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Committee inquiring into the management of breast cancer finds a lack of co-ordination in treatment currently available

RICHARD PALFREYMAN: Six Australian women die each day from the complications of breast cancer, and according to a new parliamentary report, breast cancer treatment is a lottery. The Community Affairs Standing Committee report into the management and treatment of breast cancer found that many general practitioners lack diagnostic expertise, and that survival from breast cancer is dependent on the first referral a patient gets. The committee has recommended that patients have access to multi-disciplined medical teams where oncologists work closely with surgeons, pathologists and radiologists. Catherine McGrath this morning spoke to committee member, Liberal MP, Trish Worth, and the Director of the Oncology Unit at the Flinders Medical Centre in South Australia, Dr Steven Birrell.

TRISH WORTH: It has been said to the committee that the standard of treatment and the type of treatment you get will be dependent upon where you're first referred. That's why we need as much information spread around every level of the profession as possible because the general practitioner can be a very important person in this whole process, the first point of contact for that woman and responsible for where that woman is referred.

CATHERINE MCGRATH: Well, this is a big worry for patients in Australia, isn't it, because you're, indirectly through your report, undermining the faith they have in their general practitioner, and also undermining their faith in the whole medical profession if they can't trust the sort of treatment that they're being delivered.

TRISH WORTH: I wouldn't like to undermine their faith because I think that a great number of medical practitioners are doing the right things and I can't stress that enough really. But I think if there is general community education, the right questions will be asked and I think that is important.

CATHERINE MCGRATH: Well, Dr Steven Birrell, if I could bring you in here, how should breast cancer be treated and what is wrong with the sort of treatment many women are getting now?

STEVEN BIRRELL: Well, it's not just a matter of what is wrong, it's a matter of the fact that breast cancer diagnosis and treatment is changing rapidly, and to cope with the changing environment of health care and also the understanding of breast cancer, it requires input from many people. And what is being advocated by many experts in the field is that when a woman develops breast cancer, for her to be given as much information as possible, it requires information coming from many directions - from radiotherapists, from medical oncologists, from surgeons.

CATHERINE MCGRATH: For women now who are being treated for breast cancer, if they're just being treated by perhaps an oncologist, what are you saying about that treatment, that it's not adequate, they need more professional input?

STEVEN BIRRELL: A lot depends on the expertise of the person involved. It is very difficult to keep up with all the latest literature which is coming out from around the world. And I think it is very difficult for a patient to evaluate the credentials of the person that is treating her, and a lot depends on the appropriate referral from the general practitioner in the first instance. Now, as Trish has mentioned, a major component of the report has been education of the general public, but also the general practitioners as to what is considered to be appropriate referral.

CATHERINE MCGRATH: Patients will be listening to this now and wondering if they're getting the right treatment. I mean, what can you really tell them? What sort of treatment do you think patients should be getting?

STEVEN BIRRELL: Well, it's very difficult to generalise because breast cancer is such a .. presents, not as a uniform disease, it can present as a very diverse presentation of a cancer. I believe that the patient should discuss the issues or concerns with their primary health care giver, now whether that be an oncologist or the general practitioner, to openly discuss what is new in breast cancer, what is changing, what I should be having done. And I believe that women are becoming much more .. I think the politically correct term is 'empowered' to undertake this and discuss things with their medical practitioners.

CATHERINE MCGRATH: Trish Worth, can I ask you, what do you advise patients to do if they're not happy with their treatment? What power do they have at the moment?

TRISH WORTH: I think that they should know that it's just okay for them to ask for a second opinion.

CATHERINE MCGRATH: Well, where do you see the blame as being? If it's a lottery out there for people, if they're presenting with breast cancer, and whether they get good treatment or bad treatment is, at the moment, a matter of luck, depending on their GP and who their GP knows. Where is the system falling down, because this is quite an outrageous circumstance for patients?

TRISH WORTH: I think that it depends how they're diagnosis is made. If they've had a routine mammogram through the screening program and a small lesion which can't be detected just by palpation is discovered, then they're probably most fortunate. But even then, they will be back to their general practitioner for their referral after that. We heard evidence in South Australia that 80 per cent of women were being referred to a small number of surgeons who were participating in the multi-disciplinary approach and specialising in that area. Now, if that could be mirrored in all other States and if that 80 per cent could be got up to 100 per cent, then I think the problems would be solved. Of course, distance, remote and rural Australians don't have exactly the same opportunities as those in the metropolitan area do, but even some women in the metropolitan area may be very close to a facility and just not accessing it because they are not empowered, they're not asking for it.

RICHARD PALFREYMAN: Liberal MP, Trish Worth and Dr Steven Birrell in Adelaide.