Policy priorities

Equitably increase participation in breast cancer screening by ensuring improved access to BreastScreen Australia and actively encouraging participation among women in under-screened populations.

Since the implementation of BreastScreen Australia in 1991, participation rates in the program have remained relatively consistent - between 53% and 54% from 2014-15 and 2018-19.⁽¹⁾ BreastScreen Australia has a target for biennial screening of 70% of all women aged 50-74 years,^(2,3) and the National Preventive Health Strategy (2021 – 2030) has a participation rate target of 65%; neither target has been met. Rescreening rates in the BreastScreen program are also low, with 50.9% of women returning to the BreastScreen Australia program within the recommended two-year period following their first screen.^(4,5)

Adequate population coverage is necessary to continue to achieve substantial reductions in breast cancer mortality and ensure cost-effectiveness of the current program. We know that outside of the national program, some women receive breast screening via private providers, and therefore the total population coverage is not known, however estimates from Queensland indicated participation rates of 53% within the BreastScreen Australia Program, and 11% for screening outside the Program.⁽⁶⁾ Given the lack of national data available on private screening, Cancer Council supports the RACGP’s recommendation to include breast cancer screening on the National Cancer Screening Register.⁽⁷⁾ This would allow for greater transparency on the rates of breast cancer screening taking place, both within and outside the BreastScreen Australia program.

To improve participation rates in breast screening across all groups of women, it is essential to enhance community understanding of the benefits and importance of participating in regular and ongoing breast screening. This will also require culturally appropriate collaboration with Aboriginal and Torres Strait Islander women, and other culturally and racially marginalised communities. Considerations include national campaigns, and community events to raise awareness. Further to this, it is important to increase health professionals’ understanding of the benefits of the program. As such, there is a role for additional education and engagement within General Practice, to support referring women to the program.

Encourage participation among women in under-screened populations

Aboriginal and Torres Strait Islander women, and some priority populations as identified in the Australian Cancer Plan, have poorer breast cancer outcomes on average and are less likely to participate in the BreastScreen program than other Australian women. Cultural, linguistic, and religious differences, poverty, remoteness, and low health literacy are factors which can influence women’s ability to consider and access BreastScreen Australia services,^(8-10) and this intersectionality can drive down screening participation.

Efforts to develop targeted and co-designed community-led strategies to increase participation in breast cancer screening are ongoing, acknowledging the importance of culturally appropriate services and communication to meet the specific needs of these communities.

Beast practice examples and innovative ideas

Support the implementation of risk-based screening in Australia.

Findings from the 2023 Roadmap to Optimising Breast Screening in Australia (the ROSA project) indicated that risk-based breast cancer screening could save lives, and that risk-based breast screening would help future-proof the BreastScreen Australia program.⁽¹⁷⁾ A risk-based approach to breast screening may reduce potential harms and reduce the substantial public health impact of breast cancer.⁽¹⁸⁾

Cancer Council advocates for the full implementation of the Roadmap to help improve breast cancer screening and breast cancer outcomes and experiences in Australia. This includes policy and guideline reviews, enhanced data collection and reporting, trial design and related studies, evidence reviews, linked data analyses and specific research studies to address priority evidence gaps, with ongoing consumer and stakeholder engagement.

Build community understanding of breast cancer modifiable risk factors.

Public understanding of the link between risk factors such as alcohol (pre- and post-menopausal), obesity (post-menopausal), physical inactivity (post-menopausal) and breast cancer remains low. However, improving public awareness of key modifiable risk factors and their association with breast cancer has been identified as a key prevention strategy, globally.^(19-21) Research conducted by the Foundation for Alcohol Research and Education (FARE) in 2018 revealed that whilst 69% of Australians are aware of the association between alcohol use and liver cancer, only 16% were aware of the link between alcohol and breast cancer.⁽²²⁾ Strategies that raise community awareness and support behaviour change are needed to improve understanding around the risks of breast cancer, and also to encourage women to modify their behaviours to reduce breast cancer risk.

For further information on these modifiable risk factors, their current impact on cancer in Australia, and Cancer Council’s national policy priorities, please visit the alcohol, physical activity, and obesity policy pages.