The National Program for the Early Detection of Breast Cancer, now known as BreastScreen Australia, was established in July 1991 as a joint Commonwealth and State initiative. The aims of the Program, to which all States and Screening and Assessment Services subscribe, are listed below.

Aims of the BreastScreen Australia Program

The aims of the Program are:

1. To ensure that the Program is implemented in such a way that significant reductions can be achieved in morbidity and mortality attributable to breast cancer.
2. To maximise the early detection of breast cancer in the target population.
3. To ensure that screening for breast cancer in Australia is provided in dedicated accredited Screening and Assessment Services as part of the BreastScreen Australia Program.
4. To ensure equitable access for women aged 50-69 years to the Program.
5. To ensure that services are acceptable and appropriate to the needs of the eligible population.
6. To achieve high standards of program management, service delivery, monitoring and evaluation, and accountability.
   

The National Program mandates a population-based approach to screening incorporating a consistent national service delivery model, comprehensive accreditation standards and recruitment targets which are designed to maximise participation by women aged between 50 and 69 years.

By September 1996, 35 Screening and Assessment Services were operating across Australia with 94 fixed and 27 mobile screening units serving 500 locations. The National Program had performed more than 2 million screening tests in the five years to August 1997 and screened 570,000 women in 1995/96. More than one third of the women screened came from NSW.

By June 2002, 10 Screening and Assessment Services were operating in NSW with 39 fixed and 158 mobile locations.

Objectives of the BreastScreen Australia Program

The objectives of the Program are:

1. To achieve, after five years, a 70 per cent participation rate in the BreastScreen Australia Program by women in the target group (50-69) and access to the Program for women aged 40-49 years and 70-79 years.
2. To rescreen all women in the Program at two-yearly intervals.
3. To achieve agreed performance outcomes which minimise recall rates, retake films, invasive procedures, 'false negatives', and 'false positives', and maximise the number of cancers detected, particularly the number of small cancers.
4. To refer to appropriate treatment services and collect information about the outcome of treatment.
5. To fund through State Coordination Units only Screening and Assessment Services which are accredited according to agreed National Accreditation Guidelines, and to ensure that those Guidelines are monitored and reviewed by appropriate State and Territory Accreditation Committees.
6. To recognise the real costs to the women of participation in the Program, and to minimise those costs. This includes the provision of services at minimal or no charge, and free to eligible women who would not attend if there was a charge.
7. To make information about mammographic screening and the BreastScreen Australia Program available in easily comprehensible and appropriate forms in a variety of forums, and to women and health-care providers in particular.
8. To achieve patterns of participation in the Program which are representative of the socioeconomic, ethnic and cultural profiles of the target population.
9. To provide services in accessible, non-threatening and comfortable environments by staff with appropriate expertise, experience and training.
10. To provide appropriate service in that: the provision of counselling, education and information is an integral part of the Program; sensitive procedures for notification of recall are in place; and the time between the initial screen and assessment is minimised.
11. To achieve high levels of participation in the development and management of the Program by members of significant professional and client groups.
12. To collect and analyse data sufficient to monitor the implementation of the Program, to evaluate its effectiveness and efficiency, and to provide the basis for future policy and program development decisions.

Key Policy Statements

The key agreed national BreastScreen Australia policy statements are:

1. Women are selected for screening on the basis of age alone. Women aged 40 years and above are eligible. All promotional materials and recruitment strategies will be targeted at women aged 50-69 years. The age range for screening will be monitored and reviewed as new data becomes available.
2. The screening interval will be every two years and will be reviewed as new data becomes available.
3. Screening will be at minimal or no cost to the women, and free of charge to eligible women who would not attend if there was a charge.
4. Comprehensive and easily understood information, emotional support and counselling will be provided as appropriate. Women will be advised of the effectiveness and risks of mammography and on the maintenance of a regime of breast care to reinforce the message that a negative mammographic screen does not preclude a diagnosis of breast cancer prior to the next screening.
5. Screening services will be provided in a manner which is acceptable to women in the target group and in accessible, non-threatening and comfortable environments.
6. General practitioners will be kept informed of the results of screening and of any further work-up required, unless a woman directs otherwise. A doctor's referral is not a prerequisite for attendance.
7. Screening will employ film-screen mammography alone as the principal screening method.
8. All women will be screened with a minimum of two-view mammography. At a subsequent re-screening one view may be used if previous mammograms have indicated that two views are not required.
9. All mammograms will be taken by a radiographer appropriately trained in screening mammography.
10. All mammographic films will be read and reported independently by two or more readers, at least one of whom shall be a radiologist. Both readers must be specially trained in screening mammography and both meet the same performance criteria. Reports will be combined into a single recommendation.
11. The results of screening will be provided promptly and directly to the woman who is the subject of the screening, in a way which is sensitive to her possible anxiety.
12. Women will be actively involved in decisions about their treatment.
13. Screening and assessment will be carried out at accredited Screening and Assessment Services.
14. BreastScreen Australia will take a woman from screening up to and including diagnosis of breast cancer.
15. Women with confirmed breast cancer will either be referred to their nominated general practitioner, or to a clinic specialising in the treatment of screen-detected breast cancer.