Breast Cancer Clinical and Population Health Research

Supported by the National Breast Cancer Foundation (NBCF) 10-year Chair grant, the focus of this program is on collaborative research and developing early-career researchers to lead studies across primary, secondary and tertiary prevention. The program’s scope includes investigations of generational shifts in risk profile, emerging breast cancer risk factors, impacts of risk-reducing interventions in the Australian population, and collaborative enhancement of iPrevent^TM (with Prof K. Phillips) to enable broader use of risk assessment in detection and prevention. Digital and exercise interventions are examples of tertiary prevention research in which we collaborate to improve the health of those affected by breast cancer.

Our team are global leaders in research into DBT population breast screening including landmark trials in the international and national context, and individual person data meta-analyses of DBT screening trials. Our work has implemented: Australia’s pilot trial of DBT screening which has informed an ongoing large-scale comparative trial of hybrid DBT technology in BreastScreen Victoria; a collaborative cohort study of DBT vs mammography with USA’s Breast Cancer Surveillance Consortium focused on women with a family history of breast cancer; and collaborative contributions to program-embedded trials in BreastScreen Norway, and the comparative trial (STREAM) in the Dutch screening program.

We have undertaken Australian-first research on AI interpretation of screening mammograms, including Australia’s first cohort study of AI embedded in BreastScreen, and studies on ethical and societal implications of AI including women’s preferences, to guide AI implementation. We have extended this work to evaluate AI for DBT screen-reading in a cohort study, with planning underway for a large-scale trial to evaluate detection metrics when AI is integrated into the screening workflow. Systematic reviews in this research focus bring together the evolving literature on AI to define its integration in different screening workflows, the evidence for each, and to inform new AI research.

We are undertaking diverse studies to generate evidence that guides current and future breast screening practice, recognising the importance of elucidating benefits and harms of screening to ensure improved health outcomes and shared decision-making. Our recent and ongoing work has included evaluation of age-based screening outcomes by risk profile; breast cancer subtype-specific screening outcome metrics; living systematic review of risk-based screening; investigating how to communicate evidence to support women (in age-range not actively invited to screen) in deciding about starting/stopping screening; co-design of risk assessment implementation in breast screening pathways; and a world-first RCT of the impact of population-based breast density notification in BreastScreen.

This research focus spans from evaluating imaging technologies for detection of in-breast recurrence to inform breast cancer surveillance guidance; to epidemiological studies to better understand the long-term risk of developing metastatic breast cancer after initial early-stage diagnosis to guide treatment decisions, and the impact of factors such as age, pregnancy and menopausal hormone therapy on risk of recurrence. It includes improving methods for population-level monitoring of the incidence and prevalence of metastatic breast cancer and post-metastasis survival using linked health data to inform the delivery of health and supportive care services.

Our research has investigated disparities in breast cancer including epidemiological work quantifying global disparities related to regions and socioeconomic indices, the uptake of breast screening practices in low-middle income countries, and late-stage diagnoses in less affluent health systems. Our emerging research in this theme focuses on identifying disparities in the Australian context and integrates co-developing interventions to improve equitable breast screening, exemplified in work under development focused on women from culturally and linguistically diverse (CALD) backgrounds, women in rural and remote regions, and those in lower socioeconomic contexts.