BreastScreen Victoria Annual Statistical Report

Transcription

1 BreastScreen Victoria Annual Statistical Report 29

2 BREASTSCREEN VICTORIA: ANNUAL STATISTICAL REPORT, 29 Produced by: BreastScreen Victoria Coordination Unit Level, 3 Pelham Street, Carlton South Victoria 353 March 24 BreastScreen Victoria 24 PH FX EM info@breastscreen.org.au Copies of this report are available online: Design: Six String Design Registration A25878W ABN BreastScreen Victoria gratefully acknowledges the support of: Australian Government Department of Health and Ageing Screening and Cancer Prevention Section, Department of Health, Victoria

3 CONTENTS INTRODUCTION 2 About Breastscreen Victoria 2 29 Highlights 4 Technical Notes 6 SCREENING 7 Recruitment 7 Demographics 8 Imaging Participation 2 Rescreen 5 Screening Outcome 7 ASSESSMENT 8 Recall To Assessment 8 Assessment Procedures 9 Outcome of Assessment 25 CANCER DETECTION 27 Summary Of Cancer Detection 27 Invasive Breast Cancer 28 DCIS 32 Interval Cancers 35 BREAST CANCER TREATMENT 37 Surgical Treatment 37 Adjuvant Therapy 39 DEFINITION OF TERMS 4 TABLES AND FIGURES 43 Tables 43 Figures 44 References 45

4 29 BreastScreen Victoria Annual Statistical Report INTRODUCTION ABOUT BREASTSCREEN VICTORIA BreastScreen Victoria is an accredited part of BreastScreen Australia, a national program jointly funded by the Victorian and Commonwealth Governments, which aims to reduce deaths from breast cancer through early detection of the disease. From July 23, the Australian government expanded BreastScreen Australia s target age range by five years, from women aged 5-69 years to women aged 5-74 years. BreastScreen Australia invites women aged 5 74 years who do not have any breast symptoms or changes to have a free screening mammogram once every two years. Women aged 4 49 years and over 74 are also eligible to attend. The Program is made up of three service components: Nineteen Screening Service Providers which oversee 39 permanent screening clinics. Eight regional Screening, Reading and Assessment Services. These services read images from multiple sites in their catchment area, including the 29 sites visited every two years by two Mobile Screening Services. The BreastScreen Victoria Coordination Unit is an independently incorporated association which administers funding for the Screening, Reading and Assessment Services, manages the centralised information and appointment service, coordinates the Mobile Screening Service, manages client information, coordinates statewide communications and recruitment, monitors service provision and coordinates special projects. The BreastScreen Australia Quality Improvement Program ensures that all BreastScreen services delivered in Victoria operate under and comply with national standards. Performance monitoring and evaluation against the standards is conducted quarterly by the State Accreditation Committee and the National Quality Management Committee. All services are assessed regularly by an independent multidisciplinary team. The Annual Statistical Report provides summary data on women who attended the BreastScreen Victoria program during 29. This report also presents comparisons and trends over time for some areas. Statistical reports for the BreastScreen Victoria program are produced for each year and present comparable data so that time trends can be identified. In some sections of this report, the numbers presented are small, and may place limitations on the interpretation of results and comparison of trends over time. The simple descriptive statistics contained in this report are intended to provide a snapshot of the BreastScreen Victoria program for 29. Where relevant, the exclusions and limitations of the data presented are noted. Further information about BreastScreen Victoria is available at 2

5 Figure : Screening and assessment pathway, 29 Recruitment Recruitment of women aged 5 69 years Women outside target age group (4 49, 7+ years) Screening Mammography screening Reading Recalled to assessment Routine rescreen recommended Assessment Further mammography +/- Ultrasound +/- Physical examination +/- Fine needle aspiration biopsy +/- Core biopsy Breast cancer detected No breast cancer detected Diagnosis Open diagnostic biopsy Breast cancer detected No breast cancer detected Treatment Definitive treatment Surgery +/- Radiotherapy +/- Chemotherapy Ongoing management Note: Open diagnostic biopsy and treatment are conducted outside the Program. 3

6 29 BreastScreen Victoria Annual Statistical Report 29 HIGHLIGHTS Screening In 29, a total of 9,72 women were screened in the BreastScreen Victoria Program. Of these women, 62,593 (85.3%) were in the 5 69 year target age group and 26,757 (4.) attended for their first screening mammogram. Of all Victorian women aged 5 69 years, 53.3% participated in the Program during the two-year period January 28 to 3 December 29. The comparable participation rates for CALD and ATSI women were 35.6% and 33.3%. Of women aged 5 67 years who were screened in 29, 79.8% returned for rescreening within 27 months. The rescreen rate for first round women aged 5 67 years was 62.6% and 82.% for subsequent round women. The comparable rates for CALD and ATSI women aged 5-67 were 78.9% and 7. respectively. Digital mammography was used for 28.7% of all breast screens. Assessment Of the women screened in 29, 78,578 (93.6%) were recommended for routine rescreen and 2,34 (6.4%) were recommended to attend for assessment. The recall to assessment rate was higher for first round women aged 5-69 (4.%) than for subsequent round women (5.). Most women undergoing assessment (76.%) were able to receive an outcome without an invasive procedure (fine needle aspiration, core biopsy or open biopsy) being performed. Breast cancer detection Of the,57 screen detected breast cancers diagnosed within BreastScreen Victoria in 29; 94 (78.%) were invasive breast cancers and 254 (2.9%) were ductal carcinoma in situ (DCIS). Of these screen detected cancers, 82.3 % were in women aged 5 69 years. Of the invasive breast cancers detected, 6.% were small (5mm or less in size), 25.8% were classified as Grade and 7. were node negative, all indicators of a good prognosis. Breast cancer treatment 8.5% of women with invasive breast cancer and 8.2% of women with DCIS underwent breast conserving surgery. Of the women diagnosed with invasive breast cancer, 97.6% underwent axillary dissection. Of these women, 24.2% were found to have positive nodes. Only 28.5% of women diagnosed with DCIS underwent axillary dissection, one of these women had positive nodes. 4

7 Figure 2: Screening and assessment pathway by round, 29 Screening a Women screened 9,72 First round Screening mammograms 26,757 (4.) Subsequent rounds Screening mammograms 63,955 (86.) Screening outcome b Routine rescreen recommended Recalled for assessment Recalled for assessment Routine rescreen recommended 23,2 (86.) 3,736 (4.) 8,398 (5.%) 55,557 (94.9%) Assessment outcome c No cancer detected Breast cancer detected Breast cancer detected No cancer detected 3,522 (94.9%) 85 (5.) 985 (.7%) 7,385 (88.%) Cancer Detection d Invasive breast cancer DCIS Invasive breast cancer DCIS 33 (72.3%) 5 (27.7%) 77 (79.2%) 22 (2.8%) Source: a Table 2, b Table 22, c Table 29, d Tables 33 and 4. The source tables may exclude data for a small number of women. Table 29 excludes women who failed to attend assessment and women who did not complete assessment. Tables 33 and 4 exclude cancers diagnosed at early review more than 6 months after the screening mammogram. Note: In all tables, percentages may not add up to due to rounding. 5

8 29 BreastScreen Victoria Annual Statistical Report TECHNICAL NOTES This Annual Statistical Report provides information about women screened by BreastScreen Victoria during the 29 calendar year. For the purposes of this report, women screened refers to the number of screening appointments attended not individual women. For example, if a woman on annual recall attended two screening appointments within the 2-month reporting period, both screening appointments are counted. Women s screening and assessment data is entered into the BreastScreen Victoria Client Information System by data services staff based at eight Reading and Assessment Services. Data is extracted centrally by the Information Services team from the data warehouse using Business Objects software. The availability of data items varies depending on where in the screening and assessment cycle the data originates, whether data is from within the Program, or whether data is obtained outside the Program (e.g. the provision of histology information following surgery). Technical notes have been created to ensure consistency in the extraction of data for each statistical report. Where relevant, the exclusions and limitations of the data presented are noted. 6

9 SCREENING RECRUITMENT Eligibility Women are eligible for screening mammography with BreastScreen Victoria from the age of 4 years. Women aged 5 69 years are actively recruited because there is strong evidence that screening is most effective in detecting early breast cancer in this age group. Women aged 4 49 years, and 7 years and over, are eligible to attend, but are not sent two-yearly rescreening reminders. There is no evidence of benefit from breast cancer screening in women less than 4 years of age. These women are advised to consult their doctor if they are concerned about breast cancer. Inviting new women Women who turn 5 years of age and who have not previously attended BreastScreen Victoria are identified from the Victorian electoral roll. These women are sent a written invitation and a brochure titled Is BreastScreen for you?. If within one month, no response is received to the invitation letter, a second invitation is posted. Reinviting women Women aged 5 69 years are routinely reinvited for screening 23 months after their previous mammogram if they have not already made an appointment on their own initiative. If there is no response within three months a second reminder letter is posted. Women recommended for annual screening will receive an invitation after months if no appointment has been made. Women aged 4 49 years who have reported a strong family history of breast cancer at a previous screening mammogram are sent two-yearly rescreening reminders. Women aged 4 49 years with a personal history of breast cancer, or a past diagnosis of lobular carcinoma in situ or atypical ductal hyperplasia, are reinvited annually. Women aged 7 years and over are not sent invitations for rescreening with the exception of women with a personal history of breast cancer or a past diagnosis of lobular carcinoma in situ or atypical ductal hyperplasia. Response to invitation During 29, 37.2% of women invited to attend their first screen made an appointment. For women invited to attend for rescreening the response rate was higher (57.%) (Table ). It is not certain that all appointments were made solely in response to the invitation letter; some women may have responded to other recruitment initiatives such as newspaper articles, advertisements or media campaigns. Table : Response to invitation, 29 Invitation type Number of women invited Appointments made Response rate Invitation 2,62 7, % Reinvitation 6,47 92,23 57.% Includes: Women who have responded to an invitation within 9 days of a letter being sent. Note: The Victorian Electoral Commission makes available the names and addresses of all Victorian women aged 5 69 years under the Electoral Act 22 as BreastScreen Victoria is a public health program which will benefit Victorian women. 7

10 29 BreastScreen Victoria Annual Statistical Report DEMOGRAPHICS Screening The information in the following nine tables comes from a registration and consent form that each woman completes before her screening mammogram. Screening by age and round BreastScreen Victoria screened 9,72 women during 29. Of these women, 26,757 (4.) attended for their first screening mammogram and 63,955 (86.) attended for their second or subsequent mammogram (Table 2). Table 2: Women screened by age and round, Total 5 69 First round women 8,58 5,828 2, ,757 7, % 8.% 2.7% 2. 3.% 4.. Subsequent round women 5,546 7,85 72,86 2,64,85 63,955 44,7 39.3% 8.9% 97.3% % Total women 4,27 87,678 74,95 2,872,2 9,72 62,593 Note: Classification of screening status is based on screening within BreastScreen Victoria. Women attending for a first screen with BreastScreen Victoria may have had previous mammography outside the Program. In 29, 85.3% of women screened were within the target age group (5-69) (Table 3). BreastScreen Victoria stopped sending rescreening reminders to women aged 7-74 years of age in 27. These women were advised they were still welcome to attend screening, but would no longer receive invitation letters. The proportion of women screened in the 7-79 year age group was 3.7% in 26, 2.4% in 27, 8.3% in 28 and 6.7% in 29. Table 3: Women screened by age, Total 5 69 Total women 4,27 87,678 74,95 2,872,2 9,72 62, % % 6.7%.6% 85.3% The number of women screened steadily increased between 2 and 26, and then declined in 27 and 28. This decline was seen in both first and subsequent round women. In 29 the total number of women screened has increased slightly from the previous year (Table 4). Table 4: Women screened by round, First round women 3,65 35,98 3,698 25,69 3,335 29,227 3,825 25,952 25,36 26, % % 3.6% 5.8% 4.8% 5.7% 3.3% 3.8% 3.8% Subsequent round women 45,587 52,772 57,28 63,99 67,48 68,439 7,645 69,338 57,784 63, % % 86.4% 84.2% 85.2% 84.3% 86.7% 86.2% 86.2% Total women 77,237 88,68 87,726 88,79 98,753 97,666 22,47 95,29 83, 9,72 Source: Table 4, 28 ASR. 8

11 Figure 3: Women screened by round, 2-29 Number of women screened 22, 2, 8, 6, 4, 2,, 8, 6, 4, 2, Year Women from culturally and linguistically diverse (CALD) backgrounds Table 5 shows the number of women who attended for screening and reported on their registration form that they usually spoke a language other than English at home as their main language. These women are defined as culturally and linguistically diverse (CALD). Table 5: CALD women screened by age, Total 5 69 CALD,43 9,889,467 2, ,99 2,356..3% % 2.5% 2.5% Aboriginal and Torres Strait Islander (ATSI) women Table 6 shows the number of women who attended for screening and reported on their registration form that they were Aboriginal or Torres Strait Islander (ATSI). Table 6: ATSI women screened by age, Total 5 69 Aboriginal and Torres Strait Islander 36.3% 53.2% 2.2% 2.2% 3.3% 333.2% 274.2% Family history of breast cancer Women with a family history of breast cancer are at increased risk of developing breast cancer (BreastScreen Australia, 25a, p. 2). In Table 7, a strong family history is defined as a woman whose mother, sister or daughter was diagnosed with breast cancer before 5 years of age, or whose father, brother or son was diagnosed with breast cancer at any age. Women who nominate other family members with breast cancer are classified as other family history. In 29, 43,74 (22.6%) of women screened reported a family history of breast cancer (Table 7). Younger women were more likely to report a family history of breast cancer. Women aged 4-49 with a strong family history of breast cancer are reinvited for screening every two years. Table 7: Women with a family history of breast cancer by age, 29 Family history of breast cancer Total 5 69 Strong family history,269 3,565 3, ,77 6, % 4.% 5.7% 8.8% 4.6% 4.% Other family history 3,48 5,455 2,896 2, ,44 28,35 24.% 7.6% 7.2% 8.8% 9.6% % 9

12 29 BreastScreen Victoria Annual Statistical Report Personal history of breast cancer Women with a personal history of breast cancer are at higher risk of breast cancer, through either a recurrence or a new primary breast cancer (National Health and Medical Research Council, 2, pp ). In general, women with a personal history of breast cancer are discouraged from attending BreastScreen Victoria. However, a small number of women who report a personal history of breast cancer do attend for screening. In 29, 42 (.2%) of women screened reported a personal history of breast cancer. Of these 42 women, 376 (93.5%) reported having a personal history of breast cancer treated with mastectomy (Table 8). Table 8: Women with a personal history of breast cancer by age, Total 5-69 Personal history of breast cancer treated with breast conserving surgery.% 8.% 8.% 7.5% 2.8% 26.% 6.% Personal history of breast cancer treated with mastectomy.4%.5%.2%. 5.7%.2%.% Breast symptoms BreastScreen Victoria is a screening program for the early detection of breast cancer for women without breast symptoms or problems. BreastScreen Victoria advises women with breast symptoms to see their own doctor. However, the Program does screen women who report breast symptoms at the time of their screening appointment. In 29, 8.7% of women reported breast symptoms at the time of screening. Younger women were more likely to report breast symptoms (Table 9). Table 9: Women with breast symptoms by age, 29 Breast symptoms Total 5 69 Breast lump and/or nipple discharge,49 2,94, ,834 4, % 3.3% 2.% % 3.% 2.8% Other breast symptoms,558 5,76 3, ,627 8, % 4.2% 5.9% 7.9% 5.6% 5.% Of the 5,834 women with a breast lump and/or nipple discharge, there were 63 women with symptoms (.8%) that were considered suspicious of breast cancer, and for which recall for assessment was recommended. This number comprised 52 women with a lump that had been present for less than 2 months which had not been investigated by a medical practitioner and 9 women with a nipple discharge that had been present for less than 2 months which had not been investigated by a medical practitioner. Breast implants Women with breast implants are eligible to screen within the BreastScreen Victoria program. During 29,.8% of women screened reported having breast implants (Table ). Table : Women with breast implants by age, Total 5-69 Breast implants ,499,334.9%.8%.8%.3%.2%.8%.8%

13 IMAGING Analogue and digital screening Digital mammography was first introduced to BreastScreen Victoria in 26. During 29 four additional screening sites were converted to digital screening; Broadmeadows, Mont Albert, Grampians and Bairnsdale. The proportion of digital screening has increased from 5.8% in 26, to 7. in 27, 2.4% in 28 and 28.7% in 29 (Table ). Table : Women screened by modality and age, 29 Modality Total 5 69 Digital 3,95 25,22 2,42 3, ,88 46, % 28.6% 29.8% 35.2% 28.7% 28.7% Analogue,77 62,457 53,494 9, ,894 5, % 7.4% 7.2% 64.8% 7.3% 7.3% Total 4,27 87,678 74,95 2,872,2 9,72 62,598 Imaging quality Most women who attended for screening had two x-ray images of each breast, giving a total of four images (Table 2). Additional images may be required for women with larger breasts, inadequate breast tissue or breast implants. In 29, 9.9% of women screened had more than four images taken. Table 2: Number of images for each woman screened by age, 29 Number of images Total 5 69 Four images or less,75 7,258 59,8, ,6 3, % 8.3% 78.8% 79.2% 79.7% 8.3% 8.% More than four images 2,376 6,42 5,97 2, ,66 32, % 8.7% 2.2% 2.8% 2.3% 9.7% 9.9% Total 4,27 87,678 74,95 2,872,2 9,72 62,593 It may be necessary to repeat screening images if the images taken are deemed to be of poor quality. Overall,.3% of all images taken were technical repeat images, with the percentage varying little across women of different age groups (Table 3). Table 3: Technical repeat images by age, Total 5 69 Images taken 6, ,2 334,34 56,486 4,82 842,935 72,54 Technical repeat images taken 839 5,66 4, ,956 9,349 Technical repeat rate.4%.3%.3%.2%.3%.3%.3% Note: Technical repeat images include images taken at the second screening attempt. The rate of technical repeat images met the National Accreditation Standards (NAS) in 29. National Accreditation Standard Result in The overall repeat rate for the Service is <3% of all screening films..3%

14 29 BreastScreen Victoria Annual Statistical Report PARTICIPATION BreastScreen Victoria targets women aged 5 69 years, although women aged 4 49 years and 7 years and over are also eligible to attend. The participation rate measures the proportion of the eligible female population attending BreastScreen Victoria within a 24-month period. A reporting interval of 24 months is used to reflect the Program s recommended screening interval of two years. The Program aims to achieve a participation rate of at least 7 of women in the target 5 69 year age group. Since 24 there has been a steady increase in the number of women in the target age group each year. There was an increase of over 6,7 women in the target age group from 28 to 29 (Table 4). Table 4: Victorian female population by year, Age group ,632 37, ,9 38,2 384,45 389, ,2 53,24 53,94 56, ,69 593, ,278 62,34 59,847 63,9 64,7 67,23 Source: Australian Bureau of Statistics (ABS): 24, 25, 27, 28, 29 Estimated Resident Population (ERP) and 26 Census of Population and Housing, Victorian Females. ERP was not available in the Census year 26. Figure 4: Victorian female population by year, , Victorian female population 6, 5, 4, 3, 2,, Year The following tables show participation rates for Victorian women who were screened by BreastScreen Victoria between and The participation rate for women aged 5 69 reached a peak of 6.2% in 2 2 before slowly decreasing to 53.3% in The decline was due to both the steady increase in the Victorian female population in the target age group between 24 and 29, and the lower numbers of women screened in 27, 28 and 29. The participation rate for women aged 7 79 also decreased in BreastScreen Victoria stopping sending screening reminder letters to women aged 7 74 years from 27 onwards. Table 5: Participation rate by age group for 2-year calendar period 998 & 999 to 28 & 29 Age group % 9.2% 8.4% 8.8% 8.4% 7.4% % 58.8% 57.6% 56.7% 53.3% % % 33.6% % Source: Table 5, Annual Statistical Report 27. Note: The eligible population is averaged over the two reporting years. For example, the population for is calculated as the average of the 28 and 29 Estimated Resident Population Figures. For the average was calculated from the 26 Census count and the 27 Estimated Resident Population. 2

15 Figure 5: Participation rate by age for 2-year calendar period, 998 & 999 to 28 & 29 Percentage of eligible population month screening period The participation rate did not meet the accreditation standard in National Accreditation Standard Result in of women aged 5-69 years participate in screening in the most recent 24-month period. 53.3% To ensure that our services are equitable and accessible, we monitor the participation rate across a number of categories. Region Figure 6 shows the geographical regions within the state. The figure is derived from the Australian Standard Geographical Classification (ASGC). Areas of Remoteness by Postcode Figure 6: Victoria by Geographic Region VIC Postcodes by area of remoteness Major Cities Inner Regional Outer Regional Remote Print date 8 September 23 Scale : 5,79, 3

16 29 BreastScreen Victoria Annual Statistical Report Participation rates for women in the target age group were similar across geographic regions (Table 6). Comparison of participation rates between Remote and other regions should be treated with caution due to the small remote population and screening numbers. Table 6: Participation rate by region and age for 2-year calendar period 28 & 29 Region Major city 7.2% 52.8% 5.9% Inner regional 7.3% 53.8% 8. Outer regional.3% 57.2% 2.5% Remote 7.2% 62.5% 26.7% All Regions 7.4% 53.3% 6.7% Source: Australian Standard Geographical Classification (ASGC), provided by the Australian Bureau of Statistics 26. CALD women Participation rates were lower for CALD women across all age groups (Table 7). Table 7: Participation rate for CALD women by age for 2-year calendar period 28 & CALD 3.6% 35.6% 2.7% All women 7.4% 53.3% 6.7% Source: The population figure for CALD women is taken from the 26 ABS Census data question: Does the person speak a language other than English at home? Note: During the 28 & 29 participation period, a total of 44,788 Victorian CALD women were screened in the Program. Aboriginal and Torres Strait Islander women Participation rates were lower for Aboriginal and Torres Strait Islander women across all age groups (Table 8). However, comparison of participation rates between Aboriginal and Torres Strait Islander women and all Victorian women should be treated with caution due to the small Aboriginal and Torres Strait Islander population and screening numbers. Table 8: Participation rate for Aboriginal and Torres Strait Islander women by age for 2-year calendar period 28 & Aboriginal and Torres Strait Islander 4.3% 33.3% 3.% All women 7.4% 53.3% 6.7% Source: The population figure for Aboriginal and Torres Strait Islander women is taken from the 26 ABS Census females by indigenous status and age data. Note: During the 28 & 29 participation period, a total of 662 Victorian Aboriginal and Torres Strait Islander women were screened in the Program. 4

17 RESCREEN Rescreen rates measure the proportion of women who return for screening in the Program within the recommended screening interval. A high rescreen rate is important to both increase the likelihood of breast cancers being detected early in screened women and to maintain overall participation. While the recommended screening interval is 24 months, a 27 month time period is set to allow a reasonable timeframe for women to respond to invitations. For the 87,85 women screened during 29 who were eligible to be rescreened, 69.8% were rescreened by the Program within 27 months. This figure rose to 79.6% within 36 months (Table 9). The rescreen rate for women aged 5-67 who were screened within 27 months rose steadily over the past four years (65.% in 26, 66.9% in 27, 73.7% in 28 and 79.8% in 29). Table 9: Rescreen rate by round and age, 29 First round women Total 5-67 Screened in 29 8,526 54,659, ,426 7,478 Rescreened within 24 months,22 4, ,69 5, % 3.8% 29.% 4.% 25.3% 3.7% Rescreened within 27 months 2,432 9,83,3 3 3,425, % 62.8% 56.6% 2.8% 5.8% 62.6% Rescreened within 36 months 3,932,728, ,45 3,24 46.% 74.9% 66.7% 2.4% 64.5% 74.5% Subsequent round women Screened in 29 5,53 7,324 72,43 2,445 6,425 32,297 Rescreened within 24 months,678 3,977 33,84,523 68,262 63, % 44.8% 45.9% 2.2% 42.3% 48.3% Rescreened within 27 months 3,27 57,268 53,842 3,455 7,782 8,6 58.4% 8.3% 74.6% 27.8% % Rescreened within 36 months 4,224 64,2 59,3 4,83 32,45 9, % 89.9% 82.2% 38.6% 82.% 9.3% All women Screened in 29 4,39 86,983 74,4 2,688 87,85 49,775 Rescreened within 24 months 2,8 36,954 33,665,533 74,952 69, % 42.5% 45.4% 2.% 39.9% 46.4% Rescreened within 27 months 5,649 67,99 54,973 3,486 3,27 9,55 4.2% 77.% 74.% 27.5% 69.8% 79.8% Rescreened within 36 months 8,56 75,84 6,644 4,855 49,495 32, % 87.2% 8.8% 38.3% 79.6% 88.5% Includes: Women recommended for routine rescreen. Excludes: Women resident interstate and women aged 8 years and over. Note: During 29, some rescreen invitations for women were sent early at 2 months. Rescreen rates did not meet the accreditation standards in 29. National Accreditation Standard Result in % of women aged 5 67 who attend for their first screen within the Program are rescreened within 27 months of those attending for a second or subsequent screening round are rescreened within 27 months. 62.6% 82.% 5

18 29 BreastScreen Victoria Annual Statistical Report CALD women The proportion of CALD women aged 5 67 years who returned to screening within 27 months was comparable to the rate for all women aged 5-67 (Table 2). Table 2: Rescreen rate for CALD women by round and age, Total 5-67 First round women Screened in 29 92, ,993,992 Rescreened within 24 months 2.2% 27.2% 22.% 2.5% 26.6% Rescreened within 27 months 28.3% 6.8% 49.9% 48.5% 59.7% Rescreened within 36 months 47.8% 73.2% 6.6% 7.7% 62.9% 72.2% Subsequent round women Screened in ,85,44,989 2,76 6,328 Rescreened within 24 months 24.7% 38.3% 35.2% 8.2% 33.5% 39.8% Rescreened within 27 months 55.8% 8.5% 69.8% 2.% 68.9% 8.3% Rescreened within 36 months 75.5% 9.4% 77.9% 28.6% 78.% 9. All women Screened in 29,4 9,857,4 2,4 23,79 8,32 Rescreened within 24 months 6.6% 36.4% 34.7% % Rescreened within 27 months % 69.% 9.5% 66.4% 78.9% Rescreened within 36 months 57.6% 87.5% 77.4% 28.% 76.2% 88.% Aboriginal and Torres Strait Islander women The rescreen rates for Aboriginal and Torres Strait Islander women aged 5 67 years were lower than the rates for all Victorian women aged 5 67 years (Table 2). Table 2: Rescreen rate for Aboriginal and Torres Strait Islander women by round and age, Total 5-67 First round women Screened in Rescreened within 24 months 24.2% 36.7% % 34.4% Rescreened within 27 months 3.3% % % 59.4% Rescreened within 36 months 45.5% 63.3% 33.3% % 62.5% Subsequent round women Screened in Rescreened within 24 months 4.5% 43.6% 2.5% 39.7% 45.% Rescreened within 27 months % 43.8% 63.8% 7.6% Rescreened within 36 months 6.7% 79.7% 65.8% 56.3% 7.4% 77.2% All women Screened in Rescreened within 24 months 2.5% 4.5% 42.5% 6.7% 37.5% 43.7% Rescreened within 27 months 25.6% 69.6% 6.8% 44.4% 59.7% 7. Rescreened within 36 months % % 66.8% 75.3% 6

19 SCREENING OUTCOME Table 22 shows the number of women within each age group who were recommended for routine rescreen and the number recommended for assessment. While 4. of first round women were recommended for assessment, the comparable figure for subsequent round women was 5.%. Table 22: Screening outcome by round and age, 29 First round women Total 5-69 Routine rescreen recommended 7,4 3,599, ,2 5, % 85.9% 85.9% 84.9% % Assessment recommended,7 2, ,736 2,59 3.6% 4.% 4.% 5.% % Total 8,58 5,828 2, ,757 7,883 Subsequent round women Routine rescreen recommended 5,9 68,53 69,397,952,36 55,557 37, % 94.7% 95.2% 94.8% 95.5% 94.9% 95. Assessment recommended 427 3,797 3, ,398 7,26 7.7% 5.3% 4.8% 5.2% 4.5% 5.% 5. Total 5,546 7,85 72,86 2,64,85 63,955 44,7 All women Routine rescreen recommended 2,529 8,652 7,62 2,7,64 78,578 52, % 93.% % % 94. Assessment recommended,598 6,26 3, ,34 9,779.3% 6.9% % 6. Total 4,27 87,678 74,95 2,872,2 9,72 62,593 7

20 29 BreastScreen Victoria Annual Statistical Report ASSESSMENT As a public health program for well women with no signs of breast cancer, the majority of women screened by BreastScreen Victoria do not have the disease. As well as achieving high cancer detection rates, BreastScreen Victoria aims to minimise unnecessary recalls and investigations. RECALL TO ASSESSMENT Women are recalled to assessment for a number of reasons including abnormal mammography, symptoms of possible breast cancer (reported by the woman or noted by the radiographer during screening) or a personal history of breast cancer. From 2 to 29, recall to assessment rates for women aged 5 69 years increased for first round women from.6% to 4.%, but remained steady for subsequent round women (Table 23). Table 23: Recall to assessment rates for women aged 5 69 by round, 2 to First round women.6%.7%.6%.5%.7% % % 4.% Subsequent round women 5.% 4.9% 4.7% 4.7% 4.6% 5.% 4.7% 4.7% 5.% 5. Total women 5.9% 5.9% 5.5% 5.5% 5.6% 5.9% 5.7% 5.6% Source: Table 23, 28 ASR. Figure 7: Recall to assessment rates for women aged 5 69 by round, 2 to 29 6% Proportion of women screened 2% 8% 4% Year 29 First round women Subsequent round women Recall to assessment rates did not met the accreditation standard for first or subsequent round women in 29. National Accreditation Standard Result in < for women aged 5 69 years who attend for their first screen are recalled for assessment <5% for women aged 5 69 years who attend for their second or subsequent screen are recalled for assessment. 4.% 5. 8

21 ASSESSMENT PROCEDURES A total of,879 women were assessed within BreastScreen Victoria. Twenty one women were cleared for routine rescreen without any further investigations being performed. For the,858 women who underwent assessment investigations within BreastScreen Victoria, Table 24 shows the range of procedures performed. An assessment outcome was determined without the need for invasive procedures (fine needle aspiration, core biopsy or open diagnostic biopsy) for 76% of women having an assessment procedure. Core biopsy was the most common invasive procedure performed (9.4%) compared with 2. for fine needle aspiration and 2.4% for open diagnostic biopsy. Table 24: Range of assessment procedures by round and age, 29 Assessment procedures performed Total 5-69 First round women Mammography only % 22.3% 2.4%.8% % Ultrasound 496,3 3 5,628,6 +/- mammography 43.5% % 44.% % 45.5% Clinical examination /- ultrasound 4.4% 8.2% 2.4% 4.7% 2..5% 8.7% +/- mammography Fine needle aspiration /-clinical examination.8% 2.3%.5% % +/- ultrasound +/- mammography Core biopsy /-fine needle aspiration 6.8% 8.2% % % 8.7% +/-clinical examination +/- ultrasound +/- mammography Open diagnostic biopsy /- core biopsy.6% 3.%.5% 2.9% 2.5% 2.9% +/-fine needle aspiration +/-clinical examination +/- ultrasound +/- mammography Total,39 2, ,633 2,455 Continued 9

22 29 BreastScreen Victoria Annual Statistical Report Table 24: Range of assessment procedures by round and age, 29 (continued) Assessment procedures performed Total 5-69 Subsequent round women Mammography only ,29, % 26.2% 24.% 2.2% 9.% 24.7% 25.2% Ultrasound 98,64, ,46 3, +/- mammography 47.3% 44.2% 4.2% 36.7% 36.4% 42.% 42.3% Clinical examination /- ultrasound 3.4% % 9.8% 22.7% 8.9% 8.4% +/- mammography Fine needle aspiration /- clinical examination.7%.8% 2.3% 2.3% /- ultrasound +/- mammography Core biopsy ,644,43 +/- fine needle aspiration 3.8% 6.7% % % +/- clinical examination +/- ultrasound +/- mammography Open diagnostic biopsy % 2.5% 3.% 6.8% 2.4% 2.4% Total 49 3,76 3, ,225 7,2 All women Mammography only 346, ,827 2, % 24.7% 23.8% 2.7% 2.2% 23.8% 24.4% Ultrasound 694 2,644, ,88 4,27 +/- mammography 44.5% 44.8% 4.3% % 42.9% 43.% Clinical examination ,2 83 +/- ultrasound 4.% 8.7% 8.2%.% 22.4% 9.4% 8.5% +/- mammography Fine needle aspiration /- clinical examination.7% % 2.2% 2. 2.% +/- ultrasound +/- mammography Core biopsy 249, ,34,862 +/- fine needle aspiration % % 24.5% 9.4% 9.4% +/- clinical examination +/- ultrasound +/- mammography Open diagnostic biopsy /- core biopsy.4% 2.6% 2.4% 3.% 6.% 2.4% 2.5% +/- fine needle aspiration +/- clinical examination +/- ultrasound +/- mammography Total,558 5,897 3, ,858 9,576 Excludes: Women assessed outside BreastScreen Victoria. 2

23 Invasive assessment procedures From 2 to 29, the use of core biopsy for women aged 5 69 years increased from 3.4% to 9.4%. Over the same time period the use of fine needle aspiration decreased from 7.% to 2.%, and the rate of open diagnostic biopsy decreased from 4. to 2.5% (Table 25). Table 25: Biopsy procedures for women aged 5 69, 2 29 Biopsy procedure Fine needle aspiration 7.% % 7.6% 6.6% 3.7% 2.8% 2.5% 2.7% 2. Core biopsy 3.4% 4.7% 4.% 5.2% 7.4% 6.8% 5.9% 8.2% 9.9% 9.4% Open diagnostic biopsy % 3.2% % 2.4% 2.6% 2.3% 2.9% 2.4% Source: Table 25, 28 ASR. Figure 8: Recall to assessment rates for women aged 5 69 by round, 2 to 29 25% 2 Proportion of women assessed 5% 5% Year Fine needle aspiration Core biopsy Open diagnostic biopsy 2

24 29 BreastScreen Victoria Annual Statistical Report Core biopsy Core biopsy is performed both to confirm a diagnosis of breast cancer, and also to confirm that a lesion is benign. A total of 2,84 core biopsies were performed on individual lesions during assessment. Of these, 4.8% of lesions were confirmed as malignant breast cancer and 5.4% were benign. Inadequate specimens were reported for.7% of all lesions having a core biopsy (Table 26). Table 26: Core biopsy result by age, 29 Core biopsy result Total 5-69 Inadequate specimen %..5%.5%.7%.8% Benign ,44, % 58.6% 4.5% 32.% % 5.4% Atypical/equivocal % 4.5% 4.3% 3.7% 6.3% 4.2% 4.4% Suspicious %.5% 3.3%.9%.8% Malignant , % 32.8% 52.8% 59.5% 68.8% 4.% 4.8% Malignant (non-breast cancer) %.5%.2%.2% Atypical ductal hyperplasia %..5%.2%.4% Lobular carcinoma in situ %.2%.%.2%.2% Total 38,242, ,84 2,265 Excludes: Women assessed outside BreastScreen Victoria. Note: This table counts lesions not women (i.e. if a woman undergoes multiple core biopsies, all lesion results are included). This differs to Annual Statistical Reports prior to 27 where one lesion was counted per woman. Open diagnostic biopsy BreastScreen Victoria aims to reach a diagnosis without the need for open diagnostic biopsy, which involves a general anaesthetic and hospitalisation. The benign open diagnostic biopsy rate provides a measure of the effectiveness of the Program in minimising unnecessary open biopsies. The benign open diagnostic biopsy rates met the accreditation standards in 29. National Accreditation Standard Result in % of women who attend for their first screen are found not to have invasive cancers or DCIS after a diagnostic open biopsy % of women who attend for their second or subsequent screen are found not to have invasive cancer or DCIS after a diagnostic open biopsy of women assessed after their first screening are found not to have invasive cancer or DCIS after a diagnostic open biopsy <3.2% of women assessed after their second or subsequent screen are found not to have invasive cancer or DCIS after a diagnostic open biopsy..27%.9% 2..8% 22

25 Preoperative diagnosis For women who have breast cancer, it is preferable that a definite diagnosis is reached without the need for an open diagnostic biopsy, otherwise described as a preoperative diagnosis. The preoperative diagnosis rate for women who were assessed by BreastScreen Victoria was 94.6% (Table 27). Table 27: Preoperative diagnosis rate by round and age, 29 First round women Total 5-69 Open diagnostic biopsy %.6% 8.2% 9.6% Preoperative diagnosis % 88.4% 9.8% 9.4% Total Subsequent round women Open diagnostic biopsy % 6.8% 3.8% 4.%. 4.9% 5. Preoperative diagnosis % 93.2% 96.2% 95.9% % 95. Total All women Open diagnostic biopsy % 3.6% 3.9%. 5.4% 5.6% Preoperative diagnosis , % 96.4% 96.% % 94.4% Total ,4 943 Excludes: Women assessed outside BreastScreen Victoria. Note: Open diagnostic biopsy : women recommended by the Program for open diagnostic biopsy who underwent the procedure. The preoperative diagnosis rate met the accreditation standard in 29. National Accreditation Standard Result in % of invasive breast cancers and DCIS are diagnosed without the need for an open diagnostic biopsy. 94.6% 23

26 29 BreastScreen Victoria Annual Statistical Report From 2 to 29 the rate of preoperative diagnosis increased from 88.4% to 94.6% (Table 28). Table 28: Preoperative diagnosis rate, Preoperative diagnosis 88.4% 9.7% 92.5% 92.3% 93.6% 94.2% 93.5% 94.2% 93.3% 94.6% Source: Table 28, 28 ASR Figure 9: Preoperative diagnosis rate, 2 29 Proportion of women diagnosed with breast cancer Preoperative diagnosis Year 24

27 OUTCOME OF ASSESSMENT Of the 9,72 women screened, 2,34 women were recommended for assessment (Table 22). Of the women recommended for assessment, 35 declined or failed to attend assessment. Of the 2,99 women who were assessed, 22 (.8%) women were assessed privately outside of the Program. Table 29 shows the final outcome of assessment for women assessed both within and outside of BreastScreen Victoria. Of women aged 5-69 who were assessed, 9.9% were found to have breast cancer. Breast cancer includes a diagnosis of invasive breast cancer or ductal carcinoma in situ (DCIS). Table 29: Outcome of assessment by age, 29 First round women Total 5-69 No breast cancer detected,24 2, ,522 2, % 94.8% 9.8% 86.% 94.9% 94.4% Breast cancer % 5.% 8.8% 3.9% % Other %..4%.%.% Total,68 2, ,72 2,52 Subsequent round women No breast cancer detected 44 3,468 2, ,385 6,46 95.% 9.5% 85.2% 79.8% 79.2% 88.% 88.4% Breast cancer % 8.4% 4.7% 9.7% 2.8%.7%.4% Other %.2%.2%.5%.2%.2% Total 425 3,792 3, ,387 7,254 All women No breast cancer detected,528 5,572 3, ,97 8, % 92.7% 85.6% 8.2% 8.5% 9.% 9. Breast cancer , % 7.2% 4.2% 9.4% 8.5% 9.7% 9.9% Other %.%.2%.4%.2%.2% Total,593 6, 3, ,99 9,756 Note: Other : women who did not complete assessment. 25

28 29 BreastScreen Victoria Annual Statistical Report Early review Women may be recommended for early review (further assessment) if a definitive diagnosis was not achieved at the initial assessment visit. Generally, women are recalled to early review at three, six or 2 months. The early review rate did not meet the accreditation standard in 29. National Accreditation Standard Result in <.2% of women who attend for screening are recommended for early review for further assessment..2% Recommendation for rescreening Of the 9,72 women who attended for screening, 78,578 women were recommended for routine rescreening at the completion of their screening (Table 22). Of the 2,99 women who were assessed,,97 women were found not to have breast cancer and were recommended for routine rescreening (Table 29). In total, 89,485 women were recommended for routine rescreening after their 29 mammogram. The usual recommendation is for routine rescreening at two years. The Program offers annual screening for women at an increased risk of developing breast cancer. This group includes women with a personal history of breast cancer and women with a diagnosis of either atypical ductal hyperplasia (ADH) or lobular carcinoma in situ (LCIS). Only.5% of women were advised to return for annual screening (Table 3). Table 3: Recommendation for routine rescreening by age, Total 5-69 Rescreen at 2 years 4,33 87,9 74,6 2,56,34 88,598 6, % 99.8% 99.5% 98.2% 93.3% 99.5% 99.6% Rescreen at year %.2%.5%.8% 6.7%.5%.4% Total 4,57 87,224 74,367 2,729,8 89,485 6,59 The annual screening rate met the accreditation standard in 29. National Accreditation Standard Result in The Service offers annual screening for of women aged 5 69 years..4% 26

29 CANCER DETECTION SUMMARY OF CANCER DETECTION Among the 9,72 women who attended for screening in 29, there were,69 breast cancers diagnosed. Twelve of these cancers were diagnosed at early review more than six months after the screening mammogram. These cancers are not counted as screen detected cancers. The following tables include only the,57 cancers that were considered screen detected cancers. Of these screen detected cancers, 94 (78.%) were invasive breast cancers and 253 (2.9%) were ductal carcinoma in situ (DCIS) (Table 3). If both invasive and DCIS are found, only the most significant invasive component is counted and reported. BreastScreen Victoria collects surgical histopathology and primary treatment information from the treating clinician for all women diagnosed with breast cancer in the Program. This information is used for reporting, quality assurance and to promote best clinical practice. Table 3: Cancer detection (invasive and DCIS) by age, Total 5-69 Invasive breast cancer % 75.3% % % 78.5% DCIS % 24.7% % % 2.5% Total , From 2 to 29, for women aged 5 69 the proportion of breast cancers detected as DCIS increased from 7.9% to 2.5% (Table 32). Table 32: Cancer detection (invasive and DCIS) for women aged 5-69, Invasive 82.% 77.% 8.3% 78.8% 8.3% 78.8% 8.6% 78.5% 78.8% 78.5% DCIS 7.9% 22.9% 8.7% 2.2% 9.7% 2.2% 9.4% 2.5% 2.2% 2.5% Source: Table 32, 28 ASR. Figure : Cancer detection (invasive and DCIS) for women aged 5-69, 2 29 Proportion of women diagnosed with breast cancer Year Invasive DCIS 27

30 29 BreastScreen Victoria Annual Statistical Report INVASIVE BREAST CANCER BreastScreen Australia aims to reduce deaths from breast cancer by the early detection of invasive breast cancer in women aged 5 69 years (BreastScreen Australia, 25a, p. 25). Cancer detection by age and round Younger women (aged 4-49 years) had lower invasive breast cancer detection rates than other age groups. For women aged 5-69 years the rate of invasive breast cancer diagnosis was higher for first round women (56.5 women per, women screened) than for subsequent round women (44.6 women per, women screened) (Table 33). Table 33: Invasive breast cancer detection by age and round, Total 5-69 (95% CI) First round women Invasive breast cancers Rate per, women screened ( ) Subsequent round women Invasive breast cancers Rate per, women screened ( ) All women Invasive breast cancers Rate per, women screened ( ) Invasive breast cancer detection rates met the accreditation standards in 29. National Accreditation Standard Result in women per, women aged 5 69 years who attend for their first screen are diagnosed with invasive breast cancer women per, women attending for a subsequent screen are diagnosed with invasive breast cancer The rate of diagnosis of invasive breast cancer is lower among subsequent round women. This is because women at the first screening round may have cancers that have recently developed or cancers that have been present for some years. The invasive cancer detection rate for women aged 5-69 is stable over time for subsequent round women (Table 34). Table 34: Invasive breast cancer detection rate for women aged 5 69 by round, First round Subsequent round Source: Figure 34, 28 ASR. Note: Rate per, women screened. 28

31 Figure : Invasive breast cancer detection rate for women aged 5 69 by round, 2 29 Rate per, women screened Year 29 First round women Subsequent round women Size The Program aims to detect invasive breast cancers when they are small and low grade, prior to spread to the regional lymph nodes. Of the 94 invasive breast cancers detected in 29, 543 (6.2%) were small ( 5mm) in size (Table 35). The proportion of large invasive breast cancers (>5mm) was higher for first round women, (52.3%) compared with subsequent round women (36.3%). This is because women at the first screening round may have cancers that have recently developed or cancers that have been present for some years. Table 35: Invasive breast cancer detection by tumour size and round, 29 mm -5mm >5mm Unknown Total invasive First round women % 23.5% 52.3% 4.5% Subsequent round women % 36.3%.8% Total women % 27.2% 38.6%.3% For women aged 5 69 years the detection rate for small cancers (28. per, women screened) was higher than that for larger cancers (7.5 per, women screened) (Table 36). Table 36: Invasive breast cancer detection for women aged 5 69 by tumour size and round, 29 5mm >5mm Unknown Total First round women Invasive breast cancers Rate per, women screened Subsequent round women Invasive breast cancers Rate per, women screened Total women Invasive breast cancers Rate per, women screened (95% CI) ( ) ( ) 29

32 29 BreastScreen Victoria Annual Statistical Report The small invasive breast cancer detection rate met the accreditation standard in 29. National Accreditation Standard Result in per, women aged 5 69 years who attend for screening are diagnosed with small ( 5mm) invasive breast cancers 28. Histologic type Table 37 shows invasive breast cancer diagnosed by tumour size and histologic type. Of the 94 invasive breast cancers diagnosed, 734 (8.2%) were invasive duct carcinoma. Of these invasive duct carcinomas, 455 (62.%) were small ( 5mm). Table 37: Invasive breast cancer by tumour size and histologic type, 29 mm -5mm >5mm Unknown Total Invasive duct carcinoma % 83.7% 77.7% 66.7% 8.2% Lobular classical carcinoma % 6.9% Mixed ductal/lobular carcinoma %.2% 3.4%.9% Tubular carcinoma % 2.4%.3% 2. Mucinous carcinoma % 3.3%.7% 2.3% Lobular variant carcinoma 3 5.3%.2% 3.2%.7% Other %.2%.7% 8.3% 2. Total Note: The Other category include: cribriform, medullary and other invasive breast cancers that were not further specified. Grade Tumours that are well differentiated (Grade ) are associated with a better prognosis. Information about tumour grade was known for 875 (96.8%) of invasive breast cancers. In 29, 25.8% of invasive breast cancers were well differentiated (Table 38). Table 38: Invasive breast cancer detection by tumour size and grade, 29 mm -5mm >5mm Unknown Total Well differentiated (Grade ) % 3.% 2.3% 25.8% Moderately differentiated (Grade 2) % 45.9% 5.7% 4.7% 47.3% Poorly differentiated (Grade 3) % 22.4% 35.8% % Unknown Grade %.6%.% 33.3% 3.2% Total