Breast cancer is the most common cancer in Australian women. The good news is that more Australian women are surviving it than ever before, and Australia ranks highly among its developed-economy peers in terms of patients’ access to cutting-edge treatments, mortality rates and chances of long-term survival. Nevertheless, it also shares with other rich countries a rising incidence rate as its population ages. And although advanced in several senses, breast cancer control in Australia faces some unique challenges.

For this report, Getting it all together: Connecting Australian breast cancer care, the Economist Intelligence Unit interviewed a range of experts working across the breast cancer field, from research to prevention to treatment, to provide a status report on Australia’s bid to eliminate the disease. Putting its efforts in an international context, the report examines what Australia is doing well, where it still faces challenges and how experts think these might be overcome. It also includes a variety of “best-practice” case studies on innovative local, national and international initiatives. The conclusion outlines what experts see as priorities in the continuing struggle against the disease.

One theme that unites the majority of findings of this paper is the importance of co-ordinating and connecting the various parts that together constitute a comprehensive national breast cancer control programme. Given the sheer number of people and institutions involved, it is not surprising that coordination among them is not always optimal: the “fragmentation factor” remains present in various aspects of research, funding and treatment. To be sure, Australia is among the global leaders in many aspects of its approach to tackling the disease, but improving connections—whether between the federal and state governments, the public and private health systems, NGOs and public bodies, researchers and clinicians, or cancer specialists and GPs—is a priority across the breast cancer field. Other key findings of the report include:

• Progress in early detection and treatment is impressive, but growing incidence demands continued focus. Headline mortality and survival figures for breast cancer in Australia have been steadily improving. This is due to the government’s commitment to evidence-based guidelines for the management of breast cancer treatment, robust funding, and a high degree of collaboration between breast cancer organisations. Internationally, Australia ranks above many of its peers in terms of incidence, mortality and screening. However,
  Australia’s own screening goals among targetdemographics have not yet been reached, and a rising incidence rate demands continued effort to maintain progress.

• A patient focus has led to good co-ordination between breast cancer bodies, but streamlining funding remains a challenge. A high degree of collaboration between breast cancer organisations across the field, together with a culture of multidisciplinary care and a strong consumer focus, have helped offset the inefficiencies of a complicated health system. However, there is no overall co-ordination of funding for initiatives related to breast cancer, inhibiting long-term investment. This also makes it tougher for NGOs, some of which question the long-term sustainability of their funding obligations. Like other countries frustrated with such fragmentation, Australian NGOs are working towards a national plan to co-ordinate priorities in strategy and funding.

• Better data co-ordination is a priority. Putting together evidence-based programmes demands quick access to comprehensive data sets. But it is far from easy to get sufficient national figures in Australia: data collection systems are incompatible, each of the states controls its own cancer registries and data applications can take months. There are also big gaps in the information on what happens to patients once they start treatment. Cancer Australia and leading NGOs have identified unifying data as a priority; innovations from elsewhere (such as the UK’s national tissue bank, the first of its kind in the world) underscore how important access to unified sources of information is for breast cancer researchers.

• Too little attention is being paid to prevention. Many think Australia (in common with many countries) pays too little attention overall to breast cancer prevention. This will demand increasing focus as geneticrisk profiling advances, particularly to fund follow-up studies on lifestyle and preventative intervention. The government is targeting more preventative healthcare in general, but identifying breast cancer risk factors—and communicating them effectively—remain a challenge.

• Translating research into clinical practice and strengthening multidisciplinary care are increasingly important. Although in its early days with regard to breast cancer, genomic research leading to personalised treatments will put a greater emphasis on translating research into clinical practice, as is happening in major cancer research centres in Canada, the UK and the US. In Australia, translational research is now on most funders’ agendas, and the development of the new large cancer centres is partly to facilitate closer links between scientists and clinicians. Regarding treatment, Australia’s public sector has a strong culture of multidisciplinary care, but there is scope for even greater integration of research with clinical practice, and for more aspects of treatment and post-treatment care to be co-ordinated.

• Some population groups are doing worse than others. As with many other diseases, breast cancer sufferers in remote and rural regions can expect worse outcomes. This is because cancer care services tend to be centralised in the cities: long travel times delay diagnosis, meaning sufferers are less likely to identify the disease early. Rural and remote communities also tend to be poorer and have greater incidence of associated lifestyle risks like smoking and obesity. Some innovative NGO-led community programmes have made headway in reaching these regions, but the problem is that the difference in breast cancer outcomes is just one of many such healthcare disparities.