BreastScreen Australia is to update its position on breast density reporting early in the new year.
Advocates for breast cancer awareness are calling for a change in the National BreastScreen Australia program, saying breast density should be included in mammogram reporting in the upcoming policy and funding review.
A spokesperson for the Department of Health and Aged Care told Cosmos:
“The report is expected to be submitted to Government in early 2025.”
BreastScreen Australia is the national breast cancer screening program, allowing women between 50 and 74 years to have a mammogram every 2 years.
A mammogram is an x-ray of tissue to check for cancer. If breast cancer is detected early, it can significantly improve the outcomes of any treatment.
But one aspect that can sometimes make detecting cancer in a mammogram difficult is breast density.
On a mammogram, a cancerous spot appears white. However, dense breast tissue also appears white. Therefore, it can be more difficult to detect cancer in patients with high density breasts.
An article published in Trends in Cancer has highlighted how AI used in conjunction with mammography can have a big impact on identifying women with increased cancer risk.
In analysing mammographic density, AI has identified new mammographic features that are indicative of early cancer detection.
“AI is enabling us to refine mammographic density as a risk factor, and hone in on particular features in a mammogram that are stronger risk predictors,” says Associate Professor Wendy Ingman from Robinson Research Institute at the University of Adelaide.
“However high mammographic density remains a significant breast cancer risk factor.”
There has been much advocacy from groups in Australia such as InfoMD urging a policy change so that women can be notified of the mammographic density.
“InforMD believes that receipt of information will enable women with high breast density to be part of decision-making around how to manage their cancer screening,” it says.
But the most recent position statement from BreastScreen Australia, from 2020, says: “Until such time that more evidence is available on how breast density should be best assessed and managed, and evidence supports clinical pathways for women, BreastScreen Australia should not routinely record breast density or provide supplemental screening for women with dense breasts.”
“In the future, breast density may have a role in determining the frequency and method of an individual’s breast screening.”
Breast density reports in some states
From August 2023, BreastScreen SA began measuring and reporting individual density for clients as part of regular breast cancer screening programs.
Dr Rod Pearce, a GP in Adelaide’s northern suburbs has been leading The Breast Screen Initiative for the Australian General Practice Network is a strong advocate for density reporting.
“It’s important that people should be aware that breast density is actually something that can be measured, but it could also change the way that mammograms are interpreted, and it could change the advice that people are given.” says Pearce.
“So, from a general practitioner point of view, we say that people should be aware of the density and then should discuss with their care providers what that means.”
However, Pearce argues that education is needed alongside breast density reporting in order to make the biggest impact.
“There needs to be an ongoing education program and support for GPs to understand the significance of density and to be able to talk to their patients about what that means and how to use it and how to interpret it.”
“We think GPs should have a closer relationship with the screening program. The screening program should be supportive of education programs so that GPs talk to their patient about their breast density, rather than leaving it as an unknown and not informing their patients.”
BreastScreen Victoria is currently rolling out statewide breast density reporting. They expect to be reporting it to all clients and their GPs by early 2025.
In December of 2023, The Royal Australian and New Zealand College of Radiologists updated its policy statement: “Whilst a future risk-based model for breast cancer screening is being developed, RANZCR recommends mandating the reporting of breast density in both screening and diagnostic settings in Australia and New Zealand,” reads the statement.
According to the Australian Institute of Health and Welfare, about 1.8 million of the 3.6 million women aged 50-74 who were eligible for screening mammograms participated in BreastScreen Australia’s program.
The National Breast Cancer Foundation says the incidence of breast cancer has risen dramatically over the past 30 years, -rising from about 9,832 new cases a year in 1994, to more than 21,000 new cases a year in 2024. As a result, 1 in 7 women will now be diagnosed in their lifetime.
Since NBCF’s inception in 1994, the death rate from breast cancer in Australia has reduced by over 40%. Despite this, 9 people in Australian die every day which is the equivalent of over 3,300 deaths from breast cancer each year.
Note: Our original article indicated that research into mammography and AI was drawn from Trends in Cancer, but it is in fact from an editorial contribution. The mistake was made in production.
