast cancer screening
1.1 Annual scoping-level summaries of evidence
a. Validated risk assessment tools (including new tools) plus high-quality case-control studies.
b. Overdiagnosis by risk group.
c. Risk-based screening modalities/protocols.
d. Modelled estimates of benefits and harms of risk-based screening protocols.
1.2 New activities to address gaps in evidence
a. Systematic review of validated risk assessment tools and breast density assessment tools.
b. Systematic review of modelled estimates.
c. Summary results from trials of risk-based population screening.
d. Collect complete information on current outcomes by risk group.
e. Develop protocols, in collaboration with AIHW and BreastScreen, to routinely report outcomes by risk group.
1.3 Clinical and health economics modelling
a. Selection of feasible and promising risk-based screening protocols for review (may include modelling current trials outside Australia).
b. Agreement about how to best measure the benefits, harms and costs of those protocols.
c. Collection of required clinical and health economics data, with careful management of sensitive financial information.
d. Modelling of selected screening protocols.
e. Consensus-based review of generated estimates (and further modelling as needed).
f. Recommendations for possible further evaluation of optimal protocols (e.g. by trial or evaluation studies).
Topic 2. Current clinical practices, and their role in risk-based breast cancer screening
2. Improved evidence on current clinical practices in risk assessment, advice and risk-based services
a. Updated information on BreastScreen jurisdiction-level practices, being mindful that data reporting requirements, including for ad hoc activities, are already significant.
b. Develop protocols, in collaboration with AIHW and BreastScreen, to routinely capture information on BreastScreen jurisdiction-level practices.
c. Evaluation of outcomes according to BreastScreen annual/biennial screening interval.
d. Evaluation of primary care risk-based management, including management of women referred to GPs by BreastScreen (due to increased risk and/or breast density) and women assessed as higher risk within primary care.
Topic 3. Stakeholders in risk-based breast cancer screening
3. Stakeholder engagement:
a. Increased engagement with key stakeholders including BreastScreen jurisdiction Managers and other personnel as appropriate, existing BreastScreen committees, primary care organisations (e.g. RACGP), specialist groups (e.g. RANZCR), State and Territory health departments, and the AIHW.
b. A program website to share core activities and results.
c. Cancer Council led stakeholder forums.
d. Presentations of findings at public lectures, conferences and other stakeholder forums.
Topic 4. Consensus-based clinical recommendation
4. Activities to reach consensus-based recommendations
a. Establish suitable Expert Reference Groups for all project activities. This may require several different groups, selected for purpose.
b. Reach consensus on core evidence requirements to assess the relative benefits, harms and costs of risk-based screening protocols.
c. Review the core evidence as generated and assembled by this program and make consensus-based recommendations based on that evidence.
Topic 5. Trial or evaluation of risk-based screening protocols
5. Trials or evaluations
a. Review risk-based breast cancer screening trials in terms of their potential translation to the Australian setting.
b. Develop an implementation framework for evaluating any changes to the current program, including impact on disadvantaged populations, factoring in access to treatment, role of primary care in risk assessment, role of FCCs.
c. Undertake concurrent foundation activities to enable future trials/evaluations, e.g. BRAVO in other jurisdictions.
d. Design a trial or evaluation if warranted.