Women’s health index prompts calls for personalised prevention and policy reform

Australia’s breast screening program has reduced mortality for decades, yet participation remains stubbornly stagnant. Experts argue the nation’s prevention strategy must evolve beyond a one-size-fits-all model if it is to improve outcomes for all women.

The latest findings from the Hologic Global Women’s Health Index, combined with emerging Australian research into personalised breast cancer screening, are fuelling renewed calls for greater investment in preventive health, risk-based screening and women’s health research.

Speaking to Health Industry Hub, National Breast Cancer Foundation (NBCF) CEO Dr Cleola Anderiesz and Hologic ANZ General Manager Kensi Naicker said the data reveals not only persistent barriers to cancer screening but also broader structural inequities affecting women’s health.

Unlike traditional health datasets that focus primarily on clinical outcomes, the Hologic Global Women’s Health Index captures women’s lived experiences across multiple dimensions of health. Developed in partnership with Gallup, the longitudinal study now spans five years, surveying 145,000 women across 144 countries and in more than 140 languages. Beyond preventive care, it measures emotional wellbeing, access to basic needs, safety and individual health.

Naicker explained the scale of the initiative, saying “Hologic decided to invest because we believe that women’s health is fundamentally not being measured. If you’re not measuring it, how do you improve it?”

He also pointed to declining affordability of essential needs, such as food and shelter, among Australian women.

“If you’re struggling in those two dimensions, you’re not going to go through a screening program, are you? We’re a first world nation and we need to do better,” Naicker asserted.

Dr Anderiesz said one of the most striking findings was that many indicators are moving in the wrong direction.

“It’s really interesting to see the longitudinal data over time. The most breathtaking piece is that many of the measures are actually getting worse, not better,” she stated.

The Hologic Global Women’s Health Index showed a low uptake of just 23% when Australian respondents were asked whether they had undergone cancer screening during the previous 12 months.

Specific to breast cancer screening, Dr Anderiesz said BreastScreen Australia’s participation rate has remained largely unchanged for years. Current attendance is 52% among eligible women aged 50-74, although private screening activity is not captured in those figures.

“We don’t necessarily reach all women equally,” Dr Anderiesz said. She emphasised First Nations women, culturally and linguistically diverse (CALD) communities, women living in rural and remote Australia and women with disability as groups facing additional barriers, including cultural safety, language, accessibility, and previous negative healthcare experiences.

Younger women face a distinct set of barriers, including the impact of structural gender bias. While women aged 40–49 are eligible to access BreastScreen Australia, they are not routinely invited for screening, which can contribute to lower awareness of available screening options.

Misconceptions about breast cancer risk also continue to influence screening behaviour.

“There are misunderstandings that people have about breast cancer risk and some myths that endure about what increases your risk of developing breast cancer. Many women incorrectly assume family history is the primary determinant of risk,” Dr Anderiesz explained. “In fact, 85%-90% of breast cancers happen in people without a family history and are sporadic cancers.”

Equally important is communicating the value of early detection.

“Your relative five-year survival is actually 100% if your breast cancer is picked up at an early stage,” she added.

While BreastScreen Australia continues to deliver public health benefits through conventional mammography, Naicker said newer technologies could significantly improve detection for women at higher risk.

“There are more advanced technologies available, or at least enhancements to technology that BreastScreen currently has not taken into consideration,” he said.

One example is contrast-enhanced mammography, which combines intravenous contrast with mammographic imaging to improve cancer detection. This approach is particularly important for women with dense breasts, where cancers are more difficult to identify using conventional mammography. However, access remains limited because the technology is not funded through the Medicare Benefits Schedule (MBS) and the out-of-pocket cost is $500-$800.

Beyond breast screening, Hologic is also deploying artificial intelligence (AI) to improve cervical screening. Its Genius AI platform, accredited by NATA and available through VCS Pathology in Melbourne, assists cytologists by highlighting potentially abnormal cells during cervical screening.

Perhaps the most significant development discussed during the interview is the NBCF-funded MyScreen Trial, which will evaluate whether breast screening should shift from an age-based model towards personalised risk assessment.

Recruiting approximately 750 women identified as higher risk through breast density and family history, participants, including those from age 40, will receive supplemental screening using either contrast enhanced mammography or MRI in addition to standard mammography.

“Essentially what the study will do is assess whether supplemental screening is feasible to deliver within the context of breast screening. Is it clinically effective and is it cost effective compared to the current screening program?” Dr Anderiesz explained.

Strengthening Australia’s evidence base remains fundamental.

“Research underpins all improvements in women’s health and we don’t get there because of good luck. We get there because we invest in research and we apply those findings,” Dr Anderiesz emphasised.

The duo voiced several state and federal policy reforms which could significantly improve outcomes, including transitioning from age-based to risk-based screening, expanding preventive health funding beyond the current 2.9%, improving breast density reporting across the nation, increasing access to mobile screening services for regional and remote communities, and strengthening the specialist workforce.

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