Unacceptable delays of preventative mastectomies create a ticking time bomb

Unacceptable delays of preventative mastectomies create a ticking time bomb in women with high genetic risk of breast cancer.

Bi-partisan Federal support includes review of priority access to critical surgery.

A united and unprecedented position statement from Breast Surgeons of Australia and New Zealand (BreastSurgANZ) and Breast Cancer Network Australia (BCNA) will be made to the Federal Government to improve access for women wanting preventative mastectomies due to high genetic risk.

5-10% of breast cancer diagnoses each year are a result of genetic mutations, which are estimated to cost the Australian healthcare system up to $79 million.

Some women with an inherited high risk of breast cancer have over a 70% chance of developing the disease. A prophylactic bilateral mastectomy removes both breasts to reduce their risk by at least 95%, but risk reducing surgeries are not consistently classified as semi-urgent elective surgeries in public health services.

Some of those wanting a prophylactic mastectomy are being forced to wait up to 5 years to have this surgery. 

BCNA Director of Policy, Advocacy and Support Services Vicki Durston says those with inherited risk factors feel like a ticking time bomb but are repeatedly told by hospitals that they are not a priority.

“Knowledge of risk is empowering but it becomes a feeling of being powerless when forced to spend years on public wait lists for risk reducing surgery. It’s a constant state of fear compounded by lack of transparency regarding timelines and the reality is some will receive a breast cancer diagnosis whilst waiting.”

BCNA reports that many women feel they have little choice but to enter the private system to safeguard their health.

“Out-of-pocket costs can be up to $50,000, women are drawing on their superannuation or borrowing money to buy themselves protection which is not a viable option for most.”

Federal Health Minister Mark Butler and Shadow Minister Senator Anne Ruston will today, meet the Australian Access to Breast Reconstruction Collaborative Group (AABRCG) that includes BCNA to formally support their call for prioritising access to prophylactic mastectomy for people with inherited high risks of breast cancer. 

Recommendations include a complete review of the current National Elective Surgery Urgency Categorisation guideline established in 2015 that surgeons, State and Territories use to prioritise surgeries in the public health system.

Currently prophylactic mastectomy is not included in the guideline and as a result is treated as a category 3, non-urgent procedure.

Dr Melanie Walker, Chair of the AABRCG and President of BreastSurgANZ says the society has endorsed the position statement amid concerns of persistent delays and inconsistencies across a non-legislated framework: “The guidelines have not kept pace with the rapid evolution of prevention strategies in the surgical space, resulting in patients waiting as long as five years”.

Dr Walker admits the delays fall well short of what is considered timely access to this critical intervention.

“Prophylactic mastectomies not only spare individuals from enduring cancer treatments such as chemotherapy and radiation but also reduce long-term healthcare costs, including ongoing surveillance. Preventative surgery is often quicker and less resource-intensive than cancer treatment, allowing us to free up surgical lists and optimise system efficiency throughout the entire health system.”

The AABRCG is also proposing the Federal Government lead the establishment of a national, standardised system for collecting and reporting on prophylactic mastectomy data related to inherited breast cancer risk to help inform future policy. 

About the Australian Access to Breast Reconstruction Collaborative Group 

The Australian Access to Breast Reconstruction Collaborative Group (AABRCG) is dedicated to advocating for improved access to breast reconstruction services across Australia by bringing together primary care expertise and cancer policy and research.

The group was established in 2020 as a partnership between Breast Surgeons of Australia and New Zealand (BreastSurgANZ), the Australian Society of Plastic Surgeons (ASPS), and Breast Cancer Network Australia (BCNA). 

Related resources

• Prioritising access to risk-reducing surgery