Breast Cancer Policy and Evaluation

On behalf of Cancer Council Australia and with funding from the Australian Department of Health, the team is leading the Breast Roadmap for Optimising Screening in Australia (Breast ROSA) project. This project is  exploring options for risk-based, personalised approaches to breast cancer screening and surveillance in Australia, through a range of activities including epidemiological studies, evidence reviews, modelled evaluations of risk-based screening protocols and process mapping of current practices within and outside the screening program (working closely with the BIRDE team). This work involves extensive stakeholder consultation and is guided by a dedicated Expert Advisory Group.

The team is jointly leading the BRAVO project with BreastScreen Victoria (BSV), the University of Melbourne, and the Peter McCallum Cancer Centre. This project is evaluating the feasibility, costs and acceptability of routine risk assessment within the BSV program through qualitative research with BreastScreen clients, BreastScreen staff surveys, and the development of a protocol to pilot routine risk assessment at screening sites. This work was funded by the Victorian Comprehensive Cancer Centre over 2018-2020, and the collaborators aim to implement pilot studies in 2021.

Australian women aged 50-74 years are currently offered two-yearly mammographic screening, as this is an effective population-level screening protocol for breast cancer for women in this age group. More personalised screening protocols might find cancers earlier and ensure the best possible balance of benefits and harms for all women, including women at higher and lower than average risk of breast cancer

Using the predictive modelling platform Policy1–Breast, the team is performing modelled evaluations of the BreastScreen Australia program to evaluate and compare the benefits, harms and costs of a range of risk-based screening protocols in Australia. The team is exploring the value of screening protocols that incorporate personalised risk assessment, potentially offering medical imaging tests and screening schedules tailored to suit each woman participating in screening. This includes options incorporating mammographic breast density, since women who have higher breast density have a higher risk of breast cancer, and potentially reduced mammographic screening test accuracy.

The team engages in specific research projects aiming to address evidence gaps to inform breast cancer health policies and guidelines. This includes research to identify and evaluate practical tools that can assist with personalised risk assessment at a population level, through validation studies of existing risk assessment tools, and analyses of large datasets using epidemiological, Artificial Intelligence and machine learning methods identify combinations of risk factors that can help estimate whether women have a higher or lower than average risk of breast cancer or screening outcomes such as interval cancers.  The team is undertaking research and development work in collaboration with CSIRO on the AutoDensity tool for measuring breast density from screening mammograms.