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Wednesday, 22 August 1984
Page: 133

Senator HAINES —My question is directed to the Minister representing the Minister for Health. Is the Minister aware of the growing concern among women and their doctors about the restrictions currently applying to mammography under the medical benefits schedule? At the moment, for a patient to qualify for a rebate for a radiographic examination of either or both breasts, there must be a reason to suspect the presence of malignancy in the breast or breasts, because of the past occurrence of breast malignancy in the patient or members of the patient's family or because symptoms or indications of malignancy were found on an examination of the patient by a medical practitioner. At the moment, it appears that the patient has to have very visible signs of cancer before radiographic examination of her breast or breasts attracts a rebate. Given the high personal and medical costs of cancer and the fact that it is a very common form of cancer among women, will the Government move urgently for a revision of the medical benefits schedule so that a more realistic set of referral criteria applies to items 2734 and 2736?

Senator GRIMES —The Government and the Minister for Health are aware of the restrictive nature of the present medical benefits schedule item for mammography , which was introduced at the suggestion of the Medicare Benefits Advisory Committee, because it was felt that we did not want the position whereby mammography was used as a routine screening procedure in otherwise well people.

Senator Jack Evans —Why not? Don't you like preventive medicine?

Senator GRIMES —I can suggest two reasons: First, the routine exposure of people to mammography in this way is not necessarily a good thing and secondly, it is an expensive procedure. I can obtain a more detailed answer for Senator Jack Evans if he is interested.

A recent statement by the National Health and Medical Research Council on breast health and mammography identified what it considered were more reasonable indications for the conduct of the procedure. It suggested:

Mammography is not commonly necessary under the age of thirty years.

Women not at increased risk should have a base-line mammogram at the age of forty years.

The frequency with which mammography should be repeated will vary with each patient. Those who should have annual mammograms are:

women with increased risk

women with very large breasts

women whose breasts are difficult to examine

women whose breasts are highly nodular.

The Council recommended that other women should have a mammogram every three to five years. It is thought that yearly mammography will be necessary in less than 50 per cent of women. The Council stated:

In the light of this report it is planned to raise this matter at the next meeting of the Medical Benefits Schedule Revision Committee (22 September 1984) with the view to amending the current item descriptions and adopting the following criteria:

where the patient is 40 years or over

where the patient is under 40 years and there is reason to suspect malignancy because of

past occurrence of breast malignancy in the patient;

occurrence of breast malignancy in patient formerly;

indication of malignancy found on examination;

nodularity of the breast;

large size of the breast.

The matter will be taken up by the Medical Benefits Schedule Revision Committee on 22 September with the expectation that the item will be changed in that regard.