Community Juries in Australia Discuss Mammogram Screening for Older Women
Importance of Breast Cancer Screening
Breast cancer is one of the most prevalent cancers affecting women globally. Early detection through screening programs has significantly improved survival rates. Mammogram screening, a specialized X-ray test, is crucial for identifying early signs of breast cancer before they are detectable by patients or doctors.
Debate Among Medical Experts
Medical professionals have differing opinions regarding the appropriate age groups for mammogram screening. In Australia, free screening is provided biennially for women over 40. Since 1991, a targeted program has invited women aged 50-69, which expanded in July 2013 to include those aged 50-74. However, the efficacy of mammogram screening for women aged 70-74 remains uncertain.
Cancers in older women often progress more slowly, and the side effects of treatment can be more pronounced. Thus, the advantages of screening must be weighed against the risks of false positives and unnecessary treatment for slow-growing cancers that might not pose significant health concerns.
Community Juries Facilitate Informed Choices
To empower older women to make informed decisions regarding mammogram screening, researchers organized two community juries. A report detailing their findings was recently published in BMJ Open. Community juries consist of public members who engage with experts to discuss specific issues, providing more nuanced opinions than traditional surveys or focus groups. While their findings are not legally binding, they offer valuable insights into public sentiment and can guide policy decisions.
Details of the Community Juries
The researchers randomly selected 34 women aged 70-74 from the Greater Sydney area to participate in the juries. The first jury comprised 18 women, while the second included 16. None of the participants had a personal history of breast cancer. The juries deliberated whether to continue the current practice of inviting women in this age group for mammogram screening or revert to the previous system where no special invitations were sent.
Meeting for two days, the juries listened to expert presentations on the benefits and risks of mammogram screening for women aged 70-74. They had the opportunity to ask questions and engage in discussions before reaching a conclusion.
Jury Findings and Recommendations
After thorough discussion, both juries largely agreed (16-2 and 10-6) that the breast cancer screening program should continue inviting women aged 70-74 for mammogram screenings. Their reasoning included the belief that this approach demonstrates societal support for older women, provides essential information for personal treatment choices, and is preferable given the lack of consensus among experts.
The researchers concluded that once accepted, screening programs hold significant symbolic value. Arguments concerning the diminishing benefits of screening with age are unlikely to convince older women that they should be excluded from these programs. In the absence of expert agreement, individuals may prefer to receive information from screening initiatives and make informed choices regarding their treatment options.
Author and Reference
Written by Julie McShane, Medical Writer.
Reference: Degeling C, Barratt A, Aranda S, et al. Should women aged 70-74 be invited to participate in screening mammography? A report on two Australian community juries. BMJ Open 2018;8:e021174. Doi:10.1136/bmjopen-2017-021174.