When 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.

Thanks 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 happen.

I 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 be heard.

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 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. 

Quality 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.

I 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.”

I want honesty from this Committee and I want a commitment to screen women in the 40-44 age group.

Jackie Blue

25th February 2004