23 February 2004 Media Statement

BreastScreen Aotearoa programme extended

Health Minister Annette King today announced a major extension of the BreastScreen Aotearoa programme being rolled out from July 1 to include women up to their 70th birthday and from their 45th birthday.

Ms King says the programme was set up in 1998 to cover women aged 50 to 64, and currently 62 percent of the eligible population is covered by the programme.

“Today’s announcement represents a huge advance for the programme, and reflects the Government’s commitment to continue building strong public health services,” she said. “The extension represents a 66 percent increase in the number of women eligible for screening and could potentially save another 32 lives a year.

“The original decision on the age-range of women covered was made mainly because of capacity restraints. However, we have been reviewing the programme for a year now, looking at the international picture and evidence, to see where and how the programme should be expanded.

“There is clear evidence of the strong benefit of extending the age-range upward, but the further you take the age-range down, the less conclusive the evidence becomes.

“About 240 women aged 45-49 are diagnosed each year with breast cancer, and about 53 of these women will die. With regular screening, women can reduce their risk of dying. In 2005, when the results of the comprehensive UK study become available, we will look again at the possibility of lowering the age to 40.”

Ms King said New Zealand can be proud of the quality of the BreastScreen Aotearoa programme, which received a strong endorsement from international expert Professor Jocelyn Chamberlain when she independently reviewed the programme in 2002.

The programme up till now has been available to more than 356,000 New Zealand women, and the extension will cover more than 238,000 women in the two new age categories.

“The extension will be rolled out progressively from July 1. An expert advisory group is being set up over the next few weeks to provide advice on a detailed implementation plan. The rollout has to be progressive, not because of financial constraints but because of capacity constraints. We have to continue to build capacity in the sector to cope with the extra demand, and we will be doing so in close consultation with the sector.

“We have steadily been building treatment capacity. In 1999, the year before we became the Government, there were only 16 radiation therapy students beginning training and 46 in training across the three years of the degree course. Last year 39 entered training and 103 were enrolled across the three years.”

Ms King says it is expected that the extension will add about $13.2 million to the cost of the programme, including treatment, in the first year, and that funding will be met through baseline increases already built in to the three-year health funding package.

“The New Zealand breast screening programme is sometimes compared to the Australian one, where there is opportunistic testing for women aged between 40 and 49. The big difference between our programmes will be that the younger New Zealand women actually become part of the regular screening programme.

Regular screening is far better than one-off, opportunistic testing. High-quality, organized screening programmes are shown to provide greater benefits and ensure regular participation. The need for effective organization and high quality was emphasized by the Gisborne Cervical Screening Inquiry. One-off testing does not amount to a screening programme.

“However, it is also intended to expand use of the BSA mobile mammography services to include women at high risk of developing breast cancer, and who are unable to access a fixed mammography site in their community. This is good news for the rural community. Beyond the target groups, we’re also looking at using the mobile vans to allow other rural women to be able to access mammography.”

ENDS

Background information

Each year approximately 2,200 New Zealand women develop breast cancer and 640 die from the disease (47 percent of these deaths are in women over the age of 70). Breast cancer is the leading cause of cancer deaths for females in New Zealand.

Death rates from breast cancer are falling as a result of improved treatment and, more recently, the introduction of a publicly-funded breast screening programme for women aged 50 to 64.

Breast Screening - Early Deaths Prevented
Age Group Population (based on average population projections 2004-2009) Number of women screened annually (based on expected or actual coverage & screening interval) * Annual population reduction in early breast cancer deaths after 10 years of screening Individual reduction in relative risk of dying early from breast cancer if a woman has regular screening

45-49 157,592 31,518 5 21%
50-64 356,900 112,424 60 31%
65-69 80,744 25,435 27 46%

*The recommended screening interval for women aged 40 to 49 is yearly. Expected coverage for these women is 20 percent of the eligible population screened each year. The recommended screening coverage for women aged 50 to 69 is 2 yearly. Expected coverage for these women over a 2 yearly screening interval is 62.6 percent or 31.3 percent per year.
In 1998, the BreastScreen Aotearoa programme was introduced for women aged 50 to 64 years. The upper limit of 64 was set to allow the health sector time to develop the capacity to accommodate the projected significant increase in volume of women aged older than 64 years. At that time it was noted that consideration would be given to extending the upper eligible age range once the BSA programme was running smoothly.

An independent review of the BSA programme conducted in 2002 concluded that the programme was developing into a well-monitored and coherent national service. The review provides a strong basis for extending the programme.

Women outside the eligible age group, and who are considered at “high risk” of developing breast cancer, will continue to receive publicly-funded mammography as at present, via the community-referred radiology service schedule managed by DHBs.

The National Screening Unit will be working closely with providers to ensure that sufficient screening capacity will be developed and that the high standards of the BSA programme are maintained. Women receive the benefit from screening only if all parts of the screening and treatment programme work well. The Ministry of Health will be working closely with the sector to ensure the extension to the programme is provided in a way that maintains the integrity and safety of the programme.

ENDS

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