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BreastScreen Australia Evaluation

BreastScreen Australia has undergone a comprehensive evaluation to assess the appropriateness, efficiency and effectiveness of the program.

Evaluation Final Reports
Background
Aim
Objectives
Evaluation Plan
Reporting
Governance arrangements
Funding
News/updates

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BreastScreen Australia Evaluation Report

At the Australian Health Ministers' Conference meeting on 4 September 2009, Health Ministers agreed to publicly release an expert committee’s evaluation of the BreastScreen Australia. The 19 recommendations of the BreastScreen Australia Evaluation Report will be considered in the context of Health Reform.

Australia has one of the best breast cancer screening programs in the world. With breast cancer being the second most common cause of cancer-related death of women in Australia, with 2,680 deaths in 2007, this is a most important and timely report, based on the best available evidence.

Key findings show that the program has clearly met its primary aim of reducing morbidity and mortality from breast cancer in the target age group, is well accepted by women, broadly available and accessible and cost-effective. The evaluation notes that BreastScreen Australia has successfully reduced mortality in the 50–69 years age group by approximately 21–28 per cent.

The Evaluation Final Report and the 10 individual project reports are listed below:

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Background

BreastScreen Australia was established in 1991. The Australian Health Ministers’ Advisory Council (AHMAC) agreed, in October 2005, to a comprehensive evaluation of BreastScreen Australia to be overseen by a committee of Australian and international experts.

The Program has been fully operational for over ten years with several cohorts of women participating in screening at two-yearly intervals so that the Program’s health outcomes can now be measured effectively. An evaluation at this point of time will allow for the Program’s impact to be measured and future directions determined.
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Aim

The aim of the BreastScreen Australia evaluation was to assess the appropriateness, efficiency and effectiveness of the Program. The evaluation also addressed the ongoing and emerging issues that have an impact on the Program, and identifies opportunities for overall improvement.

The evaluation examines the benefits of the Program in terms of reduction in breast cancer death rates through a comprehensive study of mortality, and also examines the risks associated with screening. It considers the appropriate target age range, screening interval, issues impacting on the Program’s capacity such as workforce issues, and Program performance to date. The evaluation includes an examination of participation rates and factors affecting participation.
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Objectives

The objectives of the evaluation, endorsed by Australian Health Ministers’ Advisory Council (AHMAC), are to:

assess the outcomes delivered by the Program;
assess the extent to which the Program has achieved its aims and objectives;
assess the appropriateness, efficiency and effectiveness of the Program;
assess, and address the ongoing and unresolved issues impacting on the Program; and
identify opportunities to improve the Program overall.

To achieve these objectives, the evaluation consisted of a range of evaluation projects aimed at assessing:

health outcomes – the benefits and risks of the Program;
process outcomes – efficiency of the implementation of the Program; and
economic outcomes in relation to the cost-utility, cost-benefit and cost-effectiveness of the Program.

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Evaluation Plan

The Department of Health and Ageing developed an evaluation plan which was finalised by the BreastScreen Australia Evaluation Advisory Committee (EAC) at its inaugural meeting and endorsed by AHMAC in March 2007. In line with this evaluation plan, the evaluation consisted of a number of individual projects:

a mortality study (part 1) to identify suitable methodologies to assess the impact of mammographic screening on breast cancer mortality;
a mortality study (part 2) to analyse relevant data to assess the impact of BreastScreen Australia on breast cancer mortality;
an analysis of participation and performance trends using existing BreastScreen Australia monitoring data;
a review of the Program’s capacity including infrastructure and workforce issues; and
a policy analysis project to analyse the target age range, screening interval and screening of women considered to be at a higher risk of breast cancer.
a review of the accreditation process;
a qualitative study to assess issues relating to participation, access and equity and morbidity;
a review of Program governance and management arrangements including the funding and reporting arrangements; and
an economic evaluation.

BreastScreen Australia Evaluation Plan (PDF 121 KB)
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Reporting

The final report consolidated the outcomes of the all the projects and comprehensively addressed the terms of reference set out by AHMAC for the evaluation. It also assessed the appropriateness of the Program’s objectives, and provided recommendations for the future of the program.
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Governance arrangements

The evaluation was overseen by the Evaluation Advisory Committee (EAC) comprised of eminent Australian and overseas experts, jurisdictional representatives and consumer representatives. The EAC reported to AHMAC via the Australian Population Health Development Principal Committee (APHDPC).

Members	Category	Expertise
Dr Helen Zorbas Director National Breast and Ovarian Cancer Centre	Chair and Australian expert	Practicing breast physician; population health expert; evidence based practice, clinical guidelines, monitoring, service improvement and psychosocial support to improve breast cancer care.
Dr Frida Cheok Consultant	Australian expert	Health economist and epidemiologist, experience in health services research and monitoring and evaluation of the BreastScreen Australia program.
Professor David Currow Chief Executive Officer Cancer Australia	Cancer Australia representative	Cancer care and cancer research.
Professor Dallas English Director Centre for Molecular, Environmental, Genetic and Analytical Epidemiology The University of Melbourne	Australian expert	Cancer epidemiology, environmental and genetic determinants of breast, colon, prostate and skin cancer.
A/Professor Harry de Koning Epidemiologist Erasmus Medical Centre The Netherlands	International expert	Monitoring and evaluation such as the evaluation of the national breast cancer screening programme in the Netherlands and screening women at high risk using alternative screening technologies.
Ms Valerie Lang AM	Consumer Representative	Consumer Health Forum representative.
Mr David Learmonth Deputy Secretary Department of Health and Ageing	Department of Health and Ageing representative	High level policy expertise.
Mrs Jennifer Muller Director Cancer Screening Services Unit Queensland Health	Jurisdictional member (large jurisdictions)	Management of screening programs in Australia, monitoring and evaluation.
Clinical A/Professor Jonathan Osborne State Radiologist BreastScreen Queensland	Australian expert	Radiologist with expertise in the BreastScreen Australia.
Mrs Julietta Patnick Director The National Health Service (NHS) Cancer Screening Programs United Kingdom	International expert	Management of cancer screening programs and evaluations such as the review of the NHS Breast Screening programme and economic evaluations.
Professor David Roder Head of Centre for Cancer Control research; and Associate Director of the Cancer Epidemiology Centre, Cancer Council of South Australia	Jurisdictional member (small jurisdictions)	Epidemiology of breast cancer, and health services research.
Ms Venessa Tripp	Consumer representative	Formerly a Senior Executive Service Officer in social policy areas of the Australian Public Service.
Dr Madeleine Wall Clinical Leader, BreastScreen Aotearoa, National Screening Unit, New Zealand	Observer	Radiologist; management of breast cancer screening programs.

The EAC’s role was to:

advise on the specific terms of reference for the overall evaluation;
provide advice on the evaluation plan;
prioritise specific evaluation projects;
endorse terms of reference and specifications for each project;
provide technical advice on the selection of tenders;
brief the evaluators and provide technical advice to support the evaluation;
consider progress and draft reports; and
submit the final report and recommendations to AHMAC.

The role of the Department of Health and Ageing was to:

provide secretariat support to the EAC;
develop the terms of reference for all the evaluation projects, in consultation with key stakeholders;
undertake necessary procurement processes;
manage the overall evaluation project and some of the individual projects associated with the evaluation;
consult with technical experts as required; and
provide updates to AHMAC.

Funding

The BreastScreen Australia evaluation was jointly funded by the Australian, state and territory governments, reflecting the funding arrangements for BreastScreen Australia and the division of responsibilities between the Australian, state and territory governments.

News/updates

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This page was last reviewed in December 2010.

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Page currency, Latest update: 20 December, 2010