How can Australia increase BreastScreen participation?

Australia should concentrate on improving Breastscreen participation by integrating the service within general practice clinical information systems, according to a new RACGP submission.
 
The college has also said prevention-focused MBS rebates could help increase screening access, and that funding should be geared towards to raising the number of women participating, rather than trying to trying to diagnose breast cancer earlier in those who are already being screened.
 
Dr Katrina Tiller, Chair of RACGP Specific Interests Breast Medicine, told newsGP the college welcomed the opportunity to give feedback on the program as GPs have a central place in preventive care.
 
‘[Our] submission suggests ways the program could be improved after consultation with members,’ she said.
 
‘Overall capturing more eligible people is key. With only half of eligible, invited people attending BreastScreen, discussion on how to improve screening attendance is important.
 
‘The benefits of the screening program will be seen when many of those who are eligible are screened rather than trying to diagnose breast cancer earlier in those who are already being screened.’
 
Dr Tiller says strengthening screening makes sense from both a health and an economic perspective, pointing out that treating advanced-stage versus early-stage breast cancer is associated with ‘significant increases in incremental costs’. She believes a better understanding of the relevant stage-specific costs only provides support for programs aimed at shifting cancer diagnoses to earlier disease stages.
 
‘The smaller a cancer is at detection the smaller the economic cost to the patient and to the community,’ she said.
 
‘The integration of BreastScreen results and follow up into general practice systems needs to be seamless, responsive and available for GPs to access at the point and time of care.
 
‘BreastScreen is a community health program and GPs are an integral part of the community’s participation in screening.
 
‘GPs already use their own reminder systems in their software, and having integration with the national program would allow timely reminders for screening.’
 
While breast cancer is the most common cancer diagnosed in Australian women, and the second most common cause of cancer-related death behind lung cancer, mortality has decreased since BreastScreen Australia began, from 74 deaths per 100,000 women aged 50–74 in 1991, to around 40 deaths per 100,000 since 2014.
 
However, the latest available data shows in 2020–21, just under half (48%), or around 1.7 million women aged 50–74 participated in the program.
 
As a such, the BreastScreen Australia National Policy and Funding Review is looking to gauge what is working well and what could be done better, as well as determine how participants and healthcare providers want it to look like in the future.
 
Aside from suggested improvements to the program, the RACGP also outlined existing challenges faced by women seeking breast cancer screening, including cost, access, and cultural barriers.
 
It points out that BreastScreen centres are often located within hospital services where parking can be an issue with access and cost in a metropolitan setting, and that screening services located in community hubs would enable easier access.
 
Mobile screening services could also be considered for rural and remote communities, the college said, while noting that screening attendance for culturally and linguistically diverse (CALD) and Aboriginal and Torres Strait Islander women is lower than average.
 
Aboriginal and Torres Strait Islander women aged 50–74 also have a higher mortality rate than non-Indigenous women (53 compared with 40 deaths per 100,000 women).
 
The RACGP says including more women and Aboriginal and Torres Strait Islander health workers at screening clinics, and providing prompt assessment after a patient is recalled, could help to mitigate some of these issues.
 
‘A whole-of-community approach needs to be taken and engaging the Aboriginal and Torres Strait Islander health practitioners and remote area nurses is key,’ the submission states.
 
‘Health services need to be culturally safe, and follow-up services for treatment need to be affordable and accessible to ensure ongoing success of the program.’
 
The RACGP recommends greater ongoing engagement with these communities and with Aboriginal and Torres Strait Islander health practitioners employed by BreastScreen, as well as having ‘community champions’ embedded in Aboriginal Community Controlled Health Organisations, general practices and Primary Health Networks.
 
‘[We need to] invest in groups who are not attending, including those who are [from] CALD backgrounds who find the BreastScreen process difficult to attend for emotional and cultural reasons,’ Dr Tiller added.
 
Meanwhile, greater support for preventive health in general would generate better outcomes across the board, the submission states.
 
‘GPs are well trained and able to value add consultations with quick preventive health reminders,’ Dr Tiller said.
 
‘However, a patient often comes with more than one issue in the first place so preventive health can go to the bottom of the list.’ 
 
Other recommendations included in the submission: 

• Encourage patients with a family history of breast cancer who attend the program to see their GP to discuss individual circumstances
• Encourage patients who attend the program to consider other evidence-based screening, eg bowel cancer
• Emphasise the importance of breast screening and personal risk to patients presenting for other issues, such as cervical and STI screening, pregnancy planning, menopausal symptoms, who do not currently attend the BreastScreen program

breast cancer BreastScreen cancer screening review preventive health