DRAFT
Introduction
Since 1991, Australia has had a national program to encourage women to screen for
breast cancer. Under the auspices of the national program, the state based BreastScreen
NSW program has a network of 40 regional centres and 18 mobile units that tour NSW.
The first screening units became operational in 1989 and state-wide coverage was
achieved in 1995 (BreastScreen NSW, 2008). The BreastScreen program offers free
screening mammograms to women in the target age group of 50 to 691 and encourages
them to screen every two years.
The program uses a number of strategies to recruit women to the program and then to
retain them by encouraging biennial screening in subsequent years. To aid recruitment,
women turning 50 years of age are sent an initial letter of invitation. To help women
become regular screeners, a reminder letter is sent when two years have lapsed since the
last screen. In addition, some strategies are aimed at both recruiting and retaining
women. These include wide ranging media campaigns to provide information about
breast cancer, the benefits of screening and details of the BreastScreen program. Such
strategies inform, emphasise and remind women about the importance and timeliness of
screening and are aimed at changing the perception or expectation of benefits associated
with mammography.
Breast screen services abide by a set of nationally determined program objectives
(Australian Institute of Health and Welfare, 2000). Two of these are relevant in the
context of participation. First, the program aims to achieve a participation rate of 70%
amongst women aged 50 to 69 years. Second, the national policy states that the program
selects women for screening on the basis of age alone2. This implies that amongst
1 The program does not offer mammography services for diagnostic purposes. Diagnostic mammograms
are usually provided in the private sector and subsidised by the Medicare program
2 From an epidemiological perspective, important variations in risk may occur within the target-age group
related to hereditary or other factors. However, program objectives have not identified priority groups
within this target age group. Instead, the program’s objectives and policies imply that each woman in the
age group is deemed to be of equal priority