Jane Estoesta

Mammography screening and breast cancer mortality in New South Wales, Australia.

AbstractObjective: To investigate the relationship between utilisation of service mammography screening and breast cancer mortality in New South Wales (NSW) women. Setting: Population-based biennial mammography screening was progressively introduced in NSW from 1988, with active recruitment and re-invitation for women aged 50–69 years, and reached full geographic coverage by 1996. Biennial mammography screening participation has varied widely over time and by municipality. Methods: Breast cancer mortality by age, period and municipality was obtained from the NSW Central Cancer Registry. Biennial mammography screening rates for the same strata were obtained from the BreastScreen NSW database. Temporal changes in breast cancer mortality for NSW were summarised as annual average declines using Poisson regression. Breast cancer mortality for 1997–2001 was examined in relation to lagged biennial screening rates by municipality, adjusted for age, area socio-economic and geographic indicators, and breast cancer incidence, also using Poisson regression. Results: For the 50–69 year age group, the mean annual breast cancer mortality decline was 0.8%(not significant) for 1988–1994, and 4.4%(p < 0.0001) for 1995–2001. Statistically significant negative associations between breast cancer mortality in 1997–2001 and lagged biennial screening rates were found with the highest significance at a four-year lag for women aged 50–69 years (p= 0.0003) and also for women aged 50–79 years (pc = 0.0002). From the regression coefficient, a 70% biennial screening rate is associated with 32% lower breast cancer mortality (compared to zero screening). Conclusions: The effect of population-based mammography screening on breast cancer mortality in NSW inferred using this method is consistent with results of trials and other service studies. This suggests that population-based mammography screening programs can achieve significant reductions in breast cancer mortality with adequate participation.

Fertility control? Middle-aged Australian women's retrospective reports of their pregnancies

Objective: To assess middle‐aged Australian womens retrospective reports of how intended and wanted were their pregnancies, and the degree of happiness associated with these pregnancies.

Contraception and pregnancy then and now: Examining the experiences of a cohort of mid-age Australian women

Background: More than 50% of women who have an unplanned pregnancy report using a contraceptive method. Since the launch of the pill 50 years ago, a number of cross‐sectional surveys have examined contraceptive use in the Australian context. There is, however, little data on contraceptive use and efficacy over a womans reproductive years.

Age-specific interval breast cancers in New South Wales and meta-analysis of studies of women aged 40-49 years

Objective: To compare interval cancers in the 40–49 year age group with other age groups in New South Wales and with published trials and service studies. Setting: New South Wales data were derived from the population-based biennial mammography screening program, which achieved state-wide coverage in 1995. Women aged 40–49 years screened during 1995–1998 were included. Methods: Bilateral two-view mammography with reading by two radiologists was employed for biennial screening examinations. Interval cancers were detected by the screening program and by linkage with the state-wide cancer registry. Incidence of interval cancer based on the date of diagnosis was estimated as a proportion of the expected underlying breast cancer incidence for first- and second-year interval cancers. Sensitivity estimates were also calculated. Comparative data for the 40–49 year age group were derived from the published literature for meta-analyses of trial and service studies. Results: Interval cancer rates for New South Wales decreased with increasing age, with the highest proportional incidence in the 40–49 year age group for first year (56%, 95% confidence interval [CI] 50–62%) and second-year (86%, 95% CI 82–90%) interval cancers. Proportional incidence for women aged 50–69 years for first- and second-year interval cancers was 31% (95%CI 29–33%) and 50% (95% CI 47–52%) respectively. Sensitivity estimates for the program increased significantly with age, with lowest sensitivity estimates evident for women 40–49 years. In women aged 40–49 years the meta-analysed proportional incidence rate for randomised trials of screening for first- and second-year interval cancers was 42% (95% CI 21–62%) and 63% (95% CI 55–71%) respectively, while for service studies it was 44% (95% CI 31–58%) and 72% (95% CI 51–92%). Proportional incidence in the New South Wales program for women aged 40–49 years was not significantly different to the meta-analysed proportional incidences for trial and service studies in the first year, or for service studies in the second year. Conclusion: Proportional incidence of interval cancer was significantly higher in women aged 40–49 years in New South Wales relative to older age groups, but did not differ significantly from service studies of women in a similar age group. The effectiveness of mammography screening for this age group needs to be examined in view of the comparatively high rate of interval cancers.

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

BackgroundAustralian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs.MethodsWe undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically.ResultsThree main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted.ConclusionsExploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women.

Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia

BackgroundImproving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia.MethodsWe undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services.ResultsThis review identified the dimensions of access to surgical and medical abortion at clinic or hospital-outpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care.ConclusionsKey insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical abortion. However, to implement such directives leadership is required from Australian medical, nursing, midwifery and pharmacy practitioners, academic faculties and their associated professional associations. In addition, political will is needed to nationally decriminalise abortion and ensure dedicated public provision that is based on comprehensive models tailored for all populations.

Prevalence and associated factors of urinary leakage among women participating in the 45 and Up Study

The study was undertaken to investigate the prevalence of urinary leakage and its associated factors among a sample of females aged 45 years and over in New South Wales.

Interval breast cancers in New South Wales.

This article describes a study that examined the effectiveness of mammographic screening offered to 50–69 year old women in NSW through BreastScreen NSW in 1996.