About the Program
- How BreastScreen Australia works
- Monitoring and evaluation
- Accreditation: a sign of quality
BackgroundBreast cancer is a major health issue for women: it is the second most common cause of cancer-related death in Australian women. 2,680 Australian women died from breast cancer in 2007. The lifetime risk of women developing breast cancer before the age of 75 years is one in 11. Well organised mammographic screening can substantially reduce deaths from breast cancer.
In June 1990 the ministers responsible for health in all states and territories joined the Commonwealth in agreeing to jointly fund a national mammography screening program. The National Program for the Early Detection of Breast Cancer, now known as BreastScreen Australia, was established by the Commonwealth and the states and territories in 1991 and is now recognised as one of the most comprehensive population-based screening programs in the world. BreastScreen Australia is targeted specifically at well women without symptoms aged 50-69, although women aged 40-49 and 70 years and older are able to attend for screening.
At present, BreastScreen Australia operates in over 500 locations nationwide, via fixed, relocatable and mobile screening units. Screening has increased significantly since commencement of BreastScreen Australia in 1991, with a total of 1, 641, 316 women screened across Australia in 2007-2008. Of these women, 1,273,403 (78%) were in the screening program target age group of 50-69 years. The program's aim is to achieve a participation rate of 70% among women aged 50-69 years. At present, the program is screening 54.9% of women in this age group.
In the context of the national program, 'screening' refers to population-based screening, of apparently well women in the target age group, for breast cancer. Screening mammography is carried out in an organised and systematic manner to detect unsuspected cancer at an early stage so that early treatment can reduce illness and death from breast cancer. This population based approach is distinctly different from the use of mammography to investigate symptoms in an individual woman, which is a diagnostic procedure.
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How BreastScreen Australia worksThere are two components within the program: Screening and Assessment Services and Co-ordination Units at state and territory levels.
The Screening and Assessment Services provide all services from the initial mammogram to any follow up diagnostic procedures needed. All services have the same basic structure: each has an assessment centre and one or a number of screening units. In smaller services, screening and assessment services are often co-located.
The initial mammogram is performed in a screening unit. If a woman needs further investigation, she is recalled to the assessment centre, where the abnormality is assessed by a multidisciplinary team.
Services vary in size: some cover vast geographical areas (relocatable and mobile screening units); others only part of a city. Services also vary in nature, as some are wholly in the public sector whilst others are wholly in the private sector. Some services are a mix of both public and private.
The effectiveness of BreastScreen Australia is dependent on maintaining high standards in all areas of program delivery. Accreditation is vital to this. All BreastScreen Australia services are required to be accredited according to the BreastScreen Australia National Accreditation Standards, which have been developed by professionals involved with the program.
The Co-ordination Units do the planning and overall co-ordination of the program in each state and territory and play a large role in the recruitment of women.
The state and territory governments have primary responsibility for the implementation of the program at their local level. The Australian Government provides overall coordination of policy formulation, national data collection, quality control, monitoring and evaluation.
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Monitoring and evaluationNational standards and a national accreditation process have been established. All BreastScreen Australia services must be accredited.
The collection of data in the program is a high priority, as it enables the monitoring of the program's efficiency and performance and provides a means to ensure that high quality is maintained. A National Standardised Data Set, definitions and common performance measures have been developed. All states and territories have agreed to collect data in accordance with the Standardised Data Set.
The Australian Institute of Health and Welfare (AIHW) produces annual reports on key program activity, performance and outcome indicators to monitor the achievements of BreastScreen Australia. The latest report is available BreastScreen Australia monitoring report 2009-2010 .
It is important to point out that every woman who presents for mammography screening is asked to sign a consent form so that her data can be used for these purposes. Information is only reported as total numbers which does not allow identification of data from an individual woman. BreastScreen Australia operates under strict confidentiality and privacy guidelines.
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Accreditation: a sign of qualityAll BreastScreen Australia services are regularly reviewed to ensure they are providing a high quality service. The performance of every BreastScreen Australia Service is measured by assessing how closely it meets a set of nationally agreed standards.
Accreditation is the process that evaluates the overall service. All services must participate in the accreditation process to be part of BreastScreen Australia. The accreditation system includes checking that services meet the standards through site visits, self-assessment and reporting to the accrediting body.
Services are only accredited if they are providing an acceptable quality of service.
Those that are very successful are given accreditation for four years. They monitor their own performance and are reviewed again in four years.
Others receive accreditation for two years, and are reviewed again after that time.
Services can also receive two year accreditation with high priority recommendations. This means there are particular standards the accrediting body recommends they improve upon. Their managers and the National Quality Management Committee monitor these services more closely.
For further information on BreastScreen Australia's commitment to quality see the following links:
1. BreastScreen Australia - Our Commitment to Quality as at 25 October 2010 (PDF 52 KB)
2. Updating BreastScreen Australia's Accreditation System
3. BreastScreen Australia National Accreditation Standards (PDF 942 KB)
4. Addendums to the BreastScreen Australia National Accreditation Standards (as at 15 November 2010)
6. Addendums to the BreastScreen Australia Accreditation Handbook (as at 15 November 2010):
- - Section 3 Levels of accreditation - a tiered system (3.1 & 3.4) (PDF 15 KB)
- Section 4 Key components of the accreditation process (4.5) (PDF 11 KB)
- Section 13 Updated recommendations for the remuneration of BreastScreen Australia Site Visitors (as at December 2010) (PDF 25 KB)
- Appendix A - audit of individual service components (previously entitled 'Flexibility in Accreditation - A case study') (PDF 40 KB)
8. BreastScreen Australia Data Dictionary Version 1 (PDF 53KB)
9. Addendum to the BreastScreen Australia Data Dictionary Version 1 (as at 15 November 2010): National Accreditation Status Report (May 2012)
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Page currency, Latest update: 12 April, 2013