Hunter oncologist Dr Nicholas Zdenkowski has voiced his concerns about the impact of BreastScreen services closing during the COVID lockdown.

Doctor Nick Zdenkowski. Photo source: Hunter Valley Oncology

BreastScreen NSW temporarily suspended all screening services on August 19 due to the increased risk associated with the latest COVID- 19 outbreak and the need to redeploy staff to areas of greater concern. 

Dr Zdenkowski, a medical oncologist at Hunter Valley Oncology, said BreastScreen should have remained open because its closure represented an issue for patients seeking preventive healthcare. 

“With the closure of BreastScreen, the regular screening mammograms aren’t being done routinely, and some people miss out,” he said.

“After the last lockdown when BreastScreen was closed, I saw more patients with larger cancers that they had found themselves, rather than being found at BreastScreen.”

As a result, he said, “my impression was that there was a need for more chemotherapy to be given, more likelihood of radiotherapy being given and potential for a worse prognosis”.

It was a consistent theme across the medical profession, Dr Zdenkowski observed.  

“My colleagues have seen a similar sort of thing. I work with breast surgeons, radiologists, and many were saying that there were women presenting with more advanced cancers.

“There was modelling completed last year, which showed a substantial drop in the number of women attending for screening scans, and after it reopened there was not a substantial catch-up,” Dr Zdenkowski said.

“You’d think there would be some sort of catch-up where women would go back and there would be an increased number of appointments, but that is not the case.

“There is probably a whole lot of women out there who missed their mammogram.”

Dr Zdenkowski said early detection for breast cancer was vital to achieve the best outcome, and without detection measures, patient mortality would rise. 

A report by the Australian Institute of Health and Welfare indicated that in 2016, more than 50 per cent of invasive breast cancer cases in women aged 50-74 were detected through BreastScreen clinics across Australia.

“Breast cancer mortality has decreased since BreastScreen Australia began, from 74 deaths per 100,000 women aged 50-74 in 1991, to 40 deaths per 100,000 women in 2018,” the report said. 

Modelling released by the Radiation Therapy Advisory Group examining the duration of BreastScreen’s closure and its impact on patient mortality showed that “if you missed your BreastScreen or it was delayed, there’s an increased risk of a cancer being diagnosed at a later stage that may end up being incurable,” Dr Zdenkowski said. 

In Australia, between January and June last year, about 145,000 fewer mammograms were conducted compared to the same period in 2018. 

The modelling suggested that with a shutdown, there was a slight increase in patient mortality. 

“There were increased numbers of women according to modelling that could die as a result of the BreastScreen being shut down. The longer the shutdown, the greater the impact and the more women more likely to experience bad outcomes as a result.”

State Member for Wallsend Sonia Hornery was among many local women whose scheduled mammogram appointments at BreastScreen were cancelled during lockdown.

She was not notified about the cancellation of her appointment, and has not been advised of any rescheduling, or if she will have priority once clinics reopen. 

While she said she “understands the need” for some services to stop during the pandemic, she said COVID-safe practices should be put in place to keep staff safe. 

“This is a vital service, and if Bunnings and the Reject Shop are considered essential then surely BreastScreen is just as essential and should be reopened in a COVID-safe way.” 

It’s an issue constituents have consistently raised with her, and had compounded the stress many faced regarding routine check-ups, she said. 

She said for many patients, “stress levels are through the roof”.

“I have had dozens of calls, emails and messages from women who have had their appointments cancelled due to the closure.  Many are concerned due to missing their regular check-ups, given their family history of breast cancer or previous personal issues with breast cancer.”

Hornery said she had discussed the closure with a number of her colleagues “at a state level” and “would like to see this vital service reviewed and a COVID-safe plan put in place allowing it to reopen”.

BreastScreen said “the decision to suspend screening” on August 19 “was made in response to the increasing risk posed by the COVID-19 Delta strain and a need to redeploy staff to support the pandemic response at each local health district”.

The service said redeployed staff worked in areas like vaccination, testing, support for Special Health Accommodation and relieving frontline workers who needed to quarantine.

Dr Zdenkowski said that a more nuanced approach should have been taken towards the statewide shutdown of BreastScreen, considering the vast differences across regions of NSW.

“So you have places like south-west Sydney and they have a much greater need for those workers to be doing other things beside BreastScreen, but when you’re outside that area I think that there’s no good reason for BreastScreen to close.”

A statement by the provider said, “the current situation is being monitored daily and BreastScreen NSW is working closely with services at each local health district to resume screening as soon as possible”. 

The service recently announced it would resume services in locations at less risk, however, clinics across the Hunter are yet to receive the green light. 

While the “decision to reopen will be made on a case-by-case basis”, BreastScreen NSW has assured existing patients “who had their bookings cancelled or were due for their mammogram during the suspension will be contacted to book as a priority”.

“We continue to urge any women experiencing breast symptoms to see their regular doctor without delay to get a referral for diagnostic testing, which continues to be the nationally recommended pathway for symptomatic women,” BreastScreen said. 

However, Dr Zdenkowski said that for many women, having their screening mammogram through a diagnostic testing provider wasn’t an option, which represented a huge issue of disparity between patients. 

“As BreastScreen is a universally accessible, free service, women unable to access private clinics as a result of financial constraints can [access BreastScreen],” he said.

“There are women doing telephone consults with their GP and they can ask to be sent to a private facility rather than BreastScreen to have their scans done. So they can still have a mammogram at a private imaging facility.” 

The oncologist said private practices were permitted to operate “because they’re diagnostic facilities – they’re primarily the practices for people who have a known health condition, or who are being assessed because they have symptoms”.

Their other functions include screenings such as mammograms. 

He said private facilities were now seeing an increased number of women going for routine screening mammograms, which created disparity because the clinics “may charge a fee”.

He said for those “who have the money and the health literacy to go and have their screen privately” it’s “all well and good”, but for others, it’s a very different story. 

While BreastScreen hasn’t indicated when exactly it will resume in the Hunter, petitions have emerged asking NSW Health Minister Brad Hazzard to prioritise its reopening statewide. 

Dr Zdenkowski suggested that anyone with concerning symptoms such as a breast lump, nipple inversion or discharge, a lump under their arm or swelling/inflammation in the breast should see their doctor without delay. These are potential symptoms of breast cancer, and the earlier the diagnosis and treatment, the better the outcome.

Maia O’Connor

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