Overview
Breast Cancer Prevention Policy
Breast cancer is the most commonly diagnosed cancer (excluding non-melanoma skin cancer) and the second most common cause of cancer death in Australian women[1]. One in eight women in Australia will be diagnosed with breast cancer by the age of 85[1]. Breast cancer incidence in Australian women has increased significantly over the past 30 years, however death rates have fallen significantly over the same period[2].
Population-based mammography screening for breast cancer was introduced in Australia from 1991 to 1995 through the BreastScreen Australia program. Access to BreastScreen Australia by Australian women is determined by age alone. The program is targeted specifically at well women with no symptoms aged 50–69 years; with the target group being extended to women aged 70–74 from 2013.
The introduction of BreastScreen Australia was associated with a particularly sharp increase in breast cancer diagnoses between 1990 and 1995. The rate of diagnosis has remained relatively stable since 1995, when the program became fully operational, and is projected to remain so until 2020[3][4].
In the 20 years after the implementation of BreastScreen Australia breast cancer mortality rates decreased by 37% among women aged 50–69 years, the target age range for screening during that period[5]. The decrease in mortality has been attributed in part to increased early detection through screening, and in part to advances in management and treatment[6][7].
There has been much discussion on the potential benefits and harms associated with population-based mammography screening. While there is debate about the extent of the harms associated with screening, particularly in relation to overdiagnosis, evidence of benefits is generally considered to outweigh the harms in 50–69 year old women[6].
This chapter of the National Cancer Prevention Policy outlines the impact of breast cancer in Australia and breast cancer risk factors, presents the evidence around population-based mammography screening for breast cancer, including information on the potential benefits and harms of screening, outlines the current policy context in Australia, and outlines a number of policy priorities to reduce the breast cancer burden in Australia.
References
- Australian Institute of Health and Welfare. Cancer data in Australia. Canberra: AIHW; 2019 Jul 26 [cited 2019 Aug 25]. Report No.: Cat. no: CAN 122. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/summary.
- Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books. [homepage on the internet] Canberra: AIHW; 2017 Available from: http://www.aihw.gov.au/acim-books/.
- Australian Institute of Health and Welfare, Cancer Australia. Breast cancer in Australia: an overview. Canberra: AIHW; 2012 Oct 9. Report No.: Cancer series no. 71. Cat. no. CAN 67. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737423006.
- Australian Institute of Health and Welfare. Cancer incidence projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: AIHW; 2012.
- Australian Institute of Health and Welfare. BreastScreen Australia monitoring report 2010–2011. Canberra: AIHW; 2013 Oct 25 Available from: http://aihw.gov.au/publication-detail/?id=60129544882.
- BreastScreen Australia Evaluation Taskforce. BreastScreen Australia Evaluation. Evaluation final report. Canberra: Australian Government Department of Health and Ageing; 2009 Jun. Report No.: Screening Monograph No.1/2009. Available from: http://cancerscreening.gov.au/internet/screening/publishing.nsf/Content/programme-evaluation.
- Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators, Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005 Oct 27;353(17):1784-92 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16251534.