BreastScreen Victoria Annual Statistical Report

BreastScreen Victoria Annual Statistical Report 2010

BREASTSCREEN VICTORIA: ANNUAL STATISTICAL REPORT, 2010 Produced by: BreastScreen Victoria Coordination Unit Level 1, 31 Pelham Street, Carlton South Victoria 3053 December 2014 BreastScreen Victoria 2014 PH 03 9660 6888 FX 03 9662 3881 EM info@breastscreen.org.au Copies of this report are available online: www.breastscreen.org.au Design: Six String Design Registration A0025878W ABN 54505 206 361 BreastScreen Victoria gratefully acknowledges the support of: Australian Government Department of Health Screening and Cancer Prevention Section, Department of Health, Victoria

CONTENTS INTRODUCTION 2 About Breastscreen Victoria 2 2010 Highlights 4 Technical Notes 6 SCREENING 7 Recruitment 7 Demographics 8 Imaging 11 Participation 12 Rescreen 15 Screening Outcome 17 ASSESSMENT 18 Recall To Assessment 18 Assessment Procedures 19 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 41 TABLES AND FIGURES 43 Tables 43 Figures 44 References 45 1

2010 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 1 July 2013, the Australian government expanded BreastScreen Australia s target age range by five years, from women aged 50-69 years to women aged 50-74 years. BreastScreen Australia invites women aged 50 74 years who do not have any breast symptoms or changes to have a free screening mammogram once every two years. Women aged 40 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, 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 2010. 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 2010. Where relevant, the exclusions and limitations of the data presented are noted. Further information about BreastScreen Victoria is available at www.breastscreen.org.au. 2

Figure 1: Screening and assessment pathway, 2010 Recruitment Recruitment of women aged 50 69 years Women outside target age group (40 49, 70+ 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

2010 BreastScreen Victoria Annual Statistical Report 2010 HIGHLIGHTS Screening In 2010, a total of 198,160 women were screened in the BreastScreen Victoria program. Of these women, 170,698 (86.1%) were in the 50 69 year target age group. Of all women screened, 31,964 (16.1%) attended for their first screening mammogram. Of all Victorian women aged 50 69 years, 54.2% participated in the Program during the two-year period 1 January 2009 to 31 December 2010. The comparable participation rates for women from culturally and linguistically diverse (CALD) backgrounds and Aboriginal women were 38% and 35.6%. Of women aged 50 67 years who were screened in 2010, 77.6% returned for rescreening within 27 months. The rescreen rate for first round women aged 50 67 years was 60.4% and 80.5% for subsequent round women. The comparable rates for CALD and Aboriginal women aged 50-67 were 77.5% and 60.6% respectively. Digital mammography was used for 43.2% of all screening mammograms. Assessment Of the women screened in 2010, 185,521 (93.6%) were recommended for routine rescreen and 12,639 (6.4%) were recommended to attend for assessment. The recall to assessment rate was higher for first round women aged 50-69 (13.9%) than for subsequent round women (4.8%). Most women undergoing assessment (77.4%) 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 1,223 screen detected breast cancers diagnosed within BreastScreen Victoria in 2010, 989 (80.9%) were invasive breast cancers and 234 (19.1%) were ductal carcinoma in situ (DCIS). Of these screen detected cancers, 83.6 % were in women aged 50 69 years. Of the invasive breast cancers detected, 58.1% were small (15mm or less in diameter), 25.8% were classified as Grade 1 and 72.4% were node negative, all indicators of a good prognosis. Breast cancer treatment 80% of women with invasive breast cancer and 78.6% of women with DCIS underwent breast conserving surgery. Of the women diagnosed with invasive breast cancer, 97.2% underwent axillary dissection. Of these women, 24.5% were found to have positive nodes. Only 32.9% of women diagnosed with DCIS underwent axillary dissection, three of these women had positive nodes. 1 1 For further information see Table 44. 4

Figure 2: Screening and assessment pathway by round, 2010 Screening a Women screened 198,160 First round Screening mammograms 31,964 (16.1%) Subsequent rounds Screening mammograms 166,196 (83.9%) Screening outcome b Routine rescreen recommended Recalled for assessment Recalled for assessment Routine rescreen recommended 27,526 (86.1%) 4,438 (13.9%) 8,201 (4.9%) 157,995 (95.1%) Assessment outcome c No cancer detected Breast cancer detected Breast cancer detected No cancer detected 4,146 (94.4%) 237 (5.4%) 998 (12.2%) 7,165 (87.7%) Cancer Detection d Invasive breast cancer DCIS Invasive breast cancer DCIS 182 (77.1%) 54 (22.9%) 807 (81.8%) 180 (18.2%) Source: a Table 2, b Table 22, c Table 29, d Tables 33 and 40. 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 40 exclude breast cancers diagnosed at early review more than six months after the screening mammogram and cancers diagnosed at early rescreen for women who presented with a breast lump and/or clear or blood-stained nipple discharge in the same breast in which the breast cancer was diagnosed. Note: In all tables, percentages may not add up to 100% due to rounding. 5

2010 BreastScreen Victoria Annual Statistical Report TECHNICAL NOTES This Annual Statistical Report provides information about women screened by BreastScreen Victoria during the 2010 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 12-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 pathway 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

SCREENING RECRUITMENT Eligibility Women are eligible for screening mammography with BreastScreen Victoria from the age of 40 years. Women aged 50 69 years are actively recruited because screening has been found to be most effective in detecting early breast cancer in this age group. Women aged 40 49 years, and 70 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 40 years of age. These women are advised to consult their doctor if they are concerned about breast cancer. Inviting new women Women who turn 50 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 50 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 11 months if no appointment has been made. Women aged 40 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 40 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 70 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 2010, 28.0% of women invited to attend their first screen made an appointment. For women invited to attend for rescreening the response rate was higher (55.1%) (Table 1). 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 1: Response to invitation, 2010 Invitation type Number of women invited Appointments made Response rate Invitation 54,353 15,223 28.0% Reinvitation 164,196 90,408 55.1% Includes: Women who have responded to an invitation within 90 days of a letter being sent. Note: The Victorian Electoral Commission makes available the names and addresses of all Victorian women aged 50 69 years under the Electoral Act 2002 as BreastScreen Victoria is a public health program which will benefit Victorian women. 7

2010 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 198,160 women during 2010. Of these women, 31,964 (16.1%) attended for their first screening mammogram and 166,196 (83.9%) attended for their second or subsequent mammogram (Table 2). Table 2: Women screened by age and round, 2010 40 49 50 59 60 69 70 79 80+ Total 50 69 First round women 8,775 20,686 2,205 251 47 31,964 22,891 59.5% 22.3% 2.8% 2.2% 3.8% 16.1% 13.4% Subsequent round women 5,985 72,143 75,664 11,227 1,177 166,196 147,807 40.5% 77.7% 97.2% 97.8% 96.2% 83.9% 86.6% Total women 14,760 92,829 77,869 11,478 1,224 198,160 170,698 100% 100% 100% 100% 100% 100% 100% 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 2010, 86.1% of women screened were within the target age group (50-69) (Table 3). BreastScreen Victoria stopped sending rescreening reminders to women aged 70-74 years of age in 2007. 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 70-79 year age group was 13.7% in 2006, 12.4% in 2007, 8.3% in 2008, 6.7% in 2009 and 5.8% in 2010. Table 3: Women screened by age, 2010 40 49 50 59 60 69 70 79 80+ Total 50 69 Total women 14,760 92,829 77,869 11,478 1,224 198,160 170,698 7.4% 46.8% 39.3% 5.8% 0.6% 100% 86.1% The number of women screened steadily increased between 2001 and 2006, declined in 2007 and 2008, then increased again in 2009 and 2010 (Table 4). Table 4: Women screened by round, 2001-2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 First round women 35,908 30,698 25,691 31,335 29,227 31,825 25,952 25,316 26,757 31,964 19.0% 16.4% 13.6% 15.8% 14.8% 15.7% 13.3% 13.8% 13.8% 13.8% Subsequent round women 152,772 157,028 163,099 167,418 168,439 170,645 169,338 157,784 163,955 166,196 81.0% 83.6% 86.4% 84.2% 85.2% 84.3% 86.7% 86.2% 86.2% 86.2% Total women 188,860 187,726 188,790 198,753 197,666 202,470 195,290 183,100 190,712 198,160 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Source: Table 4, 2009 Annual Statistical Report 8

Figure 3: Women screened by round, 2001-2010 Number of women screened 220,000 200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year First round women Subsequent round women 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, 2010 40 49 50 59 60 69 70 79 80+ Total 50 69 CALD 1,660 11,759 11,198 1,791 84 26,492 22,957 11.2% 12.7% 14.4% 15.6% 6.9% 13.4% 13.4% Aboriginal and Torres Strait Islander women Table 6 shows the number of women who attended for screening and reported on their registration form that they were Aboriginal and/or Torres Strait Islander (ATSI). Table 6: Aboriginal or Torres Strait Islander women screened by age, 2010 40 49 50 59 60 69 70 79 80+ Total 50 69 Aboriginal and Torres Strait Islander 48 193 148 23 3 415 341 0.3% 0.2% 0.2% 0.2% 0.2% 0.2% 0.2% Family history of breast cancer Women with a family history of breast cancer are at increased risk of developing breast cancer (BreastScreen Australia, 2005a, p. 20). In Table 7, a strong family history is defined as a woman whose mother, sister or daughter was diagnosed with breast cancer before 50 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 2010, 45,265 (22.8%) 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 40-49 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, 2010 Family history of breast cancer 40 49 50 59 60 69 70 79 80+ Total 50 69 Strong family history 1,347 3,813 3,165 711 104 9,140 6,978 9.1% 4.1% 4.1% 6.2% 8.5% 4.6% 4.1% Other family history 3,690 16,289 13,632 2,233 281 36,125 29,921 25.0% 17.5% 17.5% 19.5% 23.0% 18.2% 17.5% 9

2010 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, 2001, pp. 97 98). 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 2010, 439 (0.2%) of women screened reported a personal history of breast cancer. Of these 439 women, 392 (89.3%) 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, 2010 40-49 50-59 60-69 70-79 80+ Total 50-69 Personal history of breast cancer treated with breast conserving surgery Personal history of breast cancer treated with mastectomy 1 26 12 7 1 47 38 0.01% 0.03% 0.02% 0.06% 0.08% 0.02% 0.02% 3 47 139 137 66 392 186 0.02% 0.1% 0.2% 1.2% 5.4% 0.2% 0.1% 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 2010, 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, 2010 Breast symptoms 40 49 50 59 60 69 70 79 80+ Total 50 69 Breast lump and/or nipple discharge 1,076 3,269 1,618 241 30 6,234 4,887 7.3% 3.5% 2.1% 2.1% 2.5% 3.1% 2.9% Other breast symptoms 1,572 5,185 3,310 794 91 10,952 8,495 10.7% 5.6% 4.3% 6.9% 7.4% 5.5% 5.0% Of the 6,234 women with a breast lump and/or nipple discharge, there were 659 women with symptoms (10.6%) that were considered suspicious of breast cancer, and for which recall for assessment was recommended. This number comprised 563 women with a lump that had been present for less than 12 months which had not been investigated by a medical practitioner and 96 women with a nipple discharge that had been present for less than 12 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 2010, 0.8% of women screened reported having breast implants (Table 10). Table 10: Women with breast implants by age, 2010 40-49 50-59 60-69 70-79 80+ Total 50-69 Breast implants 172 861 573 69 2 1,677 1,434 1.2% 0.9% 0.7% 0.6% 0.2% 0.8% 0.8% 10

IMAGING Analogue and digital screening Digital mammography was first introduced to BreastScreen Victoria in 2006. The proportion of digital screening has increased from 5.8% in 2006, to 17.0% in 2007, 21.4% in 2008, 28.7% in 2009 and 43.2% in 2010 (Table 11). Table 11: Women screened by modality and age, 2010 Modality 40 49 50 59 60 69 70 79 80+ Total 50 69 Analogue 8,528 53,226 43.894 6,201 633 112,482 97,120 57.8% 57.3% 56.4% 54.0% 51.7% 56.8% 56.9% Digital 6,232 39,603 33,975 5,277 591 85,678 73,578 42.2% 42.7% 43.6% 46.0% 48.3% 43.2% 43.1% Total 14,760 92,829 77,869 11,478 1,224 198,160 170,698 100% 100% 100% 100% 100% 100% 100% Imaging quality Most women who attended for screening had two x-ray images of each breast, giving a total of four images (Table 12). Additional images may be required for women with larger breasts, inadequate breast tissue or breast implants. In 2010, 21% of women screened had more than four images taken. Table 12: Number of images for each woman screened by age, 2010 Number of images 40 49 50 59 60 69 70 79 80+ Total 50 69 Four images or less 12,111 74,096 60,546 8,827 857 156,437 134,642 82.1% 79.8% 77.8% 76.9% 76.2% 79.0% 78.9% More than four images 2,649 18,733 17,323 2,651 267 41,623 36,056 17.9% 20.2% 22.2% 23.1% 23.8% 21.0% 21.1% Total 14,760 92,829 77,869 11,478 1,124 198,060 170,698 100% 100% 100% 100% 100% 100% 100% It may be necessary to repeat screening images if the images taken are deemed to be of poor quality. Overall, 1.4% of all images taken were technical repeat images, with the percentage varying little across women of different age groups (Table 13). Table 13: Technical repeat images by age, 2010 40 49 50 59 60 69 70 79 80+ Total 50 69 Images taken 64,904 410,957 348,039 50,848 5,249 879,997 758,996 Technical repeat images taken 1,029 5,855 4,744 777 70 12,475 10,599 Technical repeat rate 1.6% 1.4% 1.4% 1.5% 1.3% 1.4% 1.4% 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 2010. National Accreditation Standard Result in 2010 2.10.3 The overall repeat rate for the Service is <3% of all screening films. 1.4% 11

2010 BreastScreen Victoria Annual Statistical Report PARTICIPATION BreastScreen Victoria targets women aged 50 69 years, although women aged 40 49 years and 70 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 70% of women in the target 50 69 year age group. Since 2004 there has been a steady increase in the number of women in the target age group each year. There was an increase of 17,574 women in the target age group from 2009 to 2010 (Table 14). Table 14: Victorian female population by year, 2004 2010 Age group 2004 2005 2006 2007 2008 2009 2010 40-49 368,632 371,965 369,191 380,200 384,405 389,474 394,189 50-69 516,102 531,124 531,194 560,892 577,069 593,824 611,398 70-79 162,278 162,304 159,847 163,009 164,710 167,231 169,694 Source: Australian Bureau of Statistics (ABS): 2004, 2005, 2007, 2008, 2009, 2010 Estimated Resident Population (ERP) and 2006 Census of Population and Housing, Victorian Females. ERP was not available in the Census year 2006. Figure 4: Victorian female population by year, 2004 2010 700,000 Victorian female population 600,000 500,000 400,000 300,000 200,000 100,000 0 2004 2005 2006 2007 2008 2009 2010 Year 40 49 50 69 70 79 The following table shows participation rates for Victorian women who were screened by BreastScreen Victoria between 2001 2002 and 2009 2010. The participation rate for women aged 50 69 declined slowly from a peak of 60.1% in 2001 2002, to 54.2% in 2009 2010. This decline was mainly due to the increase in the Victorian female population in the target age group between 2004 and 2010. Lower numbers of women screened in 2007 and 2008, also contributed to lower participation rates. The participation rate for women aged 70 79 decreased from a peak of 33.9% in 2005-2006 to 14.2% in 2009 2010. BreastScreen Victoria stopping sending screening reminder letters to women aged 70 74 years from 2007 onwards. Table 15: Participation rate by age group for 2-year calendar period 2001 & 2002 to 2009 & 2010 Age group 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 40-49 9.0% 8.0% 9.2% 7.8% 7.3% 50-69 60.1% 58.9% 57.8% 53.4% 54.2% 70-79 33.4% 33.4% 33.9% 23.8% 14.2% Source: Table 15, Annual Statistical Report 2008. Note: The eligible population is averaged over the two reporting years. For example, the population for 2009 2010 is calculated as the average of the 2009 and 2010 Estimated Resident Population (ERP). 12

Figure 5: Participation rate by age group for 2-year calendar period 2001 & 2002 to 2009 & 2010 70% Percentage of eligible population 60% 50% 40% 30% 20% 10% 0% 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 24 month screening period 40-49 50-69 70-79 The participation rate did not meet the accreditation standard in 2009 2010. National Accreditation Standard Result in 2009 2010 1.1.1 70% of women aged 50-69 years participate in screening in the most recent 24-month period. 54.2% 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 13

2010 BreastScreen Victoria Annual Statistical Report Participation rates for women in the target age group were similar across geographic regions (Table 16). Comparison of participation rates between Remote and other regions should be treated with caution due to the small remote population and screening numbers. Table 16: Participation rate by region and age for 2-year calendar period 2009 & 2010 Region 40 49 50 69 70 79 Major city 7.0% 53.4% 13.2% Inner regional 7.8% 55.9% 16.0% Outer regional 10.0% 57.2% 18.6% Remote 17.4% 61.6% 27.6% All Regions 7.3% 54.2% 14.2% Source: Australian Standard Geographical Classification (ASGC), provided by the Australian Bureau of Statistics. CALD women Participation rates were lower for CALD women across all age groups (Table 17). Table 17: Participation rate for CALD women by age for 2-year calendar period 2009 & 2010 40-49 50-69 70-79 CALD 3.9% 38.0% 10.2% All women 7.3% 54.2% 14.2% Source: The population figure for CALD women is taken from the 2006 ABS Census data question: Does the person speak a language other than English at home? Note: During the 2009 & 2010 participation period, a total of 49,749 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 18). 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 18: Participation rate for Aboriginal and Torres Strait Islander women by age for 2-year calendar period 2009 & 2010 40-49 50-69 70-79 Aboriginal and Torres Strait Islander 4.9% 35.6% 14.1% All women 7.3% 54.2% 14.2% Source: The population figure for Aboriginal and Torres Strait Islander women is taken from the 2006 ABS Census females by indigenous status and age data. Note: During the 2009 & 2010 participation period, a total of 713 Victorian Aboriginal and Torres Strait Islander women were screened in the Program. 14

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 194,183 women screened during 2010 who were eligible to be rescreened, 32.1% were rescreened by the Program within 24 months, 69.2% within 27 months and 80.6% within 36 months (Table 19). The rescreen rate for women aged 50-67 who were screened within 27 months rose steadily over the past four years (65.1% in 2006, 66.9% in 2007, 73.7% in 2008, 79.8% in 2009 and 77.6% in 2010). Table 19: Rescreen rate by round and age, 2010 First round women 40-49 50-59 60-69 70-79 Total 50-67 Screened in 2010 8,669 20,387 2,120 236 31,412 22,314 Rescreened within 24 months 962 4,825 504 19 6,310 5,317 11.1% 23.7% 23.8% 8.1% 20.1% 23.8% Rescreened within 27 months 2,465 12,391 1,112 39 16,007 13,478 28.4% 60.8% 52.5% 16.5% 51.0% 60.4% Rescreened within 36 months 3,853 15,602 1,337 63 20,855 16,904 44.4% 76.5% 63.1% 26.7% 66.4% 75.8% Subsequent round women Screened in 2010 5,898 71,388 74,517 10,968 162,771 134,407 Rescreened within 24 months 1,661 25,687 26,929 1,832 56,109 51,568 28.2% 36.0% 36.1% 16.7% 34.5% 38.4% Rescreened within 27 months 3,577 56,183 54,554 4,067 118,381 108,133 60.6% 78.7% 73.2% 37.1% 72.7% 80.5% Rescreened within 36 months 4,571 64,094 61,219 5,707 135,591 121,165 77.5% 89.8% 82.2% 52.0% 83.3% 90.1% All women Screened in 2010 14,567 91,775 76,637 11,204 194,183 156,721 Rescreened within 24 months 2,623 30,512 27,433 1,851 62,419 56,885 18.0% 33.2% 35.8% 16.5% 32.1% 36.3% Rescreened within 27 months 6,042 68,574 55,666 4,106 134,388 121,611 41.5% 74.7% 72.6% 36.6% 69.2% 77.6% Rescreened within 36 months 8,424 79,696 62,556 5,770 156,446 138,069 57.8% 86.8% 81.6% 51.5% 80.6% 88.1% Includes: Women recommended for routine rescreen. Excludes: Women resident interstate and women aged 80 years and over. Note: Some rescreen invitations for women were sent early at 21 months. Rescreen rates did not meet the accreditation standards in 2010. National Accreditation Standard Result in 2010 1.2.1 75% of women aged 50 67 who attend for their first screen within the Program are rescreened within 27 months. 1.2.1 90% of those attending for a second or subsequent screening round are rescreened within 27 months. 60.4% 80.5% 15

2010 BreastScreen Victoria Annual Statistical Report CALD women The proportion of CALD women aged 50 67 years who returned to screening within 27 months was comparable to the rate for all women aged 50-67 (Table 20). Table 20: Rescreen rate for CALD women by round and age, 2010 40-49 50-59 60-69 70-79 Total 50-67 First round women Screened in 2010 1,003 2,714 431 55 4,203 3,103 Rescreened within 24 months 10.3% 18.9% 69.9% 0.0% 16.4% 18.9% Rescreened within 27 months 27.7% 60.5% 48.0% 5.5% 50.7% 59.4% Rescreened within 36 months 42.0% 75.7% 58.7% 14.5% 65.1% 74.2% Subsequent round women Screened in 2010 638 8,965 10,684 1,715 22,002 17,858 Rescreened within 24 months 23.7% 32.2% 31.8% 10.9% 30.1% 34.6% Rescreened within 27 months 60.8% 79.6% 70.4% 25.2% 70.3% 80.7% Rescreened within 36 months 80.7% 89.7% 78.5% 36.4% 79.9% 89.6% All women Screened in 2010 1,641 11,679 11,115 1,770 26,205 20,961 Rescreened within 24 months 15.5% 29.1% 31.2% 10.6% 27.9% 32.3% Rescreened within 27 months 40.6% 75.1% 69.5% 24.6% 67.2% 77.5% Rescreened within 36 months 57.0% 86.4% 77.8% 35.8% 77.5% 87.3% Aboriginal and Torres Strait Islander women The rescreen rates for Aboriginal and Torres Strait Islander women aged 50 67 years were lower than the rates for all Victorian women aged 50 67 years (Table 21). Table 21: Rescreen rate for Aboriginal and Torres Strait Islander women by round and age, 2010 40-49 50-59 60-69 70-79 Total 50-67 First round women Screened in 2010 34 49 15 1 99 64 Rescreened within 24 months 2.9% 10.2% 40.0% 0.0% 12.1% 17.2% Rescreened within 27 months 8.8% 28.6% 60.0% 0.0% 26.3% 35.9% Rescreened within 36 months 44.1% 38.8% 6.7% 100.0% 36.4% 39.1% Subsequent round women Screened in 2010 14 136 127 21 298 248 Rescreened within 24 months 35.7% 28.7% 35.4% 14.3% 30.9% 32.7% Rescreened within 27 months 57.1% 64.7% 65.4% 38.1% 62.8% 66.9% Rescreened within 36 months 57.1% 75.0% 78.0% 47.6% 73.5% 79.0% All women Screened in 2010 48 185 142 22 397 312 Rescreened within 24 months 12.5% 23.8% 35.9% 13.6% 26.2% 29.5% Rescreened within 27 months 22.9% 55.1% 64.8% 36.4% 53.7% 60.6% Rescreened within 36 months 47.9% 65.4% 70.4% 50.0% 64.2% 70.8% 16

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 13.9% of first round women were recommended for assessment, the comparable figure for subsequent round women was 4.9%. Table 22: Screening outcome by round and age, 2010 40-49 50-59 60-69 70-79 80+ Total 50-69 First round women Routine rescreen recommended 7,568 17,816 1,889 215 38 27,526 19,705 86.2% 86.1% 85.6% 85.7% 80.9% 86.1% 86.1% Assessment recommended 1,207 2,870 316 36 9 4,438 3,186 13.8% 13.9% 14.3% 14.3% 19.1% 13.9% 13.9% Total 8,775 20,686 2,205 251 47 31,964 22,891 Subsequent round women Routine rescreen recommended 5,513 68,540 72,208 10,640 1,094 157,995 140,748 92.1% 95.0% 95.4% 94.8% 92.9% 95.1% 95.2% Assessment recommended 472 3,603 3,456 587 83 8,201 7,059 7.9% 5.0% 4.6% 5.2% 7.1% 4.9% 4.8% Total 5.985 72,143 75,664 11,227 1,177 166,196 147,807 100% 100% 100% 100% 100% 100% 100% All women Routine rescreen recommended 13,081 86,356 74,097 10,855 1,132 185,521 160,453 88.6% 93.0% 95.2% 94.6% 92.5% 93.6% 94.0% Assessment recommended 1,679 6,473 3,772 623 92 12,639 10,2456 11.4% 7.0% 4.8% 5.4% 7.5% 6.4% 6.0% Total 14,760 92,829 77,869 11,478 1,224 198,160 170,698 100% 100% 100% 100% 100% 100% 100% 17

2010 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 2001 to 2010, recall to assessment rates for women aged 50 69 years increased for first round women from 10.7% to 13.9%, but remained steady for subsequent round women (Table 23). Table 23: Recall to assessment rates for women aged 50 69 by round, 2001 to 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 First round women 10.7% 10.6% 11.5% 11.7% 13.0% 12.5% 14.0% 13.7% 14.1% 13.9% Subsequent round women 4.9% 4.7% 4.7% 4.6% 5.1% 4.7% 4.7% 5.1% 5.0% 4.8% Total women 5.9% 5.5% 5.5% 5.6% 5.9% 5.7% 5.6% 6.0% 6.0% 6.0% Source: Table 23, 2009 Annual Statistical Report Figure 7: Recall to assessment rates for women aged 50 69 by round, 2001 to 2010 16% Proportion of women screened 12% 8% 4% 0% 2001 2002 2003 2004 2005 2006 2007 2008 Year 2009 2010 First round women Subsequent round women Recall to assessment rates did not met the accreditation standard for first round women in 2010. National Accreditation Standard Result in 2010 2.6.1 <10% for women aged 50 69 years who attend for their first screen are recalled for assessment. 2.6.2 <5% for women aged 50 69 years who attend for their second or subsequent screen are recalled for assessment. 13.9% 4.8% 18

ASSESSMENT PROCEDURES A total of 12,304 women were assessed within BreastScreen Victoria. Twenty two women were cleared for routine rescreen without any further investigations being performed. For the 12,282 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 77.4% of women having an assessment procedure. Core biopsy was the most common invasive procedure performed (18.6%) compared with 1.8% for fine needle aspiration and 2.1% for open diagnostic biopsy. Table 24: Range of assessment procedures by round and age, 2010 Assessment procedures performed 40-49 50-59 60-69 70-79 80+ Total 50-69 First round women Mammography only 254 559 44 8 0 865 603 21.8% 20.1% 14.8% 25.8% 0.0% 20.2% 19.5% Ultrasound +/- mammography Clinical examination +/- ultrasound +/- mammography Fine needle aspiration +/-clinical examination +/- ultrasound +/- mammography Core biopsy +/-fine needle aspiration +/-clinical examination +/- ultrasound +/- mammography Open diagnostic biopsy +/- core biopsy +/-fine needle aspiration +/-clinical examination +/- ultrasound +/- mammography 533 1,377 150 11 5 2,076 1,527 45.7% 49.4% 50.3% 35.5% 62.5% 48.4% 49.5% 154 225 31 5 0 415 256 13.2% 8.1% 10.4% 16.1% 0.0% 9.7% 8.3% 16 47 8 1 1 73 55 1.4% 1.7% 2.7% 3.2% 12.5% 1.7% 1.8% 187 524 59 6 2 778 583 16.0% 18.8% 19.8% 19.4% 25.0% 18.1% 18.9% 22 55 6 0 0 83 61 1.9% 2.0% 2.0% 0.0% 0.0% 1.9% 2.0% Total 1,166 2,787 298 31 8 4,290 3,085 100% 100% 100% 100% 100% 100% 100% Continued 19

2010 BreastScreen Victoria Annual Statistical Report Table 24: Range of assessment procedures by round and age, 2010 (continued) Assessment procedures performed 40-49 50-59 60-69 70-79 80+ Total 50-69 Subsequent round women Mammography only 96 881 831 126 17 1,951 1,712 21.2% 25.0% 24.7% 22.3% 22.7% 24.4% 24.8% Ultrasound +/- mammography Clinical examination +/- ultrasound +/- mammography 219 1,619 1,433 214 20 3,505 3,052 48.3% 45.9% 42.5% 37.9% 26.7% 43.9% 44.2% 69 337 232 48 13 699 569 15.2% 9.6% 6.9% 8.5% 17.3% 8.7% 8.2% Fine needle aspiration +/- clinical examination +/- ultrasound +/- mammography Core biopsy +/- fine needle aspiration +/- clinical examination +/- ultrasound +/- mammography 9 65 60 14 2 150 125 2.0% 1.8% 1.8% 2.5% 2.7% 1.9% 1.8% 52 553 734 151 21 1,511 1,287 11.5% 15.7% 21.8% 26.7% 28.0% 18.9% 18.7% Open diagnostic biopsy 8 73 81 12 2 176 154 1.8% 2.1% 2.4% 2.1% 2.7% 2.2% 2.2% Total 453 3,528 3,371 565 75 7,992 6,899 100% 100% 100% 100% 100% 100% 100% All women Mammography only 350 1,440 875 134 17 2,816 2,315 21.6% 22.8% 23.8% 22.5% 20.5% 22.9% 23.2% Ultrasound +/- mammography Clinical examination +/- ultrasound +/- mammography Fine needle aspiration +/- clinical examination +/- ultrasound +/- mammography Core biopsy +/- fine needle aspiration +/- clinical examination +/- ultrasound +/- mammography 752 2,996 1,583 225 25 5,581 4,579 46.4% 47.4% 43.1% 37.8% 30.1% 45.4% 45.9% 223 562 263 53 13 1,114 825 13.8% 8.9% 7.2% 8.9% 15.7% 9.1% 8.3% 25 112 68 15 3 223 180 1.5% 1.8% 1.9% 2.5% 3.6% 1.8% 1.8% 239 1,077 793 157 23 2,289 1,870 14.8% 17.1% 21.6% 26.3% 27.7% 18.6% 18.7% Open diagnostic biopsy 30 128 87 12 2 259 215 1.9% 2.0% 2.4% 2.0% 2.4% 2.1% 2.2% Total 1,619 6,315 3,669 596 83 12,282 9,984 100% 100% 100% 100% 100% 100% 100% Excludes: Women assessed outside BreastScreen Victoria. 20

Invasive assessment procedures From 2001 to 2010, the use of core biopsy for women aged 50 69 years increased from 14.7% to 18.6%. Over the same time period the use of fine needle aspiration decreased from 7% to 1.8%, and the rate of open diagnostic biopsy decreased from 3.7% to 2.1% (Table 25). Table 25: Biopsy procedures for women aged 50 69, 2001 2010 Biopsy procedure 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Fine needle aspiration 7.0% 6.3% 7.6% 6.6% 3.7% 2.8% 2.5% 2.7% 2.0% 1.8% Core biopsy 14.7% 14.1% 15.2% 17.4% 16.8% 15.9% 18.2% 19.9% 19.4% 18.6% Open diagnostic biopsy 3.7% 3.2% 3.0% 2.3% 2.4% 2.6% 2.3% 2.9% 2.4% 2.1% Source: Table 25, 2009 Annual Statistical Report Excludes: Women assessed outside BreastScreen Victoria. Figure 8: Biopsy procedures for women aged 50-69, 2001-2010 25% 20% Proportion of women assessed 15% 10% 5% 0% 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year 2010 Fine needle aspiration Core biopsy Open diagnostic biopsy 21

2010 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 2,778 core biopsies were performed on individual lesions during assessment. Of these, 44.4% of lesions were confirmed as malignant breast cancer and 48.2% were benign. Inadequate specimens were reported for 0.5% of all lesions having a core biopsy (Table 26). Table 26: Core biopsy result by age, 2010 Core biopsy result 40-49 50-59 60-69 70-79 80+ Total 50-69 Inadequate specimen 1 9 3 0 0 13 12 0.4% 0.7% 0.3% 0.0% 0.0% 0.5% 0.5% Benign 188 733 356 56 5 1,338 1,089 68.4% 54.9% 37.2% 30.9% 17.9% 48.2% 47.5% Atypical/equivocal 11 63 40 3 2 119 103 4.0% 4.7% 4.2% 1.7% 7.1% 4.3% 4.5% Suspicious 0 12 11 1 0 24 23 0.0% 0.9% 1.1% 0.6% 0.0% 0.9% 1.0% Malignant 69 494 533 119 19 1,234 1,027 25.1% 37.0% 55.6% 65.7% 67.9% 44.4% 44.8% Malignant (non-breast cancer) 1 2 0 1 0 4 2 0.4% 0.1% 0.0% 0.6% 0.0% 0.1% 0.1% Atypical ductal hyperplasia 3 20 10 1 2 36 30 1.1% 1.5% 1.0% 0.6% 7.1% 1.3% 1.3% Lobular carcinoma in situ 2 3 5 0 0 10 8 0.7% 0.2% 0.5% 0.0% 0.0% 0.4% 0.3% Total 275 1,336 958 181 28 2,778 2,294 100% 100% 100% 100% 100% 100% 100% 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 2007 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 2010. National Accreditation Standard Result in 2010 2.8.1 0.35% of women who attend for their first screen are found not to have invasive cancers or DCIS after a diagnostic open biopsy. 2.8.2 0.16% of women who attend for their second or subsequent screen are found not to have invasive cancer or DCIS after a diagnostic open biopsy. 2.8.3 4.0% of women assessed after their first screening are found not to have invasive cancer or DCIS after a diagnostic open biopsy. 2.8.4 <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. 0.22% 0.08% 1.6% 1.6% 22

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 94.8% (Table 27). Table 27: Preoperative diagnosis rate by round and age, 2010 40-49 50-59 60-69 70-79 80+ Total 50-69 First round women Open diagnostic biopsy 2 10 1 0 0 13 11 5.1% 6.3% 3.4% 0.0% - 5.6% 5.9% Preoperative diagnosis 37 149 28 3 2 219 177 94.9% 93.7% 96.6% 100% - 94.4% 94.1% Total 39 159 29 3 2 232 188 100% 100% 100% 100% 100% 100% 100% Subsequent round women Open diagnostic biopsy 2 18 26 2 2 50 44 8.3% 5.6% 5.1% 1.9% 10.5% 5.1% 5.3% Preoperative diagnosis 22 304 480 106 17 929 784 91.7% 94.4% 94.9% 98.1% 89% 94.9% 94.7% Total 24 322 506 108 19 979 828 100% 100% 100% 100% 100% 100% 100% All women Open diagnostic biopsy 4 28 27 2 2 63 55 6.3% 5.8% 5.0% 1.8% 9.5% 5.2% 5.4% Preoperative diagnosis 59 453 508 109 19 1,148 961 93.7% 94.2% 95.0% 98.2% 90% 94.8% 94.6% Total 63 481 535 111 21 1,211 1,016 100% 100% 100% 100% 100% 100% 100% 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 2010. National Accreditation Standard Result in 2010 2.7.1 75% of invasive breast cancers and DCIS are diagnosed without the need for an open diagnostic biopsy. 94.8% From 2001 to 2010 the rate of preoperative diagnosis increased from 90.7% to 94.8% (Table 28). Table 28: Preoperative diagnosis rate, 2001 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Preoperative diagnosis 90.7% 92.5% 92.3% 93.6% 94.2% 93.5% 94.2% 93.3% 94.6% 94.8% 23

2010 BreastScreen Victoria Annual Statistical Report Source: Table 28, 2009 Annual Statistical Report Figure 9: Preoperative diagnosis rate, 2001 2010 100% Proportion of women diagnosed with breast cancer 90% 80% 70% 60% 50% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Preoperative diagnosis Year 24

OUTCOME OF ASSESSMENT Of the 198,160 women screened, 12,639 women were recommended for assessment (Table 22). Of the women recommended for assessment, 75 declined or failed to attend assessment. Of the 12,564 women who were assessed, 260 (2.1%) women were assessed privately outside of the Program. Table 29 shows the outcome of assessment for women assessed both within and outside of BreastScreen Victoria. Of women aged 50-69 who were assessed,10.1% 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, 2010 40-49 50-59 60-69 70-79 80+ Total 50-69 First round women No breast cancer detected 1,155 2,677 278 30 6 4,146 2,955 96.1% 94.2% 90.3% 90.9% 75.0% 94.4% 93.8% Breast cancer 42 161 29 3 2 237 190 3.5% 5.7% 9.4% 9.1% 25.0% 5.4% 6.0% Other 5 5 1 0 0 11 6 0.4% 0.2% 0.3% 0.0% 0.0% 0.3% 0.2% Total 1,202 2,843 308 33 8 4,394 3,151 100% 100% 100% 100% 100% 100% 100% Subsequent round women No breast cancer detected 444 3,257 2,930 471 63 7,165 6,187 94.7% 90.7% 85.0% 80.8% 76.8% 87.7% 87.9% Breast cancer 25 328 515 111 19 998 843 5.3% 9.1% 14.9% 19.0% 23.2% 12.2% 12.0% Other 0 4 2 1 0 7 6 0.0% 0.1% 0.1% 0.2% 0.0% 0.1% 0.1% Total 469 3,589 3,447 583 82 8,170 7,036 100% 100% 100% 100% 100% 100% 100% All women No breast cancer detected 1,599 5,934 3,208 501 69 11,311 9,142 95.7% 92.3% 85.4% 81.3% 76.7% 90.0% 89.7% Breast cancer 67 489 544 114 21 1,235 1,033 4.0% 7.6% 14.5% 18.5% 23.3% 9.8% 10.1% Other 5 9 3 1 0 18 12 0.3% 0.1% 0.1% 0.2% 0.0% 0.1% 0.1% Total 1,671 6,432 3,755 616 90 12,564 10,187 100% 100% 100% 100% 100% 100% 100% Note: Other : women who did not complete assessment. 25

2010 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 12 months. The early review rate did not meet the accreditation standard in 2010. National Accreditation Standard Result in 2010 2.22.1 <0.2% of women who attend for screening are recommended for early review for further assessment. 0.15% Recommendation for rescreening Of the 198,160 women who attended for screening, 185,521 women were recommended for routine rescreening at the completion of their screening (Table 22). Of the 12,564 women who were assessed, 11,311 women were found not to have breast cancer and were recommended for routine rescreening (Table 29). In total, 196,832 women were recommended for routine rescreening after their 2010 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 0.5% of women were advised to return for annual screening (Table 30). Table 30: Recommendation for routine rescreening by age, 2010 40-49 50-59 60-69 70-79 80+ Total 50-69 Rescreen at 2 years 14,654 92,055 76,924 11,115 1,119 195,867 168,979 99.8% 99.7% 99.5% 97.9% 93.2% 99.5% 99.6% Rescreen at 1 year 26 235 381 241 82 965 616 0.2% 0.3% 0.5% 2.1% 6.8% 0.5% 0.4% Total 14,680 92,290 77,305 11,356 1,201 196,832 169,595 100% 100% 100% 100% 100% 100% 100% The annual screening rate met the accreditation standard in 2010. National Accreditation Standard Result in 2010 1.5.1 The Service offers annual screening for <10% of women aged 50 69 years. 0.4% 26

CANCER DETECTION SUMMARY OF CANCER DETECTION Among the 198,160 women who attended for screening in 2010, there were 1,235 breast cancers diagnosed. Six of these cancers were diagnosed at early review more than six months after the screening mammogram. Six cancers were diagnosed at early rescreen for women who presented with a breast lump and/or clear or blood-stained nipple discharge in the same breast in which the breast cancer was diagnosed. These 12 cancers are not counted as screen detected cancers. The following tables include only the 1,123 cancers that were considered screen detected cancers. Of these screen detected cancers, 989 (80.9%) were invasive breast cancers and 234 (19.1%) were ductal carcinoma in situ (DCIS) (Table 31). 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 31: Cancer detection (invasive and DCIS) by age, 2010 40-49 50-59 60-69 70-79 80+ Total 50-69 Invasive breast cancer 52 376 451 93 17 989 827 77.6% 77.4% 84.0% 82.3% 85.0% 80.9% 80.8% DCIS 15 110 86 20 3 234 196 22.4% 22.6% 16.0% 17.7% 15.0% 19.1% 19.2% Total 67 486 537 113 20 1,223 1,023 100% 100% 100% 100% 100% 100% 100% From 2001 to 2010, for women aged 50 69 the proportion of breast cancers detected as DCIS remained steady (Table 32). Table 32: Cancer detection (invasive and DCIS) for women aged 50-69, 2001 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Invasive 77.1% 81.3% 78.8% 80.3% 78.8% 80.6% 78.5% 78.8% 78.5% 80.8% DCIS 22.9% 18.7% 21.2% 19.7% 21.2% 19.4% 21.5% 21.2% 21.5% 19.2% Source: Table 32, 2009 Annual Statistical Report Figure 10: Cancer detection (invasive and DCIS) for women aged 50-69, 2001 2010 Proportion of women diagnosed with breast cancer 100% 80% 60% 40% 20% 0% 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Invasive DCIS 27