How has the temporary closure of BreastScreen affected GPs?

Matt Woodley

1/05/2020 4:25:39 PM

Like so many aspects of primary care, breast cancer screening has been impacted by the coronavirus.

Dr Alia Kaderbhai
Dr Alia Kaderbhai says it is important GPs ensure patients are ‘breast aware’.

The BreastScreen program has been forced into a ‘temporary pause’ across the country, with services only recently resuming in a limited capacity in a few select areas.
The halt in services has led to concerns about the potential ramifications of patients having to delay scheduled mammography, but Dr Alia Kaderbhai, Chair of the RACGP Specific Interests Breast Medicine network, told newsGP the temporary closure does not pose a great risk or danger to most women in the long-term.
‘For women at population risk of breast cancer who are asymptomatic, deferring mammography for 3–6 months is not going to have detrimental health effects, and there is plenty of good evidence to suggest this,’ she said.
‘Women who are at increased risk due to previous cancer or a strong family history, screening should be considered in a private imaging facility.’
Dr Kaderbhai said the decision to halt the BreastScreen program was required to keep healthcare workers, in particular radiographers, safe. However, she adds it is still an important preventive health campaign and an excellent way to detect breast cancer in its initial stages.
‘With early detection there are more treatment options and improved survival rates. Often less invasive treatments are needed when cancers are detected early,’ she said.
‘We need to encourage our patient to continue to be “breast aware” … it is important to highlight that that breast screening is for asymptomatic women. The danger is that symptomatic women are not presenting to their GPs during this pandemic.
‘We need to reassure women that clinics have been set up now so it is safe to attend, and that if imaging is required this is also safe.’
Dr Kaderbhai’s assessment is supported by University of Melbourne researchers Professor Maarten IJzerman and Professor Jon Emery, who have warned that reduced cancer screening could lead to ‘second and third wave effects of the COVID-19 pandemic’.
‘In Australia, cancer hospitals are … reporting reduced referrals of new patients. Although careful interpretation of this data is required, there is sufficient reason to flag this as an imminent policy problem,’ the professors state.
‘Delays in cancer incidence will significantly affect the survival of patients diagnosed during COVID times and have significant impacts on the health service capacity required to deal with later stage cancers.
‘We need to be analysing the potential impact of our response to COVID-19 on delays in cancer diagnosis, and prioritise the demand for cancer health services to maximise survival and quality of life.’
Australia’s success at flattening the coronavirus curve has meant BreastScreen programs in some states – such as Western Australia and South Australia – have slowly restarted, while others such as Victoria are also preparing to recommence.
However, Dr Kadberbhai said while the temporary closures are being reviewed across the country and there is ‘a lot of political pressure’ to resume screening, protecting healthcare workers is still a priority. 
‘The resumption of screening will have to be stratified to start with and this will potentially be based on risk,’ she said. ‘This means those at higher risk, or who had appointments cancelled will most likely be a priority.
‘It is unlikely that when screening does resume that it will be carried out in the same capacity as previously; it will have to be a staged approach in order to keep the community and health workers safe.
‘[Having said that] we need to encourage women to still tend to their preventive health issues. When this pandemic is over we don’t want to deal with another health crisis of increased cancer burden in society.’
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