The research literature review paper demonstrates breast cancer screening in Australia, the government-funded program BreastScreen Australia, its cost-efficiency and benefit-harm balance, and suggestions for cancer screening improvement.
Without a doubt, breast cancer is a significant issue for society. Australia offers a government-funded cancer screening program focused on breast screening, namely BreastScreen Australia (Lew et al., 2019). Consequently, the BreastScreen program is crucial as it helps to reduce the treatment intensity. However, the statistics of UK and European reviews on screening in Australia present that around eight breast cancers per every 1000 women between 50 and 74 age years old were overdiagnosed (Lew et al., 2019). Thus, the screening program has both negative and positive sides.
BreastScreen Australia’s Statistics
The screening strategy of BreastScreen Australia is to provide biennial mammography screening for women between 50 and 74 years (Lew et al., 2019). Accordingly, the number of people screened between 2015 and 2016 were 886 270; from them, 41 763 received a diagnostic assessment, and 580 death were prevented. Thus, the NNS and NNT per cancer death prevented are 1528 and 62, relatively (Lew et al., 2019). In addition, the BreastScreen program’s cost-effectiveness in 2018 for women between 50 and 69 years “was $38 302/LYS over 20 years, and $23 713 over 40 years (equivalent to $65 065/LYS and $40 279/LYS, respectively)” (Lew et al., 2019, p. 3).
Suggestions for Program’s Improvement
The BreastScreen program has not changed dramatically since its establishment. The minor changes include a shift from film to digital mammography and digital breast tomosynthesis introduction, DBT (Nickson et al., 2019). It’s important to add that the program needs an updated analysis of the cost-efficiency and the benefits and harms comparison to reveal future opportunities for clinical improvement and individualized approaches development (Lew et al., 2019).
Public Health Perspective
Notably, the screening program helps in detecting early cancer stages. In Australia, breast cancer efficiency on a population level is evaluated through its effect and results on breast cancer mortality (Nickson et al., 2019). In addition, based on a health perspective, the program’s usefulness can be measured with the help of treatment intensity, false-positive screens, and approximate overdiagnosis.
Key levers to improve the effectiveness of screening
One of the major issues is to understand what levers could lead to screening improvement. According to Nickson et al. (2019), the significant aspects of improving cancer screening performance include participation, test sensitivity, and protocols. For instance, the program’s involvement is lower than expected, precisely 55% against 70%, and needs to be increased. Therefore, the factors influencing BreastScreen’s participation should include information quality and broadness, socio-economic issues, and personal health. The second lever for improvement of screening is test sensitivity. Thus, the introduction of different imaging technologies is necessary. Nickson et al. (2019) suggest that Artificial Intelligence systems may help to improve test sensitivity in the future. Finally, the screening protocols provide a better understanding of the benefits and harms.
Breast density notification
In Australia, different advocacy groups are trying to prove that BreastScreen participants should know about their breast density and its impact on screening test correctness (Nickson et al., 2019). However, there is no established confirmation on the most effective way to evaluate these participants’ breast density and clinical management. Additionally, systematic breast density notification has demonstrated disagreement and “unmet knowledge needs among health service providers and women making decisions about supplemental screening” (Nickson et al., 2019, p. 4). As a result, evidence of risks and study of the benefits and harms of additional screening for breast density.
As a result, the program is effective as it offers free mammography screening every two years. The key goal of the program is to reduce cancer deaths in Australia. The program also needs improvements and innovations since it has hardly changed since its inception. The main levers for improvement are participation, test sensitivity, and protocols. In addition, the breast density notification issue should be investigated in detail.
Lew, J. B., Feletto, E., Wade, S., Caruana, M., Kang, Y. J., Nickson, C.,… & Canfell, K. (2019). Benefits, harms and cost-effectiveness of cancer screening in Australia: An overview of modelling estimates. Public health research & practice, 29(2), 1-11.
Nickson, C., Velentzis, L., Brennan, P., Mann, G. B., & Houssami, N. (2019). Improving breast cancer screening in Australia: A public health perspective. Public health research & practice, 29(2), 1-7.