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Research
BreastScreen NSW is actively engaged in research. Recent publications include work on mortality reduction in NSW, interval cancer rates, mammography image quality evaluation and radiologist reading volumes and performance. Links are provided below. Please direct any queries about these policy statements to the State Coordination Unit, BreastScreen NSW 8838-2100, or request for information | feedback on site | feedback on services.
Digital mammography
A pilot study to evaluate a digital mammography system for BreastScreen NSW is currently being undertaken. A Fuji CR system has been located at BreastScreen Greater Western Sydney and this is connected to a Sectra soft copy reading and PACS system at the State Coordination Unit. Aspects of this system were displayed at Breast 2005. It is anticipated that digital mammography will offer many advantages for screen reading and assessment timeframes, client record keeping and file storage.
PGMI/EAR
Radiographers within BreastScreen Australia use the PGMI as a tool to grade the quality of mammography images. A recent study conducted by BreastScreen NSW evaluated the validity and reliability of the PGMI grading and a proposed alternative (EAR) and showed significant problems in consistency of results using these tools. The outcomes of this study have prompted BreastScreen NSW to look at alternative grading methods.
Recruitment
Questionnaires involving women aged 50-69 who are non-atttenders or lapsed attenders at BreastScreen NSW have indicated some of the predictors for this group. The studies considered a number of variables such as the referral patterns of health professionals and the socio-economic status of the women studied. The information gained will be used to tailor strategies to recruit women to the Program.
Clinical Education
Breast Imaging Clinical Education Program (BICEP)
BreastScreen NSW promotes the continuing professional development of its radiographers and supports continuous quality improvement initiatives both within the Program and the private radiology sector.
The Breast Imaging Clinical Education Program (BICEP), introduced in 1999 in collaboration with the University of Newcastle and the University of Sydney, is a continuing professional development initiative of BreastScreen NSW. The BICEP was developed for radiographers performing breast imaging at BreastScreen NSW Screening and Assessment Services, private practices and public and private hospitals.
BICEP involves two components, one academic and one practical. The Program is accredited by the Australian Institute of Radiography (AIR) and is currently available as a postgraduate unit. BICEP undergoes regular review to ensure currency of information.
Radiographers from overseas and non-BreastScreen NSW radiographers wishing to undertake the practical component of BICEP within a BreastScreen NSW service are asked to contact the BreastScreen NSW State Radiographer, Jill Miller.
Radiology Training Program
During 2001/2002 the National Breast Cancer Centre in collaboration with the Royal Australian and New Zealand College of Radiologists and BreastScreen NSW developed a breast imaging training program for BreastScreen NSW radiologists. The program was presented as four state wide interactive teleconferences and two face to face workshops. The teleconference topics focused on screening findings - calcifications, stellate lesions, architectural distortions and circumscribed lesions. The workshops concentrated on assessment issues. Evaluation of the training program showed improvement in radiologist performance. In 2004 a videoconference on interval cancer diagnosis was also presented as part of ongoing training.
The teleconference material will shortly be available as a series of web-based learning modules.
Central Reading Facility
In response to critical workforce shortages, especially in rural areas, BreastScreen NSW has established a Central Reading Facility at the State Coordination Unit. Mammograms taken at various screening sites across NSW are sent to the Facility to be reported on by radiologists based in Sydney.
The Facility has offered BreastScreen NSW the opportunity not only to assist rural services but also to review screen reporting protocols and to enhance quality assurance measures in both reader performance and image quality.
Policy development
BreastScreen NSW strives to ensure that procedures and protocols reflect the BreastScreen Australia National Accreditation Standards and are consistent across all Screening and Assessment Services within the State. Policy development initiatives include the examples outlined below.
Family history policy
Breast cancer is a common disease. About 1 in 11 women in Australia will develop breast cancer and this means that many women have a relative who has had breast cancer. However, only a small percentage of breast cancers are linked to a significant family history, that is, an inherited genetic problem.
A significant family history is related to:
the number of blood relatives on the same side of the family who have had breast cancer or ovarian cancer
the age of these relatives when they were diagnosed
the degree of family relationship
Different BreastScreen NSW Screening and Assessment Services have differing policies regarding screening of women with a family history of breast cancer. Some BreastScreen NSW Services have invited women for annual screening if they have a first degree relative (mother/ sister/ daughter) diagnosed with breast cancer.
BreastScreen NSW has worked with the National Breast Cancer Centre to develop a valid and reliable tool to differentiate levels of family history risk. This work resulted in a Family History Questionnaire. The BreastScreen NSW trial of the Questionnaire was reported in The Breast (2003) 1 . The Family History Questionnaire is available in pad form from the NBCC under the heading ‘Do you have breast cancer in your family?’
Initially, BreastScreen NSW will implement the Family History Questionnaire at those Services currently offering annual screening for family history. Women will be asked to complete the Questionnaire and those women whose family history risk is judged to be moderate to high will be eligible for annual screening. Those women whose risk is considered to be the same or about the same as the general population, will be eligible for screening at the normal two yearly interval.
Based on the trial results, the rate of annual screening in these Services will be reduced by 50%, as many women with a first degree relative with breast cancer will fall into the 'at population risk' group.
Symptomatic women policy
In 2002, BreastScreen Australia issued the National Policy Framework for Symptomatic Women. Based on this, BreastScreen NSW developed a policy for the management of symptomatic women.
The main principles of the policy are:
BreastScreen is designed for asymptomatic women.
BreastScreen NSW recognises that, inevitably, a number of symptomatic women will attend for screening.
Women will be recalled for assessment on the basis of mammographic abnormality alone.
Symptomatic women whose mammograms show no visible evidence of breast cancer will be informed of the result of their screen by letter and asked to contact their doctor for investigation of the symptom/sign. A similar letter will be sent to the woman's doctor.
To encourage thorough investigation of the symptom, the result letters sent to the woman and her doctor will identify the symptom/sign noted and suggest the investigation include a physical breast examination, additional x-rays and ultrasound imaging of the breast.
About five weeks after the result letter, a reminder letter will be sent to both the woman and her doctor, encouraging the woman to ensure symptom investigation, if this has not already occurred.
References
1. TJ Fisher, J Kirk, JL Hopper, R Godding, FC Burgemeister A simple tool for identifying unaffected women at a moderately increased or potentially high risk of breast cancer based on their family history The Breast (2003)
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