Australian Doctor Australian Doctor 28th July 2017 | Page 3

Rethink on breast screening after 70
JOCELYN WRIGHT
WOMEN should be given
an informed choice about
whether to continue breast
screening
mammography
beyond the age of 70, public
health experts say.
New data show a less
favourable benefit-to-harm
ratio for screening mam-
mography for ages 70-74
compared with stopping at
69, according to Australian
epidemiologists.
Researchers from the Uni-
versity of Sydney applied
UK data on mammogra-
phy screening outcomes
to the Australian program
and found that continuing
beyond the age of 70 would
result in more false-posi-
tives, biopsies and imaging
compared to breast cancers
deaths prevented (see box).
“Some women will be
happy to choose to continue
screening until age 74, even
though they may experience
more anxiety, inconven-
ience, and physical adverse
effects; other wo men will
HARMFUL RATIOS
For every 1000 women who continue screening to age 74*
• O
 ne woman avoids dying from breast cancer
• 7
 8 women receive a false-positive result
• 8
 women are overdiagnosed and overtreated
* Compared with stopping screening at 69
Deciding whether to continue screening is a tough call for patients, says Professor Jenny Doust.
not,” the researchers said.
Study author Gemma
Jacklyn said the estimates
could be used to help older
women feel more comfort-
able with their screening
decisions.
“It means that GPs can go
through the numbers with
them, and hopefully help
them with the more detailed
and nuanced questions that
might arise from these num-
bers,” she told Australian
Doctor.
Doctors have mothing to fear from patients
recording consults, experts say
AMANDA DAVEY
record consultations is nearly
always “reasonable”, in that
it’s simply used to improve
recall and understanding of
medical information or to
share it with family, wrote Dr
Glyn Elwyn and colleagues
from the Dartmouth Institute
for Health Policy and Clinical
Practice in New Hampshire,
US.
Developing “clear policies
that facilitated the positive
use of digital recordings”
would help to minimise the
growing practice of covert
recordings.
AN increasing number
of patients are recording
consultations on
smartphones, but that’s
not necessarily anything for
doctors to fear, health policy
experts say.
In a recent Journal of
the American Medical
Association article, they say
patients may stand to benefit
more than their doctor, but
that’s no reason to deter a
practice that is only going to
become more common.
Patients’ motivation to
MDA National has
previously warned that
covert recording, given
easy access to smartphone
technology, was on the rise
in Australia.
In 2015, a patient received
a good behaviour bond
after using a pen camera to
secretly record a female GP
performing an examination
for a groin hernia.
MDA National medicolegal
manager Dr Sara Bird it
was unlikely that covert
recordings could be admitted
as evidence in court as part
of a medical negligence
case.
However, the key factor
would be whether the
probative value of the
evidence outweighed the
prejudice of admitting it.
“If a GP has a high index
of suspicion that a recording
will be or is being made, the
GP should raise the issue
with the patient,” she said.
It was also illegal to
communicate or publish the
recording to any third party
without the GP’s permission.
JAMA 2017; online.
Facebook has no guts in obesity fight
GEIR O’ROURKE

tactics,” a spokesperson told
Australian Doctor.
“There are plenty of ways
they could promote this
campaign on Facebook
without using body-shaming
tactics.”
Eating disorder researcher
and self-described “fat activist”
Sarah Harry agreed.
FACEBOOK is being labelled
anti-health for blocking a public
health campaign that used a
“grabbable gut” advertisement
targeting obesity (pictured).
The campaign features a
photo of a big belly above an
image of intra-abdominal fat
with the slogan “grabbable gut
outside means toxic fat inside”.
The campaign’s creator,
LiveLighter, a joint program of
the WA Department of Health,
the Heart Foundation WA and
Cancer Council WA, says the
advertisement conveys a vital
message in the fight against
obesity, which affects 63% of
Australian adults.
But Facebook deemed the
ad offensive.
“We are not prohibiting anti-
obesity campaigns, but instead
prohibiting body-shaming
“This ad is disgraceful and
I’m very happy they have
refused to run it because
campaigns like this promote
shame and discrimination,”
she said.
The rejection has outraged
WA AMA president Dr Omar
Khorshid, who said Facebook
was “pandering to the ‘health
at every size’ crowd”.
“Facebook has made the
wrong decision,” he said. “The
confronting imagery in the ad
may be the catalyst required
for people to eat better, get
active and start taking control
of their health destiny.”
LiveLighter campaign
director Maria Szybiak insisted
the images had been proven
to be effective and did not
stigmatise anyone.
She said it was not the
first time the public health
campaign had been blocked
over concerns about body-
shaming since first airing in
2012.
“But these media are
more than happy to sponsor
advertisements from junk food
giants directly contributing to
the obesity epidemic we are
seeking to reduce,” she said.
www.australiandoctor.com.au
A spokeswoman for the
BreastScreen Australia said
the move to extend the age
range for mammography
to ages 70-74 in 2013 had
been based on a thorough
review of the evidence.
“The Commonwealth is
currently planning to under-
take an evaluation of the
BreastScreen Australia pro-
gram expansion,” she said.
Brisbane GP and Bond
University epidemiologist
Professor Jenny Doust said
deciding on whether to con-
tinue screening was a tough
call for women to make.
“Of course nobody wants
to think ‘I’m too old to ben-
efit now from screening’,”
she said. “I tend to try and
just lay out the all the infor-
mation and leave it to the
women to decide.”
However it was difficult
to do this in the context of
a 10-15 minute GP appoint-
ment, she said.
Weighing up the benefits
and harms of breast screen-
ing mammography involved
complicated trade-offs, and
public health campaigns
could mislead women by
sending the message that
screening was essential for
their health, she said.
“If false positives were the
main harm of screening you
could put up with it, but it’s
really not clear that [screen-
ing] is beneficial,” said Pro-
fessor Doust.
International Journal of Cancer
2017; online.
In Brief
Staff writers
Cancer’s ‘toxic’
financial burden
HALF of all Australian cancer
patients experience financial
stress and money problems
often impact their treatment
decisions, new analysis by
the Cancer Council Australia
suggests. “Out-of-pocket costs
in addition to other factors are
leading to what has been described as financial toxicity in
people with cancer,” said the council’s CEO Professor Sanchia
Aranda. “We think that people are not getting the i nformation
they need. A classic example is robotic surgery for prostate
cancer. There is actually no evidence that it is any better than
open surgery. People are paying $15,000-$20,000 out-of-
pocket because they think it’s the best option.”
Legal action launched over death in custody
THE family of a 22-year-old Aboriginal woman, whom the State
Coroner ruled was treated inhumanely in the lead-up to her
death in police custody, is launching legal action against the
WA Government. Ms Dhu, whose first name is not used for
cultural reasons, died during her third visit in as many days to
the Hedland Health Campus from staphylococcal septicaemia
and pneumonia after an infection in her fractured ribs —
caused by her partner — spread to her lungs. Some police
testified during the inquest that they thought Ms Dhu, who was
in custody because of unpaid fines, was faking illness, while
some medical staff thought she was exaggerating and had
behavioural issues.
Best healthcare system in the world
AUSTRALIA’S healthcare ranks second in a selection of 11
developed countries. The international rankings were published
by US-based Commonwealth Fund and are based on a cross-
section of measures, including mortality rates, outcomes,
spending, equity, access and patient satisfaction. The UK’s
National Health Service came out top. The US, which spends
17% of its GDP on health compared with 9.4% in Australia,
was ranked last, just behind France.
Read the full Commonwealth Fund report
here: bit.ly/2v03Mhu
28 July 2017 | Australian Doctor |
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