BreastScreen suspension puts women at risk of poor prognosis

Pharma News: Health professionals are urging the NSW government to reverse the temporary closure of breast cancer screening services across NSW which was announced on Monday by BreastScreen NSW.

Professor Bruce Mann, Surgeon and Breast Cancer Network Australia (BCNA) Board Member said seeing a healthcare professional for any concerns people may have about changes to their breasts is critical.

“When a person finds a lump or sees changes in their breast, assessments and tests are key to finding out whether it’s benign or whether it’s a tumour that could be aggressive and quickly become harder to treat. These assessments need to be done urgently to give women, and men, the best chance of recovery,” said Professor Mann.

Breast Cancer Network Australia’s Director of Policy and Advocacy, Vicki Durston said a focus must remain on early detection of breast cancer and that every effort should be made to ensure people with symptoms of concern can access the services and care that they need.

“We acknowledge that every effort needs to be made to keep communities safe but breast cancer won’t wait for COVID. Closing routine screening programs will delay early detection, diagnosis and potentially lifesaving treatment. The Victorian system is still dealing with the impact of last year’s closures and the rebounding of later stage breast cancer presentations. BCNA is calling for a national roadmap to address the impact of COVID on these and related services,” she added.

Professor Fran Boyle, the president of the Clinical Oncology Society of Australia (COSA) and a medical oncologist, said “In the middle of this year what we started to see was the women who didn’t go to BreastScreen last year because it was closed, presenting with larger cancers and a higher rate of lymph node involvement needing chemotherapy treatment,” she said.

“If we shut down BreastScreen again what we will find is that we will have another wave of people with delayed diagnosis.” 

The Continuity of Care Collaboration (CCC) launched the #DontWaitMate 2.0 social media campaign in an attempt to encourage Australians to look after themselves and those they care about. An open letter to all Australians has been made public.

Medicines Australia CEO, Elizabeth de Somer, said “Medicines Australia is proud to be a founding member of the CCC collaboration. The numerous lockdowns have been hard on everyone, and it can be a stressful time.

“If you or someone you love has a long-term health condition or if you notice new symptoms, it’s important that you continue to see your doctor or other health care professional, either in person or through a telehealth consultation. I encourage everyone to share the message #DontWaitMate.”

Clinical Impact of Delayed Diagnosis

A recent report from the Radiation Therapy Advisory Group (RTAG) noted that in Australia, with the implementation of the first COVID-19 measures, from March to April 2020 breast cancer screening fell 98% across Australia. In total, between January and June 2020, around 145,000 fewer screening mammograms were conducted compared with January to June 2018.

In Victoria, where the longest most restrictive lockdown was implemented, breast cancer screening procedures fell 37% at the beginning of lockdown in 2020.

As a result of disruptions like these to cancer screening services, Cancer Australia reported that by August 2020 presentations to oncology centres had plummeted, with a 40% reduction reported compared with previous years.

For patients who were diagnosed with breast cancer, lockdown delayed treatments too, including surgery. On top of a reduction in screening, compared with March and April 2020 the number of monthly breast cancer-related surgical treatment procedures performed across Australia declined 33% by May. In Victoria they remained 33% lower by August that year. The report stated that the impact of delays in diagnosis will be compounded by any subsequent delays in treatment.

An international meta-analysis conducted in October 2020 stated that just a four-week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiation therapy indications for seven of the most prevalent cancers, including breast cancer.

The meta-analysis predicted that among 1,000 women awaiting breast cancer surgery, a delay of 4 weeks, 8 weeks and 12 weeks could result in a projected 10, 21 and 31 additional deaths respectively (in addition to a baseline mortality of 12%). The same study estimated that surgical delay of 12 weeks for all patients with breast cancer over a year would lead to 500 excess deaths in Australia.