New BreastScreen Australia position on breast density reporting
In a landmark policy change, BreastScreen Australia now recommends that breast density be reported to women as part of routine mammographic screening. This position statement is in contrast to the 2020 statement that recommended “BreastScreen Australia should not routinely record breast density”.
The new position statement recommends a nationally-consistent approach to breast density reporting, that will inform shared decision-making about breast cancer screening between women and their healthcare teams. InforMD supports BreastScreen Australia’s new position and believes that women being informed of their breast density will assist in their decision-making about how to best manage their individual breast cancer risk and screening choices.
InforMD member and community advisor Gerda Evans welcomes the change:
For many years, we have advocated for women to be informed of their breast density, and we welcome this recognition in the latest BreastScreen Australia position statement. Awareness of breast density equips women and their healthcare providers with vital information to make informed decisions about screening and management, tailored to their individual risk factors. This marks a shift toward personalised risk-based screening, moving away from the current ‘one size fits all’ approach.
We commend the statement’s call for national consistency in measuring and reporting breast density, including the recommended use of validated automated software. We also acknowledge the challenges outlined—such as ensuring equitable access, managing costs, and educating health professionals—as essential considerations in implementing these changes.
It is particularly encouraging to see BreastScreen Australia recognise emerging evidence and advancements in supplemental screening technologies like 3D mammography, contrast-enhanced mammography, and the use of AI. This demonstrates a commitment to evolving the screening program in line with scientific and technological progress. To ensure a relevant and effective screening system focused on early detection, increased government investment will be crucial.
Key points from the BreastScreen Australia Position Statement on Mammographic (Breast) Density and Screening
• Women be informed of their breast density as measured from their screening mammogram.
• BreastScreen clients may seek advice from their GP or breast specialist about how their breast density affects their choice of approach to breast cancer early detection, with consideration of other risk factors, personal circumstances, and preferences.
• GPs and breast specialists have a significant role in shared decision-making together with BreastScreen clients to help determine the most suitable management pathway for each individual woman with dense breasts.
• There is currently no consensus on optimal supplemental screening test(s) for women with dense breasts, highlighting associated increases in follow-up tests, false positive results, and costs. Supplemental imaging tests, in addition to mammography, that may be of value for screening women with dense breasts include magnetic resonance imaging (MRI), ultrasound, tomosynthesis (3D mammogram), and contrast enhanced mammography (CEM). The statement recognises the randomised controlled trial (RCT) that shows that supplemental MRI identifies more cancers in those (aged 50-75) with extremely dense breasts (BIRADS Category D).
• Equitable access to (evidence-based) care and support for early diagnosis of potential future cancers is important for all BreastScreen clients with dense breasts. Under the supplemental screening section, the statement explains that “Currently, supplemental screening is only available outside of the BreastScreen Australia program following a consultation and referral by a GP to a public or private diagnostic imaging service. This raises issues of equity of access.”
Kym Berchtenbreiter, a member of the Australian Breast Density Consumer Advisory Council, reflects on how this policy change will affect women’s opportunities for informed decision-making:
The updated BreastScreen Australia position statement on reporting breast density is welcome news. If I had known I had extremely dense breasts when I received a negative mammogram result many years ago, my choices and breast cancer diagnosis outcome may have been very different. Just 12 months after receiving that negative mammogram result, I was diagnosed with invasive breast cancer and underwent a mastectomy and chemotherapy. It’s crucial that women are informed about their breast density, so they can make informed decisions about supplemental screening options. I congratulate the Australian states that have already implemented reporting of breast density and urge all states and territories to be united in supporting this vital initiative.
However, there are still gaps in evidence around how best to provide support for Australian women notified of their breast density. These are identified in the new position statement:
• The impact of breast density notification on women.
• Management pathways for women with dense breasts, including optimal supplemental screening tests.
• Applicability of international evidence to the Australian screening context.
• Consideration of breast density within risk-based screening, particularly with advancements in applying artificial intelligence (AI) to develop personalised risk assessment approaches.
Another key change in this position statement is the acknowledgement that “using mortality as an endpoint in breast cancer screening trials is no longer feasible for determining changes in policy. This is because breast cancers, especially early cancers diagnosed on screening, are highly treatable and so improvements in mortality would not become apparent for many years, if not decades. It is now more appropriate to consider cancer detection rates, stage, morbidity, and interval cancer rates.”
This change in policy will take time to implement in states that do not currently report breast density. Four implementation considerations are highlighted in the new position statement:
1. A nationally consistent approach to the measurement and reporting of mammographic breast density as part of routine screening, encouraging the use of validated, automated software and recognising the associated costs.
2. Nationally consistent information about mammographic breast density for BreastScreen clients, including “the benefits and risks of supplemental screening in the context of individual breast cancer risk, personal circumstances, and preferences. This information should be tailored for priority population groups.”
3. Nationally consistent information and guidance for GPs when consulting patients with dense breasts, including “current limitations of the evidence about supplementary screening” and “decision aids to support shared decision making” and “determining the patient’s overall breast cancer risk using a validated risk assessment tool.”
4. Achieving equity in access to supplemental screening, “particularly for priority population groups, including rural and remote communities, Aboriginal and Torres Strait Islander people, culturally and linguistically diverse communities, LGBTQ+ people, and people living with a disability.”
Australian Breast Density Consumer Advisory Council member Krysty Sullivan supports the changes to breast density reporting, and calls for further government funding to fully support implementation:
The updated BreastScreen Australia Position Statement on Mammographic (Breast) Density and Screening is a positive and significant advancement to Australia’s BreastScreen program that promotes a nationally consistent approach to breast density. By recognising the increased risk and masking impacts of breast density and better informing GPs and women of their personal risk, it will lead to more informed conversations between women and their doctors about the screening that is right for them. Research into breast cancer risks and screening is continually evolving. It is critical that BreastScreen Australia continue to evolve the program to remain relevant into the future, providing Australian women with the latest best practices.
The recognition that women with higher breast density (BIRADS C and D) may require supplemental screenings, shows how BreastScreen Australia is embracing evidence, but it raises issues of equity of access and funding. To fully benefit from this change, it will be critical that the government funds supplemental screening where it’s indicated by guidelines.
Understand your breast density and be informed of the risks and screening outcomes.
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