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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

ID: 
21
Personal Details
First Name: 
Professor Patrick
Last Name: 
Brennan
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Breast cancer is the most commonly reported cancer experienced by Aboriginal and Torres Strait Islander women. Whilst Indigenous females are 20% less likely to be diagnosed with breast cancer, they are 1.3 times more likely to die from breast cancer compared with non-Indigenous women. Indigenous women are also more likely than non-Indigenous women to be diagnosed with breast cancer at a younger age, have advanced breast cancer, present with larger tumours and be treated by mastectomy rather than removal of tumour. Early detection of the disease is critically important, yet for this group of women the optimum imaging method is poorly understood since little is known about Indigenous mammographic breast density, a key determinant of the success of breast cancer imaging. In addition early screening which is essential for this group of women is not being achieved with attendance at screening being only around 30%
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
Cancer control is one of the Australian Government's stated health priorities. In addition in the 2014/15 Australian Government budget it is clearly stated that "The Australian Government is committed to the delivery of effective and efficient health services for Aboriginal and Torres Strait Islander people". The main aim is to close the gap and establish health equality between indigenous and non-indigenous individuals in Australia. This TCR would be completely aligned to these objectives.
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
Aboriginal and Torres Strait Islander women accounted for 3% (335,788) of the Australian population, however, their health is often affected adversely by severe socio-economic disadvantage and cultural marginalization . 89% percent of non-Aboriginal girls can expect to live to age 65, as compared to 54% of Aboriginal and Torres Strait Islander girls (AIHW, 1994). Breast cancer is the most commonly reported cancer experienced by Aboriginal and Torres Strait Islander women and the second leading cause of cancer death after lung cancer. It is interesting to note that indigenous women are significantly less likely to be diagnosed with breast cancer compared with their non-indigenous counterparts, however mortality from breast cancer in in the former is 55 per 100,000 women, compared with the non-Indigenous rate of 47. Our work by establishing knowledge around the optimal screening method and the reasons why screening is not embraced by the indigenous communities should transform breast cancer mortality and morbidity within the indigenous community.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Breast cancer is the most commonly diagnosed carcinoma among Australian women. It accounts for 25% of all female cancers reported and one in eleven Indigenous women are at risk of developing the disease. Whilst Indigenous females are 20% less likely to be diagnosed with breast cancer compared with non-indigenous women (83 and 103 per 100,000 respectively), the mortality rate for this disease is higher (48 compared with 44 per 100,000 respectively). In addition, Indigenous compared with non-indigenous women with breast cancer are more likely to have advanced disease, present with larger tumours or tumours with more distant spread; and are 30% less likely to be hospitalized for their cancer. Whilst there have been significant improvements in breast cancer survival for the general Australian population as a result of earlier diagnosis through screening mammography, improved treatments and access to services, not all have benefitted with Indigenous women continuing to experience significantly lower 5-year crude survival rates. Reasons for these inequalities are multifaceted and may be attributed to a combination of factors including but not limited to socioeconomic disadvantage, reproductive and hormonal factors, family history, remoteness, co-morbidities and advanced stage of cancer at the time of diagnosis. However, the lack of awareness of mammographic density - a critical indicator of the success of any screening program and the low participation in screening programs are seen as important causal agents: Breasts with increased density present greater diagnostic challenge since cancers will appear similar to dense regions within the breast; Only 35.5% of eligible Indigenous women participate in the National breast screening program, which is a 19% lower rate than non-indigenous women. In addition Indigenous women are less likely to participate in re-screening within the recommended 27 months and attend post-screening assessment within the recommended 28 days if recalled, than their non-Indigenous counterparts. It is well known that early detection of breast cancer through optimum and early screening can reduce mortality. Therefore if breast cancer mortality amongst Indigenous women is to be reduced, identification of optimum screening methods and increasing participation rates for initial and re-screening must be achieved.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
REPORTS: AIHW 2009. Australian Institute of Health and Welfare. Breast cancer in Australia: An overview. Australian Government Publishing Service, Canberra; 2009. AIHW 2011. Australian Institute of Health and Welfare. BreastScreen Australia monitoring report 2010–2011. Australian Government Publishing Service, Canberra; 2011. Australian Institute of Health and Welfare & Cancer Australia 2012. Breast cancer in Australia: an overview. Cancer series no. 71. Cat. no. CAN 67. Canberra: AIHW. Cancer Australia 2012. Study of breast cancer screening characteristics and breast cancer survival in Aboriginal and Torres Strait Islander Women of Australia. Cancer Australia, Surry Hills NSW Australian Institute of Health and Welfare 2015. BreastScreen Australia monitoring report 2012–2013. Cancer series no. 95. Cat. no. CAN 93. Canberra: AIHW. REFERENCES: Mandelson MT, Oestreicher N, Porter PL, et al. Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 2000;92:1081-7 Van Gils CH, Otten JDM, Verbeek ALM, Hendriks J, Holland R. Effect of mammographic breast density on breast cancer screening performance: a study in Nijmegen, the Netherlands. J Epidemiol Commun H 1998;52:267-71

Page reviewed: 30 August, 2018