Breast cancer awareness should not stop for a pandemic

Since being plunged into a pandemic, Australia has seen a decrease in health checks and preventive health screening, with a particular drop in routine care for chronic conditions and cancer screening rates.
 
The RACGP has consistently advocated for people not to delay or avoid accessing healthcare amid concerns of COVID transmission, reminding them that GPs are still available to support continuity of care.
 
One integral part they play is to help boost uptake of cancer screening.
 
A new report from the Australian Institute of Health and Welfare (AIHW), Cancer screening and COVID-19 in Australia, shows that so far this year fewer people have participated in screening than in previous years.
 
Between January to June 2020, there were 144,982 fewer mammograms and 443,935 fewer cervical screening tests completed compared with previous years. From January to July, 144,379 fewer bowel screening tests were returned.
 
Around 1100 mammograms were performed in April 2020, compared to more than 74,000 at the same time in 2018. Screening picked up again in June, with about 70,000 mammograms conducted that month, but this was still 10,000 fewer than in 2018.
 
October marks Breast Cancer Awareness month, and additional AIHW data trends reveal that awareness of preventive health measures is a continual necessity.
 
In 2016, 10,756 new cases of invasive breast cancer were diagnosed in women aged 50–74, making it the most common cancer diagnosed in Australian women.
 
Breast cancer is the second most common cause of cancer‑related death in Australian women, after lung cancer, and current figures show 9% of those diagnosed not surviving five years. In 2018, 1423 women aged 50–74 died from the cancer.
 
However, mortality has decreased since BreastScreen Australia began, from 74 deaths per 100,000 women aged 50–74 in 1991 to fewer than 50 deaths per 100,000 since 2010.
 
More than half (55%) of targeted women participate in the program, with around 1.8 million women aged 50–74 having a screening mammogram in 2017–18, and has remained consistent (between 54% and 55%) since 2010–11.
 
Despite these promising figures, the pandemic-related decrease in screening has led GPs and leading health organisations to urge Australians to ensure they are up to date.
 
Cancer Council Australia recently launched the Screening Saves Lives campaign.
 
‘We know that COVID-19 has disrupted our lives and some of us may have neglected our regular health checks,’ Cancer Council Australia’s Acting CEO and Director of Cancer Control Policy Megan Varlow said.
 
‘COVID-19 impacted participation in cancer screening in different ways. BreastScreen Australia services temporarily paused in the first stages of the COVID-19 lockdown which saw participation fall significantly.
 
‘The National Cervical Screening Program also saw a decline … the reductions during the COVID-19 lockdown are more than we would have expected.
 
‘This decline is very concerning as it means there is a sizable portion of women who are now overdue for screening.’
 
Dr Alia Kaderbhai, Chair of the RACGP Specific Interests Breast Medicine network, recently wrote in newsGP that GPs ‘should remind all our patients that cancer does not wait due to the COVID-19 pandemic’ and to continue to encourage patients to take part in routine breast cancer screening.
 
To further contribute to raising awareness and support healthcare providers in prevention and management, Cancer Australia has launched a comprehensive digital resource, Guidance for the management of early breast cancer in conjunction with its Cancer Won’t Wait public health campaign.
 
The resource provides around 200 up-to-date evidence-based recommendations and practice points to lead to optimal outcomes for women and men with breast cancer, as well as guidance for treatment planning, support and options, and follow-up and survivorship care for people with early breast cancer, from the point of diagnosis onwards.
 
‘For health professionals, knowing where to find current, best-practice advice quickly and easily on breast cancer care is critical for delivering optimal care,’ Cancer Australia CEO Professor Dorothy Keefe said.
 
‘[The resource is] a valuable tool for shared decision-making between health professionals and patients. It supports a holistic, patient-centred, multidisciplinary approach that will help to reduce unwarranted variations in early breast cancer care.’
 
The Victorian COVID-19 Cancer Network (VCCN) also affirms that ‘cancer care never stops’ and warns that, with the drop in screening participation, the coronavirus itself will ultimately have smaller health impact than on other health issues induced by the pandemic response.
 
‘The consequences of people delaying health checks could be profound for both the individual and our healthcare system,’ VCCN co-Chair Professor Grant McArthur said.
 
‘We are unfortunately preparing for a wave of cancer cases coming through in the next six to 12 months. COVID-19 has not changed the fact that one in three men and one in four women in will be diagnosed with cancer by the age of 75.’
 
The RACGP’s Red Book covers guidance on breast cancer prevention in general practice, and the National Guide provides preventive health information on breast cancer for Aboriginal and Torres Strait Islander people.
 
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