Should women aged 70-74 be invited to participate in screening mammography?

What is a community jury?

Community juries are a lot like juries in a court room. They are made up of about a dozen people, who meet over two days. They hear expert testimony and then deliberate to make a decision about what they think is the right thing to do. The Community Jury process is an effective way to involve citizens in developing a thoughtful, well-informed solution to a public problem or issue. On the final day of their moderated hearings, the members of the Community Jury vote on the issues and give their recommendations.
This jury is about who should be invited to breast screening.

In Australia prior to 2013, only women aged 50-69 were invited to participate in in the government-funded breast screening program (BreastScreen). Health promotion messages and social marketing campaigns only targeted women aged 50-69.  Women aged 70-74 were able to access free mammography screening services if they wanted to, but they did not receive invitations and screening was not actively promoted to them.

Since 2013, this has changed. The target age group for mammography screening was extended by 5 years, from 50-69 years to 50-74 years. Since this time Australian women aged 70-74 have been actively invited to participate. Health promotion messages and social marketing campaigns have also been targeted at women aged 70-74 to encourage them to participate in the program.

Our aim was to describe if women aged 70-74 think they should be in the target age group for mammography screening programs and understand their reasons for making this decision.  In doing so we hoped to work out what approaches to communicating about breast cancer screening for women aged 70-74 are considered the most legitimate and fair, both for individuals concerned and for broader society.
We held two separate juries in Sydney, April 2017. Both juries were held at the University of Sydney. 34 women aged 70-74, of diverse cultural background and living in Greater Sydney, were randomly recruited by a professional research service to participate as jurors. Women with experience of a breast cancer diagnosis (themselves) or recent experience of a close family member having breast cancer (in the last 5 years) were excluded through a screening interview, as were health professionals and those working in breast cancer advocacy.
In Part A we asked jurors if the government funded breast screening program needs to be changed in some way.  In Part B we asked jurors to consider how their decision should be implemented.

PART A: Which of these options does the jury endorse? The program should:

  1. Continue with the current program i.e. invite women and promote screening to women 70-74 to participate in the government-funded breast screening program without cost to participating women
  2. Revert to the previous screening program i.e. stop inviting women and stop promoting screening to women aged 70-74 to participate in the government-funded breast screening program.

PART B: During this jury process, you have heard a lot of information about breast screening in 70-74 year old women.  Please consider the following questions, and provide reasons for your answers:

  • Of the information you have heard, which is most essential to communicate to women 70-74 before they decide whether to participate in breast screening?
  • When and how should these women be told about or given access to this information?
  • What should we say to citizens and policymakers to convince them that your preferred option is the best option?

SPACE

The experts and the evidence presented to the juries

Nehmat Houssami

Nehmat is a public health and breast physician, and Professor of Public Health & Breast Cancer Research Leadership Fellow at the Sydney School of Public Health. She is a consultant at the Royal Hospital for Women in Sydney, and has worked in breast clinical services for nearly 25 years. Nehmat has focused her career on breast screening and diagnostics, initially through clinical practice and then through combining research with clinical practice, and has an internationally-recognized portfolio in breast cancer research mostly in imaging.

The scope of Nehmat’s research includes new technologies, population screening, preoperative staging, screening women at increased cancer risk, and the effect of testing on clinical outcomes in women with breast cancer. She has experience in evidence synthesis, and has contributed to the development of international clinical guidelines in both early and advanced breast cancer. She has more than 190 peer-reviewed publications and has been the scientific lead on various international collaborative studies including trials of tomosynthesis (3D-mammography) screening, and is also leading a pilot trial of tomosynthesis screening in Australia’s population screening program. She is co-Editor of The Breast and co-Editor of two books on breast screening.

Jenny Doust

Jenny is Professor of Clinical Epidemiology in the Centre for Research in Evidence Based Practice in Bond University. She also works as a general practitioner in Brisbane. Her main research areas are diagnosis, screening and evidence based practice in general practice.

In addition to lecturing in subjects relevant to evidence-based care and general practice, Dr Doust has conducted extensive research into a wide range of diagnostic related issues and has received numerous grants through NHMRC and other institutes.

Sanchia was appointed CEO of Cancer Council Australia in August 2015. She has more than 30 years’ experience in cancer control as a clinician, researcher, educator and senior healthcare administrator. From her early career as a Registered Nurse in New Zealand she specialised in cancer and palliative care, completing a Bachelor of Applied Science, a Master of Nursing and a doctoral thesis exploring nurse-patient relationships in cancer and palliative care. She has extensive experience in health-system administration and most recently was Director of Cancer Services and Deputy CEO at the Cancer Institute NSW

As CEO of Australia’s peak non-government cancer control organisation, Professor Aranda is a strong independent voice on evidence-based cancer control. She is engaged in all fields of cancer from primary prevention through to survivorship and advanced care, and has a particular professional interest in improved ways to care for and support cancer patients.

Robin is a medical epidemiologist with a long-standing interest in women’s health. She has broad-based experience in women’s health epidemiology having previously worked at the Research Unit of the Jean Hailes Foundation, the Royal Women’s Hospital and the Perinatal Data Collection Unit of the Victorian Department of Human Services.

Robin is Deputy Director of the Women’s Health Research Program at Monash University.  She has experience with designing, running and analysing randomised trials, cohort studies and case control studies.  She is currently responsible for a 5-year study of over 1600 women with their first diagnosis of invasive breast cancer (currently funded by the BUPA Health Foundation). Other research interests in relation to women at midlife include urinary incontinence, cardiovascular disease and metabolic disturbance, bone and joint health and cognitive function.