Policy priorities

Currently, mammography is the most effective population-based screening tool for breast cancer available^[1][2]. While the potential benefits and harms of mammography screening continue to be debated^[3], Cancer Council supports the Australian Government’s interpretation of the evidence and endorses population-based screening for breast cancer, provided participants are well-informed of the risks and benefits.

The BreastScreen Australia Evaluation made a series of recommendations to the Australian Health Ministers’ Advisory Council (AHMAC) to maximise the impact of BreastScreen Australia on breast cancer mortality in Australia^[1]. Cancer Council Australia recommends that the Australian Government respond to the recommendations of the BreastScreen Australia Evaluation.

Summarised below are Cancer Council Australia’s evidence-based policy priorities aimed to reduce the burden of breast cancer in Australia. Policy priorities in line with the recommendations of the BreastScreen Australia Evaluation are noted.

Increase participation in BreastScreen Australia

Policy priority/action	Agency	Estimated cost	Expected benefit	Comments
Increase screening participation in the target age group	BreastScreen Australia	Improved cost-effectiveness of BreastScreen, increased cost	Increased mortality reduction, see BreastScreen participation for more	Recommendation of BreastScreen Australia Evaluation
Increase rescreening rates in the target age group	BreastScreen Australia			Recommendation of BreastScreen Australia Evaluation
Increase program participation among Aboriginal and Torres Strait Islander women, and women from culturally and linguistically diverse backgrounds	BreastScreen Australia, Indigenous groups, representatives of other under-screened populations			Recommendation of BreastScreen Australia Evaluation

Adjust BreastScreen Australia accessibility to reflect evidence on benefits and harms

Policy priority/action	Agency	Estimated cost	Expected benefit	Comments
Monitor the evidence for restricting program accessibility to the target age group, for which the benefits exceed potential harms	AHMAC	See Cost-effectiveness	Increased mortality reduction	Recommendation of BreastScreen Australia Evaluation
Monitor the evidence for extending the target group to include women aged 45–49	AHMAC	See Cost-effectiveness	Increased mortality reduction, see Screening age range for more	Recommendation of BreastScreen Australia Evaluation

Ensure equitable access to BreastScreen for all eligible women

Policy priority/action	Agency	Estimated cost	Expected benefit	Comments
Develop and implement clear national policies for BreastScreen Australia to ensure equity of access for all women	BreastScreen Australia		See BreastScreen Australia Evaluation	Recommendation of BreastScreen Australia Evaluation

Ensure informed consent among BreastScreen participants

Policy priority/action	Agency	Estimated cost	Expected benefit	Comments
Improve program communications on the potential benefits and harms of screening, particularly for Aboriginal and Torres Strait Islander women, and women from non-English speaking backgrounds	BreastScreen Australia		See Informed Choice

Increase public understanding of breast cancer risk factors

Policy priority/action	Agency	Estimated cost	Expected benefit	Comments
Conduct public education campaigns to increase understanding of the association between obesity and alcohol, and breast cancer risk	Australian Department of Health and Ageing/Australian National Preventive Health Agency		See Modifiable risk factors

Expand the evidence base

Policy priority/action	Agency	Estimated cost	Expected benefit	Comments
Improve data collection through BreastScreen Australia to inform research on screening outcomes	BreastScreen Australia
Allocate funding for research to improve understanding of the potential benefits and harms of mammography screening in Australia	NHMRC	Modest, funded on a project by project  basis

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References

1. 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.
2. International Agency for Research on Cancer. IARC handbooks of cancer preventions vol. 7: Breast cancer screening. Lyon, France: IARC; 2002 Available from: http://www.iarc.fr/en/publications/pdfs-online/prev/handbook7/Handbook7_Breast.pdf.
3. Duffy SW, Chen TH-H, Smith RA, Yen AM-F, Tabar L. Real and artificial controversies in breast cancer screening. Breast Cancer Manage 2013;2(6), 519–28.