By invitation only - the case for breast cancer screening reminders for women over 69 years

Abstract

Background: Breast cancer is the leading cause of cancer death in women in Australia. Early detection provides the best chance of reducing mortality and morbidity from the disease. Mammographic screening is a population health strategy for the early detection of breast cancer in Australia. Recruitment strategies such as regular advertising and biannual screening invitations are exclusively targeted at women aged 50 - 69 years. Even though they can participate, women 70 years or over are not invited or actively encouraged to undertake screening. Research has found that a routine letter of invitation increases the number of women participating in breast cancer screening.

Methods: Cancer data analysis and a literature and policy review was conducted to assess age specific breast cancer mortality rates and the legitimacy of rationale used to limit invitations for breast cancer screening to women younger than 70 years.

Results: The proportion of women over 69 years participating in the BreastScreen program is significantly less than rate of screening in the target age range (50-69 years). Evidence and data indicate that common justifications for limiting screening reminders to the target age range including life expectancy, comorbidities, effectiveness, treatment and cost are, for many women, unreasonable.

Conclusion: There is now sufficient data to support a change in the targeted upper age range for breast cancer screening to improve the existing suboptimal surveillance in women aged over 69 years.

Figure 1

A comparison of death rates from female breast cancer in 2005 with BreastScreen participation rates in 2004–5. Data source: Ref [3] Australian Institute of Health and Welfare 2008. BreastScreen Australia monitoring report 2004–2005. Cancer series no. 42. Cat. no. CAN 37.