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Mammogram still best option for breast checks

Thursday 3 April, 2014 by Terry Slevin & Rebecca Johnson

When you undergo a test or treatment that aims to improve your health, how do you know it will work?

Unless you or someone you know has had it done before, or you have some technical expertise of your own in the area, the truth is most people have to rely on the advice of the person offering the health service.

In most cases it works out OK – but not always.

Sometimes tests and treatments don't work out well because experts have not yet found a solution to the health problem we present, often because a better scientific understanding is needed. Good research based on sound science is the key to unlocking the mysteries of human health.

Sometimes, happily more rarely, they don't work out well because the people we rely upon let us down. They may not rely on the best available science, or may not be appropriately trained to give health advice in that field. The sad reality is some people have a stronger interest in making money than in providing a sound and effective health service.

Most of us rely on the assumption that a system is in place to ensure that health-related advice and services are well regulated, effective and the people who run them are well trained and honest. There are indeed many mechanisms in place but the system is not perfect. Some still slip through the cracks.

Last month, the Australian Competition and Consumer Commission won Federal Court cases against two companies for misleading and deceptive conduct. They promoted breast cancer testing using devices that have not been proven to be able to detect cancer.

First Breast Check and then Safe Breast Imaging were successfully prosecuted for making claims that their testing technology could identify breast cancer at an early stage. In both cases, the judge found they did not have sufficient scientific evidence to support their claims.

Both cases were brought to the ACCC's attention by Cancer Council Western Australia. Breast cancer screening using mammography has a powerful body of evidence to support it and is subject to intense scientific scrutiny – a critical aspect of quality assurance.

By contrast, the accuracy of the devices used by alternative breast imaging services is unknown and untested. Women who rely on a "clear" scan from one of these services may in fact have undetected breast cancer and can lose precious time seeking diagnosis and treatment, turning up with more advanced cancer and in all likelihood, a poorer prognosis.

These cases make clear that any health service provider promoting a test, treatment or cure should do so based upon reliable evidence that the claims they make have a solid scientific basis. If not, as in the case of the two breast imaging companies, they may be subject to the full weight of the law.

It is of note that these cases were not prosecuted under health-related legislation but rather under the consumer law; the two companies were found to be in breach of the Competition and Consumer Act.

These cases remind us that health programs and services are not only a public service, they are also a business. A very big business. Each week, millions of dollars are spent on health-related services. Increasingly, those dollars are spent in the private sector where unfortunately "buyer beware" is becoming a necessary dictum.

As a result of the ACCC action, the number of companies offering unproven forms of breast cancer testing has shrunk to virtually nil. Compared with a few years ago, there are very few, if any, women putting faith in unproven technologies to determine whether they have breast cancer.

While it is important to make clear that mammography is far from perfect (there is no "perfect" test, for breast cancer or anything else), it is still the best form of population-based early detection we have for breast cancer.

Terry Slevin is the director of education and research, at Cancer Council WA. Rebecca Johnson is a public health legal adviser.

This article first appeared in The West Australian

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