I began working as a breast physician 12 years ago I naively asked why
mammograms for women in the 40s were not widely supported.
A wise colleague informed me that until the women of New Zealand got
angry and behind this issue, it would languish and until that day, clinicians
who publicly debated this issue would be perceived as self-interested and
wanting to make money out the misery and fear of women.
to Debbie and Tim Short this day has finally arrived. Women and their families
in New Zealand are very, very angry. I would like to pay tribute to Debbie and
Tim Short for their courage and determination in making this long-awaited day
would also like to acknowledge my fellow colleagues who have written and
co-signed submissions. A majority
of us, as part of our work, either indirectly or directly receives Ministry of
Health funding. I am very proud of my colleagues. Not one person wished to make
their submission confidential to this hearing. They all wanted to speak out and
Much of my own
submission refuted arguments against screening in the 40s that were presented in
a letter from the Minister of Health to Debbie and Tim Short in December 2003.
On Monday, the
Minister announced that women 45-49 years would be offered screening
mammography. Clearly, the Minister now accepts the arguments that have been
presented in this submission. But the logic of stopping at 45 years confounds
and baffles me when -
The breast cancer age-specific rate for the 40-44 age band has
increased by almost 20% since 1996.
The difference between the numbers of women diagnosed with breast
cancer in the 40-44 age band and 45-49 age band is only 3%
All the intensive meta-analyses of the randomised controlled trials
that have been conducted confirming a benefit have regarded this group of
women in the ten year age band of
The life-years saved for women 40–44 is even greater than the 45-49
The social and economic fallout is just as great and possibly greater
when a woman diagnosed in her early 40s dies of breast cancer as a woman who
is diagnosed in the late 40s.
Data from the Auckland Breast
Cancer Study Group confirms that women in the 40s, when compared to
older women, have more aggressive cancer and are more likely to have
positive lymph nodes – all of these features convey a worse prognostic
outlook. But, when the data is analysed with regards to 5-year age bands, it
confirms that women in the early 40s have more aggressive cancer than women
in the later 40s (graph attached).
Minister has indicated that she wants to wait for the results of a United
Kingdom trial that will be completed in 2005. We know that there is a delay to
see benefit when women in the 40s are screened and the benefit is only
identified with long follow-up of these trials. I predict that the data
available in 2005 will not provide the Minister with any useful information.
Much longer follow-up will be required. And, while we wait for useful
information from this trial, women in the early 40s will suffer.
I concur with Dr
Hochstein’s submission where she quotes Stephen Duffy, an internationally
respected epidemiologist…. “The time for repeatedly visiting the trials has
gone. The challenge for the future is to evaluate the effects of the service
screening programmes, which are springing up around the world, and to pinpoint
potential improvements where possible”
So, what are the real issues
behind NOT screening women in the early 40s?
They are money, manpower and resource.
mammographic screening for women in the 40s will cost money, we will need a
greater professional infrastructure, and resources to ensure those women with
breast cancer are diagnosed and treated expediently. We need to think laterally
and innovatively to solve these issues.
would like to quote Dr Daniel Kopans, a world acclaimed breast radiologist that
Dr Deborah Andrew has reported in her submission…..
“Medicine is under great pressure to reduce the cost of health care.
Nevertheless, science should not be corrupted to avoid difficult social debates.
If health planners do not believe it is worth paying for an intervention, such
as screening women in their forties, they should state this openly for public
debate. Inappropriate data analysis, to suggest that there is no benefit from
screening, should not be used to avoid complex societal issues.
By the most rigorous scientific analysis there is clear proof that
screening using mammography, beginning by the age of 40 can save lives and that
this should be done on an annual basis.”
want honesty from this Committee and I want a commitment to screen women in the
40-44 age group.