Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Reporting mammographic density through BreastScreen – what next?  (126744)

Carolyn Nickson 1 2 , Bruce Mann 3 , Karen Canfell 4 , Louiza S Velentzis 1 2 , Paul Grogan 4
  1. The Daffodil Centre, Sydney, NSW, Australia
  2. The University of Melbourne, Melbourne, VIC, Australia
  3. Royal Melbourne Hospital and Royal Women's Hospital, Melbourne, VIC, Australia
  4. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia

Background

There is growing interest in a more risk-adjusted approach to breast screening. Breast density is an important consideration, with increased breast cancer risk and reduced screening sensitivity. Over 2019-2023 the Australian Government funded Cancer Council Australia to undertake the ROSA (Roadmap to Optimising Screening in Australia) Breast project, exploring options for more risk-based, personalised approaches to breast screening in Australia. Following comprehensive technical activities and stakeholder consultation, in October 2023 the project delivered its final evidence- and consensus-based recommendations, along with a 5-year Roadmap1. This report was commended by the Health Minister and helped prompt a review of the BreastScreen Australia program2. In May 2025, the Australian Government released an updated Position Statement recommending routine notification of breast density for BreastScreen participants3.

Methods

We review the ROSA Project recommendations and Roadmap in the context of recommended routine breast density notification.

Results

Various ROSA recommendations can be prioritised, for example:

  • Large-scale Australian clinical studies and trials to inform potential risk-adjusted breast screening can readily incorporate breast density assessment
  • Improvements to coordinated care pathways are pressing given that BreastScreen is not yet equipped to offer supplemental imaging to women with higher breast density
  • Enhanced BreastScreen data collection, monitoring and evaluation can include reporting of outcomes according to breast density
  • Improvements to health record sharing between services should extend to breast density assessments, addressing potential differences between assessment methods and changes over time

Conclusions

The ROSA Roadmap can help guide next steps following routine breast density notification to ensure that BreastScreen can continue to offer and manage screening tests through a population screening program, by working towards a more risk-adjusted approach. This will ensure the ‘best test for the breast’ is equitably available to women with higher breast density, with good continuity of care through regular screening and high-quality monitoring and evaluation.

  1. Nickson C, Velentzis LS, Mann GB, Grogan P, Bateson D, Canfell K. Risk-adjusted breast screening: an Australian perspective and considerations for the Western Pacific. Lancet Reg Health West Pac. 2025 Mar 19;57:101520.
  2. Review to improve BreastScreen Australia Program. Media Release, The Hon. Mark Butler MP. 27 October 2023. Available from: https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/review-to-improve-breastscreen-australia-program
  3. BreastScreen Australia Clinical Advisory Group. BreastScreen Australia Position Statement on Mammographic (Breast) Density and Screening. Date of advice: 6 November 2024. Date released: 30 May 2025. Available from: https://www.health.gov.au/resources/publications/breastscreen-australia-position-statement-on-breast-density-and-screening