1 Preface

This report of the Australian Health Ministers' Advisory Council's Breast Cancer Screening Evaluation Steering Committee is the principal outcome of the national evaluation of breast cancer screening pilot projects. The terms of reference of the Committee are overleaf. The main purpose of this report is to make detailed recommendations about the policy aspects of developing a national breast cancer screening program for Australia. The contents of the report should also be useful to groups involved in breast cancer screening and, more generally, groups involved in public health, preventive medicine and women's health.

The recommendations of the report are presented in chapter 4. The substance of the report is structured as four main chapters:

  1.  Screening for breast cancer
    This chapter examines in detail the various methods which have been proposed for breast cancer screening, and assesses the likely impact that breast cancer screening would have on death from breast cancer in Australia. It also examines the cost -effectiveness of breast cancer and whether high quality breast cancer screening can be performed in Australia and is acceptable to Australian women.
  2. Components of a successful screening program
    This chapter examines the benefits and potential adverse effects of mammographic screening. It also discusses the requirement for a screening program to meet women's needs, and the potential involvement of general practitioners in a screening program.
  3. A breast cancer screening program for Australia
    This chapter discusses in detail proposed screening policy, organisational arrangements, funding and implementation of a national mammography screening program.
  4.  Cost of a national screening mammography program
    This chapter presents estimates of the cost of a national screening program, during both the implementation phase and steady-state operation.

The numbering of the recommendations in the text is not self explanatory.

The recommendations in chapter 4 have been placed in a logical order and numbered in sequence. This numbering has been used in the text, although in the text the recommendations do not appear in this order. This system has been used to facilitate cross referencing between the text and chapter 4. The information used in this report has been gained from the following sources:

  • Australian mammography screening pilot projects;
  • International and Australian published research on breast cancer screening;
  • Study tour by the head of the Screening Evaluation Coordination Unit of national breast cancer screening programs in Sweden, Finland, Britain and the Netherlands.

The views of a wide range of interested organisations within Australia were also sought.

To evaluate the pilot projects, standard data sets were developed in consultation with the projects, which were then requested to submit data in accordance with the data sets. In the time available, not all projects have been able to provide all the data requested. This has resulted in missing data in some tables. Nevertheless, the data provided are sufficient to draw a number of major conclusions. An important area in which data are lacking is the proportion of women who would attend screening if there were an intensive recruitment campaign using electronic media. This information, which would have significant planning and resource implications, may only be gained once large scale screening has commenced.

In relation to outstanding data, pilot projects will be asked to submit these data to the Screening Evaluation Coordination Unit at the Australian Institute of Health by 30 June 1990. It is intended to use these data (and data previously supplied but not included in this report) to prepare several technical reports and refereed publications in collaboration with pilot projects.

As part of the Steering Committee's consideration of possible methods of breast cancer screening, the Health Technology Unit at the Australian Institute of Health was requested to convene a working party to examine this issue as well as update advice on technological aspects of mammography technology. The material in section 6.5.4 which examines the possible alternative technologically based methods of breast cancer screening was prepared by the Working Party. The report of the Working Party was published in March 1990 and is available from the Australian Institute of Health (Australian Institute of Health 1990).