Breast Density Workshop Adelaide papers online

Ok that’s it folks - hope this has been of interest but please note they are just my impressions for better or worse and provided in the hope it helps someone.

Mary Rickard is a Radiologist. She indicated there is no single agreed way of measuring breast density - a matter identified as an important issue to the medical community by both Wendy Ingaman and Nehmat Houssaini .

She discussed the method used most commonly here and available in private practice but explained software differences generated different cut off points for each of the 4 levels of breast density.

She also addressed the fear of overdiagnosis with risk of false positives and incipient costs in $ and time as not all patients with dense breasts will develop breast cancer.

Jennifer Stone is a statistician who has carried out an extensive study of breast density in WA. WA is the sole Australian state that reveals breast density to people undergoing mammograms.Her work is yet to be published and she has asked we did not copy her results.Her paper is not provided online.

 I think it is ok to say whilst most of those surveyed wanted to know their breast density and knew it made mammography less effective they did not know it increased their risk of breast cancer. 

Oops forgot to mention the Workshop convenor Wendy Ingman gave a first class overview of breast density , it’s  causes and how different countries are providing/ not providing this information to women.Well worth a read.

I had the impression later that the inability to accurately measure breast density across both public and private health systems may be a  contributory factor to the ANZRC lack of support for revealing breast density to patients undergoing mammography. Basically fear of being sued .

Bernadette Richards from the Adelaide University Law school was brilliant but my goodness she talked fast and her slides belie the depth of her delivery. I am probably a bit biased as I have a legal background but I found her comments very interesting especially this piece from case law.

Rogers v Whitaker (1992) 175 CLR 479 “The law should recognise that a doctor has a duty to warn a patient of a material risk inherent in the proposed treatment; a risk is material if, in the circumstances of the particular case, a reasonable person in the patient’s position, if warned of the risk, would be likely to attach significance to it or if the medical practitioner is or should reasonably be aware that the particular patient, if warned of the risks would be likely to attach significance to it.”

I think the thrust of her delivery was the duty care attached to us all and this citation identified precedent for maybe medical negligence litigation.

Agreed @JJ70 . What Radiologist Mary Rickard seemed to indicate was the technology  for grading was available pretty much only in the private sector which brings up equity issues for those without private health insurance.

Oops as I’m a breast cancer survivor am probably not the best to comment on the two ethics speakers as to me it is a deeply personal issue. I admit to being unsettled seeing ethics in the workshop title as I see it as my body and my right to be informed about it. I am aware Ethics is becoming an increasingly used word in many areas including medical.The two speakers whilst very verbally adept did not sway my initial thoughts tbh. I don’t see this as a philosophical argument as did another bc survivor in the audience who gave voice to my thoughts.I tend to think certain areas of life are very much up to the individual not a matter for ethicists to debate.

ALL women should be informed of their breast density in simple terms. It is just NOT OK to allow women to think they have been for a mammogram and received a clear result, when in fact the readability of the mammogram was compromised by density.
 Your mammogram could be graded for it's 'readability' (a-d) in terms of density, with an explanation of low to high density. Then this could be discussed with a GP and further assessment sort if wanted or necessary.

 I refer to A/Prof Wendy Ingman's presentation: 

file:///C:/Users/Owner/Desktop/BC/can%20do%20campaign/Density/density_workshop_ingman_2018.pdf

 I’ll write about it more later but the issue Breast Screen and ANZRC seems to have is objectively measuring the level of breast density as the more dense the breast the greater the risk of an inaccurate mammogram.They seem to have concern about a substantial amount of unnecessary testing causing stress / yep cost/ possible health issues as well as the risk of litigation .