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Thursday, 9 June 1994
Page: 1573

Senator WEST —I seek leave to extend the time for the presentation of committee reports for 20 minutes to enable me to submit the report from the Standing Committee on Community Affairs relating to breast cancer screening and treatment in Australia.

  Leave granted.

Senator WEST —I present the report of the Standing Committee on Community Affairs on breast cancer screening and treatment in Australia, together with the transcript of evidence.

  Ordered that the report be printed.

Senator WEST —I move:

  That the Senate take note of the report.

In the 20 minutes available I would like to make a short statement, and I know that Senator Herron and Senator Lees also wish to make some comments. Copies of this report will be available from about 3 o'clock this afternoon, and the Table Office has copies of the recommendations available already.

  Because time is limited, I will start by thanking the people who have been involved in this report. This matter was referred to the committee on 27 May last year. We received 137 submissions, had eight public hearings around Australia and took 1,800 pages of evidence. To do this we required the assistance of many people, including individuals and organisations who made submissions and who came forward at the public hearings. However, one does not do these things without the support of the committee staff, so to Pauline, Peter, Alistair, Leonie, Jean and others who have been involved, I say a very big thank you on behalf of the committee. This issue was being dealt with at the same time as the committee tabled 11 other reports, and it has six current inquiries. That is a tremendous workload, and it would not be possible for the committee to do it without the support of the secretariat. To them, on behalf of the whole committee, thank you very much.

  This inquiry provided a unique opportunity for both individuals and organisations to express their views on this important issue. Breast cancer is a personal tragedy for both the women involved and their families and friends. It is also a major health problem facing the community, being the most common cause of death from cancer in Australian women. The lifetime risk of women developing breast cancer is one in 15 in Australia, and in 1990 some 6,998 women were diagnosed with this disease. The incidence of the disease also increases with age. Trends would suggest that the lifetime risk may be approaching one in 12. We are not able to give any figures later than 1990 because the cancer registries from each of the states are that far behind in some areas.

  The committee believes that there are a number of important recommendations to improve the efficiency of both the screening program and the treatment regime. The aim of the national program for the early detection of breast cancer is to detect malignancy at a very early stage prior to its being able to be detected by physical examination. Evidence to the committee suggested that a fully operational screening program could lead to a reduction in mortality from breast cancer among Australian women of around 17 per cent.

  The committee reviewed the operation of the national program, which is jointly funded by the Commonwealth, states and territories. It offers an integrated and systematic screening program for asymptomatic women aged 40 years and over, with women aged 50 to 69 years being actively targeted. The program operates 58 screening units in all states and the ACT, with the Northern Territory due to begin this month—June 1994. The program aims to screen 1.7 million women every two years by 1996-97, when it will be fully operational. To date, some 377,375 women have been screened. I know that Senator Herron wants to address the issue of the number that have been screened and how the states are going to reach the target by the key years.

  The committee addresses the important issue of access under the program, especially as it relates to women living in rural and remote areas, Aboriginal and Torres Strait Islander women, and women from non-English speaking backgrounds. The committee believes that access could be improved to women in rural and remote areas and that suitable strategies need to be introduced to achieve this outcome. The committee also acknowledges the unique problems facing the program in screening Aboriginal and Torres Strait Islander women. Often these problems relate to cultural differences and the different health priorities of Aboriginal and Torres Strait Islander women, who do not see breast cancer as a priority.

  The committee believes that strategies sensitive to Aboriginal and Torres Strait Islander cultural values need to be implemented to increase access to the program. These strategies should mean the development of holistic health programs, which are planned with the relevant community-based health organisations, especially Aboriginal health services. The committee also believes that strategies sensitive to the cultural backgrounds and values of women from non-English speaking backgrounds need to be introduced to increase the access of these women to the benefits of the national program.

  The committee believes that a concerted national education campaign should be undertaken to publicise the program more widely amongst women, the medical profession and the community generally. The campaign should emphasise the importance for women of the early detection of breast cancer, and clarify the limitations of the program, emphasising that mammographic screening is an aid to the early diagnosis and detection of breast cancer but will not prevent the disease.

  The committee reviewed the issue of whether women aged 40 to 49 years should be excluded from the program. It concluded that screening should continue to be available to these women, but that the program should not actively target this group. The committee is concerned that if these women are excluded from the program they will receive de facto screening under Medicare, and this screening may not meet the same quality standards as exist under the program.

  With respect to symptomatic women, the committee recognises that, although the program is for well women, should symptomatic women present for screening they should be accepted, especially as it may be difficult for them to access other services. They should also be provided with advice and information regarding the availability of further medical services.

  We note that all the screening programs and screening clinics we saw did try to screen out symptomatic women at the initial phone call and at appointment making. However, a number of women chose to deny the problem or were concerned enough that the advice they were getting might not have been accurate to choose to participate in the program because they felt it was high quality and was being carried out by experts, and therefore that they were going to get the best advice. They should not be turned away. These women have made a conscious decision to seek help, and they may make that conscious decision only once. We must not deny them the opportunity to be linked into the services they need.

  The committee looked at the operational effectiveness of the program, especially in terms of the role of general practitioners under the program and the use of non-radiologist readers. The committee believes that more should be done in the area of general practitioners' education and that information about the program should be widely disseminated to them. Efforts should be made to actively involve them, especially in the recruitment aspects of the program, and also in counselling, referrals and discussions of treatment options.

  We did have evidence that there was some confusion amongst GPs as to the difference between diagnostic and screening mammography. Not only GPs have that problem of understanding the difference; it also happens in the community. But if GPs have the problem the general community will have an even bigger problem.

  The committee also believes that non-radiologists—that is, doctors who are trained by the Society of Breast Physicians—should be employed as readers under the program because there was evidence that there was a maldistribution of radiologists in a number of areas. It believes that using breast physicians in this role will allow for greater flexibility in the implementation of the program, and improve access.

  The committee also looked at the cost effectiveness of the program overall and in terms of the mix of public and private service delivery. While there is little data at present on the cost effectiveness of the program, a detailed cost-benefit analysis of the program should form part of any ongoing evaluation. The committee also believes that the program should avoid duplication in the provision of screening services by utilising both private and public sector services, provided they can meet the accreditation standards.

  With regard to funding arrangements, the committee is of the view that the present arrangements provide a more cost effective system than the alternative of Medicare funding. The current system also ensures a rigorous approach to quality control and data collection that would be difficult to achieve if screening services were provided on an ad hoc basis through individual providers. Any move away from the current funding approach would compromise the efficiency and effectiveness of the program.

  The committee canvassed several treatment issues and, although the House of Representatives Standing Committee on Community Affairs is currently inquiring into treatment aspects, this committee has made a number of recommendations in this area. In particular, the committee believes that more information needs to be provided to women about the various treatment options available; and that women should be encouraged to participate in decisions regarding appropriate courses of treatment. In relation to the treatment of cancer patients, the committee believes that surgeons should be experienced in breast surgery. Breast cancer support and counselling services should also be encouraged and expanded.

  In the area of radiotherapy services, the committee received evidence suggesting that women in rural and remote areas in particular often have difficulty in accessing these services, and this may affect their choice of treatment. The committee believes that it is essential that the distribution of these services be improved so that women living outside the major metropolitan centres can obtain better access. The committee also believes that the level of travel and accommodation assistance may need to be reviewed and increased to improve access to services for women living in rural and remote areas. This assistance varies from state to state.

  Evidence received by the committee suggested that data on cancers generally needs to be improved. The committee was told that few, if any, hospitals have cancer registries. These registries need to be established so that data relating to treatment outcomes can be assessed. The committee also believes that state and territory cancer statistics need to be collected on a more uniform and consistent basis and provided to the Commonwealth on a more timely basis so that up-to-date national statistics on the incidence of cancers are available. I seek leave to have the rest of my speech incorporated in Hansard.

  Leave granted.

  The speech read as follows

  It is also noted in the committee's report that the collection of a comprehensive set of data by the program provides a unique opportunity for coordination and analysis of data. The committee believes that the state and territory coordination units should provide data collected through the screening program to the National Breast Cancer Centre for further analysis and research.

  The committee believes that research into breast cancer should be given a high priority and welcomes the funding initiatives in the 1994-95 budget. The committee considers that the Commonwealth government should provide a specific allocation for research into breast cancer in all future budgets and that it should also provide additional funding for clinical trials.

  The committee wishes to thank those individuals and organisations who made submissions, and gave evidence at public hearings.