Jul 302011

This article appeared in the Australian press yesterday.spot the lump

As the partner of a woman who has recently travelled the breast cancer trail I could see the implications behind such findings. Publically funded disease screening programs cost money. That’s why Australia doesn’t have an open, publically funded bowel cancer screening program. Such things are swayed by cost. Cost versus benefit. Cost to the collective public purse against the benefit of intercepting future costs of treatment for the naive, greater unwashed. Money. In the case of treatable disease, like colon cancer, breast cancer and the like, the cost versus benefit argument really holds no sway in my view. Consider Chest X-ray screening, of which Australia has no publically funded screening program. The rationale is simple. Chest X-ray screening is primarily conducted for the detection of lung cancer as a direct result of tobacco smoking. Do we all not already know that tobacco smoking is deleterious to our health? And why is that? Because weight of medical and scientific evidence, public health warnings on cigarette packets, anti-smoking vested interest groups have all, since the early part of the 20th century, warned us against taking up the habit. With all the money being spent through legislation and by public interest groups, there is simply no cost –v- benefit requirement for government to foster a chest x-ray screening program. We’ve got the message.

However, how many women from age 50 don’t engage in the BreastScreen Australia program because they either aren’t aware of it, think it doesn’t apply to them, or adopt the attitude ‘it won’t happen to me’? There are enormous numbers who simply never give it a thought. Equally, there is statistical evidence to support broadening the scope of that one program to women aged 40 & over. Should we, the tax-payer, be concerned about what statistics which measure cost against benefit say, when the ‘benefit’ is itself governed by a mortality-per-dollar-spent figure? Surely there is an ethereal but equally justifiable benefit in offering a means of re-assurance to those within the defined age groups at least? The message about breast cancer is no-where near as widely spread as that for lung cancer & tobacco smoking. Breast cancer is not a lifestyle disease as is smoking induced lung cancer. Breast cancer can strike anyone, male or female but primarily women. How you live your life is not a determinate. Your genes, your body chemistry and structural make up of the breast tissue itself seems to be the primary determining factors. Having ‘lumpy’ breasts doesn’t mean breast cancer, it could simply mean calcified milk ducts and mammography is not a 100% fool-proof means of detection either. But it IS at least 80% effective and that’s better than nothing. Detecting, via X-Ray or digital mammography, that vague looking pale white area within a breast which looks like it shouldn’t be there is hugely more beneficial than rolling fingers over the breast and maybe-maybe not feeling what the average person has no chance of recognising anyway.

Breast Cancer screening, Cervical Cancer screening and now the invite-only Bowel Cancer screening pilot programs are vital public interest, tax-payer funded research programs. Yes, that’s right, research programs. These programs gather data. Sure, they detect things which may not otherwise be detected & treated, but in their purest form they are research programs. If breast cancer is detected, BreastScreen Australia will pass you on to the next level of state or federally funded treatment regime. In Queensland, or at least Brisbane, that’s conducted by the Mater Public Hospital system. It’s an excellent system, entirely ‘free’ to the participant, filled to the gunwales with caring people who are well trained in their roles. The doctors and scientists sometimes leave a lot to be desired, but they are evidence of the research aspect of the program which funds them. My entire point in writing this piece though, rests on the mental aspect of these programs and why I believe the mental aspect to be so important. Studies such as the one linked to above the fold are false in my perception. Peace of mind is a far greater benefit to the recipient of the service than any weight of dollar spent. It’s a life-shattering experience to be screened and have positive results uncovered. The treatment is horrific, despite the care and attention lavished by the support staff. The mental aspects, at least from my experience, are on-going years after treatment regimes end, but it’s the comfort of the system, the knowing that it’s there and that it supports the participant from the moment of detection until five years from the end of treatment which simply cannot be measured in dollar terms. Cost –v- Benefit in mortality terms? Yes, that’s measureable. Cost –v- Peace of Mind? Immeasurable, priceless even. What’s more important, the knowing & treatment, or the ignorance and anxiety often accompanied by the mortality? I know where my dollars lie and I do not regret that position one iota.

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