Breast screening saves lives. Screening is one of the most effective ways to detect early signs of breast cancer, meaning treatment outcomes are much better. Early detection is the best way to improve survival. During Covid many things were forgotten. Your health and safety are important, so measures have been put in place to reduce the risk of transmission against the ongoing risk of COVID Breast cancer is the second largest cause of cancer death in Australian women after lung cancer.
It is the most common cancer diagnosed in Australian women apart from non-melanoma skin cancer 1. Cancer Council Australia recommends that eligible women participate in the BreastScreen Australia program by having a free mammogram every two years, provided they are aware of the benefits and the risks.
Mammography is the recommended screening tool for the early detection of breast cancer. Each time you have a mammogram , your breasts are exposed to a very small amount of radiation. This data visualisation shows participation data for BreastScreen Australia from — to — The bar graph on the second tab can be filtered by age group and year and shows the participation rate of each Primary Health Network for the selected period.
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Please use a more recent browser for the best user experience. Go to Cancer screening. Print this page Click to open the social media sharing options Share. Cancer screening programs: quarterly data Web report. Last updated: 01 Oct All women in Australia aged 50 to 74 years are actively invited by their local BS service to have a free mammogram every two years, with those aged 40 to 49 years and those aged over 74 years also eligible to receive a free mammogram.
The success of the BSA program is evidenced by the substantial drop in breast cancer mortality rates observed over time: 74 deaths per , women now down to fewer than 50 Australian Institute of Health and Welfare A further 30 clients A preference for the radiologist to be present onsite was reported by 24 clients Comments from clients about RRAM or onsite service preferences included:.
Lots of FIFO [fly-in, fly-out] money, it should be put into health. We should have better health care. Four clients indicated that they preferred the RRAM 2. Just under a third of clients provided final overall comments, an opportunity to provide perspectives that may not have been covered by the survey questions. The majority of comments were positive and summed up their feelings and experiences received in the clinic.
Some clients concluded:. Allows specialist diagnosis to be delivered to regional services. Don't have to travel, prompt response and treatment. Time saving and hope it doesn't put people out of employment here. Expertise here—would prefer local but if not, this is the perfect solution. Only a few final comments noted undesirable experiences and generally related to breakdowns in technology or equipment, and the preference or expectation that a radiologist be onsite.
For all innovations in health care, evaluation is important for understanding the safety and quality of changed models. The evaluation of the novel RRAM described in this paper reveals the majority of clients were aware that the radiologist was working from a remote location and were satisfied with their RRAM clinic experiences.
While the clients in this evaluation were all seen in RRAM clinics, the majority of clients did not expect there would be any differences in care if the radiologist was onsite. The majority of clients did not have a preference for either the onsite or RRAM, although a small proportion of clients reported a preference for a radiologist to be onsite.
There was some concern from service staff regarding client awareness of the RRAM [ 15 ], however this proved relatively unfounded with the majority of clients indicating they were aware that the radiologist would be working remotely in their clinic. It was also important in the context of the evaluation to establish that clients were largely aware of the RRAM.
Informing clients of new models of care, and measuring their satisfaction ensures the use of technology in health care is with deliberate design [ 10 ]. Evidence of an association between client satisfaction and telehealth has been found, although effectiveness in achieving expected outcomes and efficiency varies [ 12 ]. Even though the radiologist was working remotely in RRAM clinics, positive and professional interactions with onsite service staff e.
Participants largely felt the care they received in the RRAM clinic would be equivalent to that in an onsite clinic. A small proportion of clients expected a difference between RRAM and onsite clinics and these clients felt that onsite clinics may run faster. Supporting this view, service providers participating in other aspects of this evaluation indicated that onsite clinics were faster due to the presence of the radiologist who could often report on imaging immediately, whereas having to communicate with a remote radiologist at scheduled times or as required, tended to slow the assessment process [ 14 ].
A few clients also said they would have liked to have spoken with the radiologist and had the opportunity to ask questions. There is evidence that provision of primary care services is associated with more equitable distribution of health and improves overall health across major population sub-groups [ 18 ].
It is generally accepted that Australians living in rural and remote areas should have access to appropriate primary health care services and there has been a focus on training and retaining generalist practitioners in these areas, as opposed to specialists [ 19 , 20 ]. In the context of this evaluation, radiologists with expertise in diagnosing breast cancer is a niche speciality.
There are few diagnostic radiologists working outside of major cities in Australia [ 7 ] and workforce challenges make it unlikely to access niche speciality services in regional areas. One client felt that the RRAM was a way of distributing resources and facilitating equitable access to specialists across regional communities.
Indeed, telehealth and teleradiology are commonly used in many countries including Australia, to help address the maldistribution of the health workforce and facilitate access to health professionals [ 8 ]. Women in low and middle-income countries LMICs experience a higher burden and are more likely to die of breast cancer, than those in high-income countries, yet it receives less attention, advocacy and funding in these countries due to competing demands [ 21 ].
The World Health Organization WHO has a global strategy to improve health workforce issues by [ 22 ] and has initiated mobile health mHealth telemedicine programmes to combat some diseases, including some cancers, where there has been a high uptake of smartphones [ 23 ].
However, while telemedicine may reduce the acute challenge of geographical maldistribution in some LMIC countries, in the majority of settings access to health workers remains inequitable [ 22 ]. In Australia, this evaluation has found that the RRAM successfully makes use of teleradiology to access appropriately qualified radiologists for the provision of timely assessment services for women in rural and remote areas [ 11 , 16 , 17 ].
Women living in rural and remote areas often need to travel to metropolitan and regional centres to access health services. Over a quarter of the clients in this client survey had travelled over kms to access the RRAM clinic, and came from smaller rural and remote communities.
Some clients had travelled over kms to access the RRAM clinic. International studies found clients preferred to access radiology services locally and minimise the need to travel [ 12 , 13 ]. More broadly there is evidence that cancer-related telehealth consultations reducing the need for clients to have to travel long distances contributes to satisfaction with services as it is more convenient for them and results in less disturbance to family life [ 10 , 24 , 25 ].
Whilst the majority of clients did not have a particular preference between the onsite or RRAM, equity of access to specialists was an issue raised by some clients who felt that they had the right to be able to access specialist services locally, similar to the level of services available in metropolitan areas. Another study highlighted a perceived barrier to telemedicine was client preference for physical attendances at medical appointments [ 26 ], however evaluation of the RRAM found that only a small proportion of clients preferred to have the radiologist onsite.
Enabling timely provision of breast cancer assessment services in regional centres reduces anxiety that accompanies the diagnostic pathway. Clients in this evaluation appreciated not having a lengthy wait to attend the assessment clinic, and were satisfied that they could have procedures done on the day by a medical officer. Other components of this evaluation published elsewhere found the RRAM delivers safe and high-quality assessment services, with equivalent rates of cancer detection and diagnosis when compared with the onsite model.
This evaluation indicated that clients: i were highly satisfied with their RRAM experiences in BreastScreen assessment clinics; ii had high confidence in care received; and iii largely had no preference for either the onsite or RRAM.
Client acceptability supports continued use of the RRAM and exploration of further expansion. This is particularly important as travel restrictions consequent to the COVID pandemic limit mobility of an interstate radiology workforce, thus stimulating greater uptake of telemedicine alternatives. There were clear positive outcomes from clients attending RRAM clinics across all four participating services despite some local contextual differences in delivery.
This evaluation provides evidence of client satisfaction with the model, and the use of technology within BreastScreen assessment clinics as a component of a comprehensive evaluation strategy of the RRAM. This study was conducted in only four clinics operating under the RRAM. A comparison with clients attending clinics operating under the traditional onsite model was not undertaken but may be useful for collecting insights from a comparator group.
Client participation rates in the face-to-face interviews, online and postal return of surveys could not be determined. It is possible that there was some non-response bias that could limit the transferability of outcomes to a broader population. Broader relevance of these findings to new implementation locations may be influenced by differing local contexts.
It is important to evaluate innovations in health care delivery, including telehealth models. High satisfaction with the clinic experience appeared to be linked to positive interactions with, and characteristics of, service providers who were described as professional, friendly, helpful, comforting and compassionate, rather than whether or not the radiologist was onsite. The majority of clients did not expect to experience differences in care between the assessment models of service delivery.
A small proportion of women reported a preference for a radiologist to be onsite, but this did not impact on their confidence in the quality of care they had received. Client acceptability of the RRAM supports the continuation of the model at these sites and exploration of expansion to further appropriate sites. Findings from this study may inform future telehealth innovations which see key members of the health care team working remotely. Raw data are not available for this study due to contractual restrictions.
The approved project report may be available upon request from BreastScreen Australia. Australian Institute of Health and Welfare. BreastScreen Australia monitoring report CAN Canberra: AIHW.
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