The latest evidence does not justify a national mammographic screening program which would actively recruit women aged 40-49 years.
Mammographic screening is available to asymptomatic women aged 40-49 years through BreastScreen Australia should they request it, however, women in this age group are not actively recruited into the program.
This policy is based on the consideration of:
- currently available research evidence;
- harms and benefits to women; and
- relative costs and benefits in undertaking a population based screening approach.
BreastScreen Australia will continue to review this policy as new evidence becomes available.
Rationale and practice
In 1992, the National Health and Medical Research Council (NHMRC) undertook a review of mammography screening for women under 50 years of age and found that there is insufficient evidence to conclude that screening the population of women under 50 years of age by mammography will reduce mortality from breast cancer. The NHMRC review resulted in a statement that there is insufficient evidence to advise women under 50 years of age to have routine mammography.
In 1994, the Senate Inquiry into Breast Cancer Screening and Treatment in Australia recommended that the focus of the program remain on women aged 50-69 years, but that mammography screening continue to be available to women aged 40-49 years and 70 years and over.
Over the past few years, further data about the impact of screening women aged 40-49 years has emerged. Therefore, in 1997, a review of all of the available evidence was undertaken by Professor Les Irwig and colleagues. While there are some downsides of screening for all women, Professor Irwig and colleagues concluded that the balance of costs and benefits is different for women aged 40-49 years. Evidence indicates that there is more harm and less gain for women aged 40-49 years in terms of the number of deaths prevented. For example, due to biological differences in the breast tissue of younger women, more women aged 40-49 years will undergo further investigations and a greater number will be told incorrectly that they are clear of cancer.
Mammographic screening through BreastScreen Australia is available to women aged 40-49 years who have decided, based on current knowledge and personal choice, that they wish to attend. The size of the benefit in terms of deaths prevented balanced against the possible downsides for women, is however, insufficient to actively encourage women aged 40-49 years into the program.
Recruitment strategies and publicity materials about the Program will continue to be directed at asymptomatic women aged 50-69, where the evidence is that screening has the greatest potential to prevent mortality from breast cancer.
The National Accreditation Standards state that all women screened are advised of the benefits and limitations of mammography screening.
The age range for screening women will continue to be monitored and reviewed as new evidence becomes available.
(Irwig, L., Glasziou, P. Barratt, A. and Salkeld, G., Review of the Evidence about the value of Mammographic Screening in 40-49 year old women, National Breast Cancer Centre1
In February 2008, National Breast Cancer Centre (NBCC), incorporating the Ovarian Cancer Program, changed its name to National Breast and Ovarian Cancer Centre (NBOCC). In July 2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.