Features of BreastScreen Aotearoa (BSA) over the past 12 months include consolidation around the expansion to the eligible age range, and the introduction of additional providers in Auckland and Northland.

The extension in July 2004 of the eligible age range for free breast screening (from 50-64 to 45-69), effectively doubled the number of women eligible to take part in the programme. We were aware that some regions would not be able to meet the increased demand immediately, and anticipated that it would be three to four years before all areas had full capacity. Despite this and other challenges, in the first year of age extension BSA providers met preliminary screening capacity targets, screening a total number of 136,053 women, an increase of 25 percent on the previous year.

This hard work by providers and their staff has continued, with 296,127 women screened in the 24 months to July 2006, a 42 percent increase on the previous 24-month period. This includes 84,472 women in the expanded age range. The programme continues to track as planned, with new mobile units and new sites being introduced to increase the number of women able to be screened.

The reconfiguration of providers in the Auckland and Northland region has also been a focus. BreastScreen Counties Manukau (Counties-Manukau District Health Board) commenced screening in September 2005, while BreastScreen Waitemata-Northland (a partnership between Waitemata and Northland District Health Boards) began screening women in February 2006.

The decision to establish two new breast screening service providers alongside the current provider was designed to improve access to breast screening services for Auckland and Northland women. The new services have been a real boost to women in the region, particularly those in Northland, the North Shore, West Auckland, and South Auckland, who previously had to travel to Remuera for any follow-up assessment.

The return of the BreastScreen Aotearoa Campaign

70 percent coverage from BreastScreen South

Digital mammography

Breast cancer research published

Monitoring contract for BreastScreen Aotearoa

 

The return of the BreastScreen Aotearoa Campaign

BreastScreen Aotearoa made a return to the small screen from May to July 2006, with further screenings of the ‘Celebration’ series of television commercials. The commercials were shown in the BreastScreen Midland region, which covers the Waikato, Bay of Plenty and Lakes DHB regions. This region has 16.1 percent Maori, with traditionally low coverage figures. The campaign was aimed at increasing coverage among priority women in the region, reflecting one of the National Screening Unit’s objectives of reducing inequalities.

While a final evaluation is yet to be completed, it is clear that the campaign has had an impact on increasing awareness and understanding of the programme in the Midland region.

70 percent coverage from BreastScreen South

In the middle of last year, BreastScreen South achieved what is believed to be a world first - meeting 70 percent coverage targets for ethnic minority women (Māori and Pacific).  Joan Miles, Programme Manager for BreastScreen South believes the following factors contributed to this significant achievement:

• recruitment through general practices, with each GP paid an annual fee to recruit eligible women into the programme. This gave BreastScreen South access to a database of almost every woman in the region, and enabled them to focus their health promotion team on Maori and Pacific women
• the introduction of marae-based screening, using a mobile screening unit
• the appointment of a Taua (or Kuia) to the programme
• the use of targeted health promotion - working collaboratively with local iwi providers.

Digital mammography

BreastScreen Waitemata Northland has introduced digital mammography at two of its sites, and other providers are considering doing the same.

Internationally, an increasing number of screening sites have introduced or are introducing digital mammography and softcopy reading into their screening practice. Randomised controlled trials have found that this is just as effective as the film screen methods currently used by most New Zealand providers. Digital mammography enables the image to be viewed on a computer screen, which means the images can be transmitted to radiologists for interpretation. This has the potential to reduce current issues around the shortage of radiologists in some areas.

Digital mammography will potentially deliver many benefits for the early detection of breast cancer and the extension of BreastScreen Aotearoa to women 45 to 69 years of age.

Breast cancer research published

Over the past 12 months, National Screening Unit Public Health Medicine Specialist Dr Simon Baker has had two articles on breast cancer research published in the New Zealand Medical Journal.

The first article explored the benefits and harms of screening women under 50. Using data from major statistical reviews of breast screening, combined with a web-based literature search and review, Dr Baker concluded that breast screening reduces breast cancer deaths among women aged 40 to 74 years. Benefit is greatest, and harms are lowest, for women over 50.

The second article considered the most appropriate screening interval for women under 50. The National Screening Unit carried out a review of the international evidence on the benefits and harms of different screening intervals for women aged 45 to 49 years, using a systematic search and review of the literature. The review found no robust trial evidence on which to base a screening-interval decision. A multi-disciplinary Expert Advisory Group considered the evidence and decided, after much discussion, to recommend a two-yearly screening interval for women 45 to 69.

Monitoring contract for BreastScreen Aotearoa

The University of Queensland is carrying out independent monitoring for BreastScreen Aotearoa. The contract for monitoring is for three years, and took effect from October 2005. The latest report, from July to December 2005 found that overall targets for key indicators are either being exceeded or close to being achieved.  However, there is some variation across lead providers.

Leading public health physician and epidemiologist Professor Richard Taylor is heading the University’s monitoring work.