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4102.0 - Australian Social Trends, 2000  
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Contents >> Health >> Health Related Actions: Cancer screening

Health Related Actions: Cancer screening

Breast and cervical cancers together accounted for 19% of female cancer deaths in 1998. The reduction of morbidity and mortality from breast and cervical cancers is the primary aim of screening programs specifically targeting these cancers.

National Health Survey information
The most recent National Health Survey was conducted by the ABS in 1995. It included a self- enumeration form for women, collecting supplementary information on several specific topics, including breast examinations, mammograms (breast x-rays) and Pap smear tests. Mammograms and Pap smear tests taken for both screening and diagnostic purposes were included.

Population screening

Breast cancer screening
The National Program for the Early Detection of Breast Cancer was established in 1991; since 1994 it has been called BreastScreen Australia.1 The program recommends that women in the target age group (50-69 years) have a mammogram every two years. Women in the 40-49 years and 70-79 years age groups also have access to mammograms, but are not actively recruited.2

Cervical screening
Although Pap smears have been available since the 1960s it was not until 1991 that the National Cervical Screening Program came into effect, following recommendations from the Australian Health Ministers Advisory Council. The Program aims to reduce cervical cancer morbidity and mortality by ensuring that: women in the target group are routinely screened every two years; Pap smears contain adequate samples of cervical cells; national uniform and reliable data are kept; and effective follow-up and treatment is available to women with screen-detected abnormalities.1

It is estimated that population screening using the Pap smear has the potential to reduce cervical cancer by up to 90%. This is because the Pap smear is able to identify early changes or pre-cancerous lesions, as well as low and high-grade abnormalities of the cervix.1

The target group for cervical screening is all women aged between 20 and 69 years who have ever been sexually active (excluding those who have had a total hysterectomy or a previously diagnosed gynaecological cancer). The Program actively recruits women in this group by a range of strategies. Women over 70 are screened on request, but not actively recruited. There are Pap test registers in all States and Territories.1

Years of potential life lost
Premature mortality can be calculated in terms of the years of potential life lost if the individual survived a particular cause. Premature mortality in this instance is assumed to be any death up to the age of 75 years. By estimating potential years of life lost, it is possible to assess the significance of a cause of untimely death relative to other causes.

Cancer was the leading cause of death in 1998. It was a greater cause of premature mortality in females than in males, accounting for 40% of years of potential life lost for females, compared with 25% for males. Breast and cervical cancers together accounted for 19% of female cancer deaths. Screening is currently believed to be the most effective method of reducing mortality from breast and cervical cancer.1 Population based screening programs, BreastScreen Australia and the National Cervical Screening Program, were established in the early 1990s. The primary objective of these programs is to reduce morbidity and mortality from breast and cervical cancer. BreastScreen Australia's main aim is to detect small cancers in the breast which are more easily treatable while in their early stages. The National Cervical Screening Program seeks to detect the precursors to cancer or abnormalities of cells in the cervix which may lead to invasive cervical cancer.

BREAST AND CERVICAL CANCER DEATH RATES FOR WOMEN, BY AGE, 1998

Breast cancer deaths
Cervical cancer deaths
Age group (years)
rate(a)
rate(a)

20-24
0.3
0.5
25-29
1.0
0.8
30-34
4.0
0.7
35-39
9.1
2.7
40-44
18.2
2.7
45-49
31.7
2.5
50-54
46.5
4.0
55-59
53.1
3.7
60-64
69.2
7.8
65-69
72.0
6.0
70-74
81.2
8.5
75 and over
137.7
13.8

(a) Per 100,000 women in each age group.

Source: Unpublished data, Causes of Death collection.


Mortality

In 1998 there were 2,542 deaths due to breast cancer, accounting for 17% of female cancer deaths and 4% of all female deaths. Breast cancer was the leading cause of death from cancer for women in each age group between 25 and 64 years. As with most cancers, death rates increase with age, from a rate of 0.3 per 100,000 females aged 20-24 years in 1998 to 138 per 100,000 for women aged 75 years and over.

In 1998, 269 women died from cervical cancer, accounting for 1.8% of female cancer deaths and 0.4% of all female deaths in that year. Again, the death rate increased with age, from 0.5 per 100,000 women aged 20-24 years to 14 per 100,000 aged 75 years and over.

Risk factors for breast cancer
There are a number of interrelated risk factors associated with breast cancer. These include: a previous history of breast cancer; increasing age (breast cancer is rare in women under 30, but the risk rises steadily with age); having a mother, sister or daughter with breast cancer; and a history of primary cancer of the ovary or endometrium. However, these factors explain no more than 30% of breast cancers.3

WOMEN WHO HAD HAD REGULAR BREAST EXAMINATIONS, 1995

WOMEN WHO HAD HAD REGULAR BREAST EXAMINATIONS, 1995 - GRAPH

    Source: Year Book Australia, 2000 (cat. no. 1301.0).

    Breast examinations
    The early detection of breast cancer opens the opportunity for appropriate early treatment. Mammographic screening for women over 50 years is generally considered to be the most effective means of reducing mortality from breast cancer. In addition to mammographic screening, State and Territory cancer organisations recommend monthly breast self examination and annual clinical breast examination to detect early symptoms of breast cancer.4

    In 1995, 67% of women said that they regularly examined their own breasts for unusual lumps. Most women who regularly examined their own breasts did so at least once a month (73% of women who examined their breasts regularly, and 49% of women overall).

    Approximately 72% of women had had a breast examination performed by a doctor or medical assistant at some time during their lives, but only 42% of women reported that they had regular breast examinations performed by these health professionals.

    In all age groups, self examination was more common than examination by a doctor or medical assistant. Proportional differences between the two examination type groups were smallest in those aged 45-54 years and 55-64 years, due to an increase in the percentages of women in these age groups who had regular breast examinations by a health professional.

    WOMEN WHO HAD HAD A MAMMOGRAM, 1995

    WOMEN WHO HAD HAD A MAMMOGRAM, 1995 - GRAPH

      Source: Year Book Australia, 2000 (cat. no. 1301.0).


      Mammograms
      Overall, 36% of women had had a mammogram for either diagnostic or screening purposes. The most frequent reason given for a woman's last mammogram was a general checkup (54% of women who had had a mammogram), followed by the presence of symptoms (28%) and a family history of breast cancer (9%).

      Those in age groups within the target range for screening (50-69 years) were most likely to have had one (68% of those aged 45-54 years, and 74% of those aged 55-64 years).

      WOMEN WHO HAD HAD A PAP SMEAR TEST, 1995

      WOMEN WHO HAD HAD A PAP SMEAR TEST, 1995 - GRAPH

        Source: Year Book Australia, 2000 (cat. no. 1301.0).

        Pap smear tests
        The National Cervical Screening Program recommends that all women who have been sexually active at any stage in their lives have a Pap smear test every two years, until the age of 70 years.1

        In 1995, most women (95%) had heard of a Pap smear test. Older women were those least likely to have heard of this test, with 22% of women aged 75 years and over reporting that they had not heard of it. Altogether, 84% of women had had a Pap smear test, 62% within the previous two years. Women in age groups between 25 years and 64 years were the most likely to have had this test.

        Usual language spoken at home
        Women who do not speak fluent English may be disadvantaged in obtaining information and education about health-related matters, including breast examinations, mammograms and Pap smear tests. Although the National Health Survey did not ask about fluency in English, it did ask whether a person usually spoke English at home, which may give some indication about their fluency in English.

        In 1995, women who did not usually speak English at home were less likely than those who did to either examine their own breasts regularly (49% and 68% respectively) or to have had a breast examination performed by a doctor or a medical assistant (55% and 73%).

        Although women who did not speak English at home were less likely than women who did to have heard of a mammogram (62% compared with 89%), they were only slightly less likely to have had one (34% compared with 36%). Women who did not usually speak English at home were also less likely to have heard of a Pap smear test (77%) than were women who did (97%) and were less likely to have had a Pap smear test (61% compared with 86%).

        STANDARDISED DEATH RATES FOR BREAST AND CERVICAL CANCER

        Breast cancer
        Cervical cancer
        Year
        rate(a)
        rate(a)

        1984
        26.3
        4.3
        1985
        27.3
        4.5
        1986
        26.9
        4.3
        1987
        26.5
        4.0
        1988
        26.9
        4.1
        1989
        27.2
        4.1
        1990
        26.9
        3.9
        1991
        27.0
        3.6
        1992
        25.4
        3.4
        1993
        26.9
        3.3
        1994
        26.5
        3.4
        1995
        25.6
        3.3
        1996
        25.0
        2.9
        1997
        24.2
        2.8
        1998
        23.0
        2.5

        (a) Per 100,000 persons, age-standardised to the total mid-year estimated resident population in 1991.

        Source: Unpublished data, Causes of Death collection.


        Changes in death rates over time

        Between 1984 and 1998 the standardised death rates for both breast and cervical cancer declined (from 26.3 to 23.0 and 4.3 to 2.5 per 100,000 persons respectively). Death rates from breast cancer fluctuated only slightly between 1984 and 1993, after which there was a small but steady decline. Deaths from cervical cancer declined fairly steadily throughout the period.


        Endnotes

        1. Australian Institute of Health and Welfare 1998, Breast and cervical cancer screening in Australia 1996-1997, AIHW cat. No. CAN 3, Cancer Series number 8, AIHW, Canberra.

        2. National Program for the Early Detection of Breast Cancer 1994, National Accreditation Requirements, Commonwealth Department of Human Services and Health, Canberra.

        3. National Health and Medical Research Council 1995, Clinical Practice Guidelines: The Management of Early Breast Cancer, AGPS, Canberra.

        4. National Health and Medical Research Council National Breast Cancer Centre, Don't ask for an opinion - ask for the scalpel: print media coverage of breast cancer in Australia in 1995 <URL: http://www.nbcc.org.au/>, (accessed 5 February 2000).



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