Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

National guidelines for early detection of breast cancer in younger women – a key to reducing inequity (#456)

Carolyn Nickson 1 , Louiza S Velentzis 1 , Paul Grogan 1 , Bruce Mann 2 , Karen Canfell 1
  1. The Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, Sydney, NSW, Australia
  2. Breast Service, The Royal Women’s and Royal Melbourne Hospital, Melbourne, VIC, Australia

Aims

To evaluate the equity and effectiveness of Australian services for the early detection of breast cancer in women under 50.

Methods

We summarised breast cancer burden in women <50, mapped service availability, utilisation and outcomes, and analysed related guidelines and policies.

Results

Around 20% of Australian breast cancers are diagnosed in women <50; incidence has increased by 50% over the last 20 years.1 Breast cancer is the second-highest disease burden in Australian women aged 40-49,2 with poorer relative survival compared to older women.3 Early detection saves lives and reduces treatment intensity.4

BreastScreen Australia is available but not targeted to women aged 40-49. Although these services comprise around 10% of BreastScreen episodes, they are not subject to the same level of quality assurance monitoring in place for the target age group (50-74).5 As recommended by the ROSA-Breast project,6 risk-adjusted entry age may be warranted, noting that many countries start screening at 45 (as per European Breast Guidelines7) or age 40 (as per WHO recommendations8).

Outside BreastScreen, different guidelines for referring and managing younger women considered at-risk or symptomatic (e.g. RACGP ‘Red Book’, RANZCR statements, eviQ, Medicare Schedule) mean that women’s pathways to early diagnosis depend on where they live and who they see, with an overreliance on patient-initiated action and capacity for out-of-pocket costs. Qualitative studies show this generates confusion for clinicians and patients9, and disparities related to health literacy and socio-economic status.

Current health data collection and reporting limits our capacity to assess the population-level clinical and cost effectiveness of available services for early detection of breast cancer in younger women.

Conclusions

National Australian clinical guidelines for the early detection of breast cancer would help reduce inequities for women <50 and increase our capacity to evaluate and make evidence-based improvements to these health services.

  1. Australian Institute of Health and Welfare. Cancer data in Australia. Canberra 2023. Available from: www.aihw.gov.au/reports/cancer/cancer-data-in-australia
  2. Australian Institute of Health and Welfare & Cancer Australia 2012. Breast cancer in Australia: an overview. Cancer series no. 71. Cat. no. CAN 67. Canberra: AIHW.
  3. National Cancer Control Indicators. Relative survival by stage at diagnosis (female breast cancer). Charts. Available from: ncci.canceraustralia.gov.au/relative-survival-stage-diagnosis-female-breast-cancer
  4. Elder K, Nickson C, Pattanasri M, et. al. Treatment intensity differences after early stage breast cancer (ESBC) diagnosis depending on participation in a screening program. Ann Surg Oncol. 2018;25(9):2563–72.
  5. Australian Institute of Health and Welfare. BreastScreen Australia Monitoring Report 2023. Data tables. AIHW, 2023. DOI: 10.25816/w6zm-mt86
  6. The Daffodil Centre (2023). The ROSA Project – summary. Summary of ‘Roadmap for Optimising Screening in Australia – Breast’, investigating risk-based breast cancer screening. Produced by the Daffodil Centre on behalf of Cancer Council Australia. Available from: www.cancer.org.au/go/rosabreast
  7. Schünemann HJ, Lerda D, Quinn C, et. al. European Commission Initiative on Breast Cancer (ECIBC) Contributor Group. Breast Cancer Screening and Diagnosis: A Synopsis of the European Breast Guidelines. Ann Intern Med. 2020 Jan 7;172(1):46-56. Doi: 10.7326/M19-2125.
  8. World Health Organisation.WHO position paper on mammography screening. Accessible via: www.who.int/publications/i/item/9789241507936
  9. Collins IM, Steel E, Mann GB, et. al.. Assessing and managing breast cancer risk: clinicians' current practice and future needs. Breast. 2014 Oct;23(5):644-50. doi: 10.1016/j.breast.2014.06.014. Epub 2014 Jul 4.