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Tuesday, 3 May 1994
Page: 125

(Question No. 1191)

Senator Newman asked the Minister for Health, upon notice, on 8 March 1994:

  Why is no Medicare rebate payable when a woman, on the advice of her doctor, undergoes a mammography to establish the suitability of hormone replacement therapy.

Senator Crowley —The Minister for Human Services and Health has provided the following answer to the honourable senator's question:

  Hormone replacement therapy (HRT) has two main uses: on a short-term basis for the alleviation of menopausal and other symptoms; and, on a long-term basis, to prevent or delay the development of post-menopausal osteoporosis and its associated fractures.

HRT is only one of a number of therapies used in the treatment of osteoporosis. Evidence of the effectiveness of long-term use of HRT in preventing fractures is inconclusive, especially on the duration of HRT needed to produce protective effects and the risks associated with extended use.

In particular, the issue of whether long-term use of HRT is associated with an increased risk of breast cancer is the subject of considerable controversy amongst the scientific and medical community. No clear consensus has been reached concerning the existence or magnitude of any increased risk of developing breast cancer in women receiving HRT on a long-term basis.

The Pharmaceutical Benefits Advisory Committee is planning to convene a consensus conference on the use of HRT in 1995. This should enable consensus to be reached on the implications of extended use of HRT for breast cancer risk.

In the interim, when assessing a woman's suitability for long-term use of HRT, it is a matter for the individual clinician to determine on the basis of clinical indications whether the patient is at risk of breast cancer and, if so, to order a mammogram.

The Government's funding arrangements for mammography recognise the dual use of mammography in the screening and diagnosis of breast cancer.

For mammography screening, special purpose grants have been made to the States and Territories which aim to ensure the provision on a national basis of a network of accredited screening and assessment facilities. The structure of the screening program was based on the recommendations of the Steering Committee established to evaluate the effectiveness of mammography screening. While services target women aged 50 to 69 years, the age group for whom research has demonstrated a clear health benefit from mammography screening, they are also available to women over 40 years of age. Services are provided at no cost to the patient and women are invited to undergo a screening mammogram every two years.

For diagnostic mammography, Medicare benefits are available where a woman presents to her doctor with symptoms or indications of malignancy in the breast, or with a family history of breast cancer.