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Tuesday, 8 February 2005
Page: 187


Senator Allison asked the Minister representing the Minister for Health and Ageing, upon notice, on 16 November 2004:

(1)   What action is the Government taking in response to data that shows that 25 per cent of new breast cancer cases are now in women aged between 20 and 49.

(2) (a)   What information is available regarding the level of awareness of women between the ages of 40 and 49 that they can access free mammograms through the BreastScreen Australia program; and (b) what data is available on the proportion of women in this age group who are using the program.

(3)   What action is the Government taking to educate women under the age of 40 about the importance of breast self-examination.

(4)   What data is available on the relationship between the cost of mammograms and the late detection of breast cancer in young women.

(5) (a)   What has the Government done to distribute the National Health and Medical Research Council Clinical practice guidelines for the management and support of younger women with breast cancer; (b) what has the Government done to monitor the use of these guidelines; and (c) can the results of such monitoring be made available.

(6)   Given that young women who are not able to take Tamoxifen face costs of thousands of dollars per year for alternative medications such as Zoladex or Arimidex, will these drugs be considered for listing on the pharmaceutical benefits scheme for those young women; if so, when.

(7)   What measures will the Government implement to help these young women pay for the costs of life-saving treatment.


Senator Patterson (Minister for Family and Community Services and Minister Assisting the Prime Minister for Women’s Issues) —The Minister for Health and Ageing has provided the following answer to the honourable senator’s question:

(1)   While 25% of new breast cancers occur in women aged 20 to 49 years, some three quarters of these new cases are in women aged 40 to 49 years. Women in this age group are eligible to receive mammographic screening through BreastScreen Australia.

(2) (a)   This information is not directly available, however, the evaluation of the 2000-01 BreastScreen Australia campaign showed that over a third of the women aged 40 to 49 years surveyed who had had a mammogram had it through BreastScreen Australia. BreastScreen Australia specifically targets women aged 50 to 69 years as the group with the highest risk and most likely to benefit from screening. As a result, research focuses on the target age group. (b) In 2000-01, 20.5% of women aged 40 to 49 years had a screening mammogram through BreastScreen Australia.

(3)   Meta-analyses and randomised controlled trials have shown no difference in the size or stage of breast cancers at diagnosis or in the number of deaths from breast cancer for women taught to use a systematic approach for breast self-examination compared with those who did not receive instruction. At this time, there is insufficient evidence to encourage or discourage the practice of a systematic approach to breast self-examination to reduce mortality from breast cancer. The Government provides information to women of all ages on breast cancer through the National Breast Cancer Centre (NBCC), which has a leading role in improving outcomes for women with, or at risk of, breast cancer. The Government has provided funds to support a recent NBCC campaign aimed at women of all ages titled, “Any change is worth talking about”. The key message for this campaign is that women of all ages should be aware of any changes in their breasts.

(4)   The Australian Government is not aware of any published research on the relationship between cost of mammograms and the late detection of breast cancer in young women.  

(5) (a)   The National Breast Cancer Centre is the main organisation through which the Australian Government delivers its breast cancer program.

Produced by the National Breast Cancer Centre and endorsed by the National Health and Medical Research Council, the Clinical practice guidelines for the management and support of younger women with breast cancer were launched by the Centre at the 6th Annual Breast Care Nurses Conference in March 2004.

The National Breast Cancer Centre has distributed copies of the guidelines to the following target groups:

  • specialist breast clinicians and treatment centres (eg. surgeons, medical and radiation oncologists specialising in breast cancer);
  • non-government organisations including State and National Cancer Councils; and
  • breast cancer consumer advocacy groups including Breast Cancer Network Australia and the Young Women’s Breast Cancer Action Group.

Other promotional activities have included:

  • articles sent to all Australian Divisions of General Practice for inclusion in their newsletters;
  • articles in:

  

   - the National Breast Cancer Centre’s bulletin ‘BreastFax’;

  

   - Breast Cancer Network Australia’s ‘The Beacon’;

  

   - the newsletters of relevant professional colleges and groups including the Royal Australian College of Surgeons and the Medical Oncology Group of Australia; and

   ยท         profiling of guidelines at national and state-based conferences by the National Breast Cancer Centre.

The guidelines are also available on the National Breast Cancer Centre’s website. Questions, based on the guidelines, that younger women might want to discuss with their doctors before making treatment decisions have been posted on the Centre’s website and the availability of this information was promoted via ‘BreastFax’.

(b)   and (c) The National Breast Cancer Centre monitors the number of copies of the guidelines that are ordered and distributed. Four hundred and fifty copies of the guidelines were disseminated to key target groups in March 2004. An additional 1,579 copies have been ordered subsequent to this initial dissemination process.

(6)   Both ZOLADEXR (goserelin acetate) and ARIMIDEXR (anastrozole) are listed on the Pharmaceutical Benefits Scheme (PBS). ZOLADEX is available on the PBS for the treatment of ‘hormone-dependent locally advanced (equivalent to stage III) or metastatic (equivalent to stage IV) breast cancer in pre-menopausal women’ (in addition to certain forms of prostate cancer and endometriosis).

ARIMIDEXR (anastrozole) is currently available on the PBS for the:

  • Treatment of hormone-dependent advanced breast cancer in post-menopausal women.
  • Treatment of hormone-dependent early breast cancer in post-menopausal women in whom tamoxifen citrate therapy is contraindicated.
  • Treatment of hormone-dependent early breast cancer in post-menopausal women who are intolerant of tamoxifen citrate.

These restrictions are reflective of the patient groups in which the drug has proven medical effectiveness and cost-effectiveness. If patients do not meet these criteria, they will need to purchase these drugs as private prescriptions. For the PBS listing of these drugs to be expanded, the manufacturer would need to provide the appropriate scientific data to meet the PBAC’s medical effectiveness and cost-effectiveness criteria.

(7)   Some younger women diagnosed with breast cancer will qualify to receive these drugs through the PBS where their conditions meet the abovementioned criteria.

The PBS is not a capped program and there is always a capacity to list new therapies (and to extend existing listings) once the proper assessment of the evidence has been made and the medicines have been found to be cost-effective. The pharmaceutical manufacturers of these products are able to present evidence to the PBAC to alter existing PBS listings.