14 February 2004
the House of Representatives:
request: That the Parliament urges the Government to urgently amend the
Government Breast Screening Programme to include women aged from 40 years to 70
years (the same as Australia) instead of the present 50 to 64 years.”
AT PARLIAMENT 18 NOVEMBER 2003
the 25th November 2003, 1,001 additional late signatures were
forwarded to the Clerk of the Health Select Committee and since then an
additional 420 late signatures have been received which are attached to this
motivation in starting this large Petition was initiated by a news item of a
report published in the New Zealand Medical Journal 10th May 2002, by
Professor David Skegg, University of Otago, that concluded there was a 28% pro
rata mortality of Breast Cancer in New Zealand greater than Australia. Since
2002 there has been significant new evidence strongly supporting Breast
Screening from 40years as presented in the contributions from medical
specialists that are part of this submission.
There are 647 deaths per annum from Breast Cancer which is approximately
50% more than total road deaths.
the time, Petitioner, Debbie Short was undergoing Radiotherapy, was bald from 3
months Chemotherapy she had had prior, following from a Mastectomy removing 8
malignant tumours and Lymph Nodes in December 2001.
story of the difference in Breast Cancer between New Zealand and Australia had
become yesterday’s news. So, in
July 2002, Tim and Debbie Short called a Public Meeting and in September 2002
the Petition commenced. We are a family with our three wonderful daughters
Rebecca, Jacinda and Louisa sharing this journey, we are “Mum, Dad and the
Kids” and it is equally our girl’s petition.
The Petition eventuated in Doctor’s surgeries nationwide and so many
other places. Two of our girls are
now at Tauranga Girls College, where, with 1,700 pupils,
part of our submission, there are contributing articles from many eminent
Medical Specialists from New Zealand and Internationally, and three personal
Case Studies. (see number 10).
is a tragedy at any age when a woman gets Breast Cancer.
It is a greater tragedy, the younger a woman is, and many younger women
who get Breast Cancer, still have a young family, are in the work force and are
productive contributors to the economy. Many
women in their 60’s have said to us that if they could, they would transfer
their option of eligibility to screening, to their daughters, who have more life
years. More women in the 40 – 50
year age group have high grade cancer (NZ Medical Journal 24th
October 2003) which is many times more costly to treat than for low grade
cancer. So in effect, by not
picking up more women with Breast Cancer in the 40 – 50 year age group, it is
a double whammy i.e. loss of productive contribution and their cancer is likely
to be more costly to treat.
So why aren’t we screening women from 40 years?
BreastScreen Aotearoa in 1998 began Breast Screening women 50 – 64
years of age, which was a big step forward, but now it is past due to expand the
programme. BreastScreen Australia began in 1991 offering free mammography
screening from 40 years, but actively recruiting 50 – 69 years.
The take-up rates between 50 – 64 years in New Zealand is 56.2% and 50
– 69 years in Australia is 54.3% - so very similar but our survival rate 28%
pro rata worse! The reason why we
aren’t screening from 40 is we have sadly become a people of debaters, always
now needing to seek absolutes before action and more reports before lives. If
the same model of absolutes were used in the Court Room instead of the balance
of probability, the prisons would be almost empty.
The reality is 647 p.a. women are dying of Breast Cancer of which
one-third get Breast Cancer under 50.
There is no disagreement that early detection saves lives! The highest risk factor in getting Breast Cancer is being a
woman and 90% of woman who get Breast Cancer have no family history.
The Contributors to the submission(No.10) in their reports cover
differentiation i.e. tumours changing to a more aggressive form and the higher
rate in younger women. It is accepted that screening 40-49yrs has to be annually
but only two yearly 50yrs which speaks volumes about the necessity to screen
40-49yrs. The Contributors will
dispel the red herrings of false positives, false negatives and dense breasts.
There has been controversy over the effectiveness of screening women 40
– 50 years; there have been flawed studies (Canadian trial), and other data,
which has been inappropriately analysed causing confusion.
Daniel B Kopans contributing article, “An Overview of the Breast Cancer
Screening Controversy”, gives a better understanding how this has happened.
Also see Ian Campbell’s (Waikato Hospital) “A Review of the
Evidence” and Dr Barbara Hochstein’ contribution.
There has been a myth that
once woman turn 50 years, they magically change.
As is transparent in the articles to the submission, women are at high
risk 40 – 50 years, as they are 50 – 69 years and the harms of screening are
not suddenly less at 50 years. It
has been argued that if a biopsy proves to be benign, that the process was
flawed and caused unnecessary anxiety. The
harms do not equate to dying from Breast Cancer.
The recall rate where screening is offered from 40 years is fairly
constant across all ages. WHAT
So is screening 40-50 years effective? We refer you to the following
contributions whereby the answer has to be a resounding YES!
Mr John Harman
Dr Jackie Blue co-signed by 13
other eminent Medical Specialists
Mr Ian Campbell
Dr Barbara Hochstein
Professor Laszlo Tabar-20 yr trial
with a 45% mortality reduction by screening woman 40-49 years as published in UK
medical Journal The Lancet 26-4-03(attached).
“In women aged 40-49 years, there was a significant 48% reduction in
breast cancer mortality in those exposed to screening, a non-significant 19%
reduction in unexposed women and a significant 45% reduction in the age-group as
a whole.” This is a huge 45%
mortality reduction. This research has received no criticism - the Minister in a
reply to the petitioners 10-12-03 said its only 29% i.e. 48%-19%, this is an
incorrect dissection as there is a 45% reduction in the age group as a whole.
This is the largest and longest research trial that has ever been done involving
210,000 woman and much larger than another UK trial that won’t be reporting
until 2005. Women are dying unnecessarily we need to act now.
the collection of data of many of the randomised trials that show the benefit of
screening 40-50yrs, mammographic
equipment has advanced further identifying
tumours not previously detectable.
remains the primary screening technique in the diagnosis of breast cancer, with
a mammographic detection rate of 92% in this patient group.
This is comparable to detection rates reported in the literature.
However, breast ultrasound , in conjunction with mammography, has become
an integral part of the diagnostic work up for patients with clinical symptoms
or mammographically detected abnormalities.
Ultrasound was also the method of choice in 77.9% of patients who
underwent image-guided needle biopsy.” (NZ Medical Journal – The Auckland
Breast Cancer Register: a special project of the Auckland Breast Cancer Study
Group). This is the reality in
practice despite “the Ministry of Health would not advocate the use of an
ultrasound as a screening tool in BreastScreen Aotearoa”. (Letter to the
Petitioners, Debbie and Tim Short, from the Minister of Health 10.12.03).
Another reason why screening from 40 hasn’t occurred is there is a big
reluctance by Medical Specialists to speak out in a small country because either
they work directly for the Ministry of Health, District Health Board, or their
clinical infrastructure needs the support and goodwill of whichever Government
is in power. We have been given the private support of a significant number of
other medical specialists that we cannot quote. To many there is a climate of
Another reason is younger women, until now, are not getting angry enough.
It has been to their detriment because they are too busy, being mothers, and
contributing productively to the work force, they are in the age group of being
busy people. There has not been a
political lobby group for younger women, like Grey Power is for older women.
In fact, we have over 1,500 New Zealanders who have confirmed in writing,
that they will become members of a protest Breast Cancer Action Party at the
next General Election (which is so much hoped won’t be necessary).
8. So is the reason, the cost! of screening annually 40-50yrs? - The infrastructure already exists. The Ministry of Health hasn’t released the cost to operate Breast Screening 40-49yrs and we challenge them to do so. We can though, easily establish the mammogram cost (i.e. without the cost of maintaining a screening register with active recruitment).
are 275,376 (2001 census) women aged 40 – 49 years and at the current Breast
Screening take up rate of 56.2% i.e. 154,761 women X $100 mammogram - this would
cost only 15.5 mil p.a.
After considering all the evidence, the only logical reason left why
screening isn’t offered for women 40 – 49 years is that the Government is
not interested in giving women the choice, preferring to take a fiscal
punt and gamble with their lives.
The most significant part to
our submission, is the contributory reports below and evidence
that strongly supports Breast Screening from 40 years:
(a) CASE STUDY 1 – DEBBIE
SHORT - PETITIONER
(b) CASE STUDY 2 - MARIE AVERIL ROIGARD - PASSED AWAY 15.03.02 - 45 YEARS
(c) CASE STUDY 3 – LIBBY
BURGESS – SCREENING MAMMOGRAM AT 40 YEARS
Laszlo Tabar, MD, Professor
of Radiology, University of Uppsala, Uppsala, Sweden
Chairman, Department of Mammography, Falun Central Hospital,
Including Publication Lancet April
26th 2003 - LANCET ARTICLE 26 APRIL 2003
– MAMMOGRAPHY SERVICE SCREENING AND MORTALITY IN BREAST CANCER PATIENTS:
20-YEAR FOLLOW-UP BEFORE AND AFTER INTRODUCTION OF SCREENING
Dr Jackie Blue, Breast Physician, St Marks Woman’s Health, Auckland
Dr Benji Benjamin, Clinical
Director, Radiation Oncology, Auckland Hospital
Dr Barbara Hochstein,
Breast Radiologist, Lakes Radiology and Lakeland Health, Rotorua
Dr David Benson-Cooper Breast Radiologist, Mercy Radiology Auckland
Mr Wayne Jones Clinical Director - General Surgery Auckland Hospital, Head of the Auckland Breast Surgery Unit - General Breast and Endocrine Surgeon, Auckland
Dr Sonja Freese Breast Physician Breast Associates Auckland
Dr Sue McKeage Breast Surgeon Auckland
Dr Margie Weston
Breast Radiologist Auckland
Mr Stan Govender,
Breast Surgeon, Auckland
Dr Marli Gregory,
Breast Physician, Auckland
Mr John Harman,
Breast Surgeon, Auckland
Dr Heather McIntyre,
Breast Physician, Auckland
Dr Karen Parker,
Breast Physician, Auckland
Dr Ken Judd,
Breast Radiologist, Auckland
ORAL STATEMENT BY DR JACKIE BLUE - TO THE HEALTH SELECT COMMITTEE - MAMMOGRAPHIC SCREENING IN THE 40'S - ON 25.2.04
Mr Ian D Campbell,
Breast Surgeon, Clinical Director, Waikato Hospital
Lecturer, Waikato Academic Division, Auckland School of Medicine
Mr John Harman,
Breast Surgeon, FRACS, St Marks Womens Health, Auckland
Dr Barbara Hochstein, FRACR,
Consultant Radiologist, & Breast Imaging Subspeciality,
Lakeland Health & Lakes Radiology, Rotorua
Clinical Lecturer, Dept of Anatomy with Radiology,
Auckland Medical School
Dr Deborah Andrews FRACR, Radiologist,
Medex Radiology, Tauranga
Belinda Scott (Mrs), FRACS,
Chairperson, NZBCF Medical Committee
Belinda Scott (Mrs), Breast Surgeon, Director Breast Associates, Auckland
Mr Wayne Jones,
and Endocrine Surgeon, Clinical Director Auckland Hospital
Mr Alex Ng, Breast
and General Surgeon, Auckland Hospital
Danute Ziginskas, Consultant
Pyschologist to St Marks Breast Centre, Auckland
(m) AN OVERVIEW OF THE BREAST CANCER SCREENING CONTROVERSY
Daniel B Kopans, Associate
Professor of Radiology, Harvard Medical School, Cambridge, MA;
of Breast Imaging, Massachusetts General Hospital, Boston.
D.B. Kopans, R.H. Moore, K.A.
McCarthy, D.A. Hall, C.A. Hulka, G.J. Whitman, P.J. Slanetz and E.F. Halpern Department
of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
COLLEGE OF RADIOLOGY SUPPORTS ANNUAL
STATES DEPARTMENT OF HEALTH & HUMAN SERVICES
HHS AFFIRMS VALUE OF MAMMOGRAPHY FOR DETECTING BREAST CANCER
MAMMOGRAPHY FOR FORTY-SOMETHING WOME N:
NEW ANALYSIS EMPHASIZES BENEFITS OF YEARLY EXAMS
Joann Schellenbach, National Director Media Relations,
American Cancer Society
A. Short, Chairperson