Breast Cancer is the most common cancer affecting women in Australia. However, Australia also has some of the best cancer survival rates in the world, largely due to extensive efforts to detect and treat cancer early. October marks Breast Cancer Awareness Month which provides an opportunity to reflect on how far we’ve come in terms of understanding the importance of screening, as well encourage conversations about how we can improve access to screening for all women and gender diverse people in Australia.
In Australia, breast cancer mortality has decreased by approximately 21–28% due to screening alone. However, evidence shows that screening rates are not equal across all groups. For instance, in 2022–2023, participation rates were 11% lower among women who spoke a language other than English at home. This disparity is linked to several structural barriers, including lack of access to Medicare, screening costs, geographical location, limited culturally appropriate in-language health information, and more broadly, the fragmented nature of Australia’s health system.
Everyone has the right to cancer screening and therefore concerted efforts must be made to ensure migrant and refugee people’s needs are meaningfully considered across all stages of care, from receiving screening invitations to having access to equitable screening. Currently, many migrant and refugee women and gender diverse people are missing out on screening invitations because these invitations rely on information from the electoral roll, which excludes non-citizens. For a truly inclusive and accessible public health strategy, all people living in Australia should be included, regardless of their citizenship or visa status.
Breast screening is free for all who hold a Medicare card, however, for those without a Medicare card like temporary migrants and asylum seekers, the availability of free breast screening differs across states and territories. Furthermore, in addition to bearing the high out-of-pocket costs associated with healthcare, stories from women like Lisbett Lillo reveal the impact of discriminatory migration policies on temporary visa holders and their families. Lisbett, who was working in agriculture as a farmhand, was diagnosed with breast cancer five years after migrating to Australia. In addition to receiving the distressing news of her diagnosis, she was also informed that the “nature of her diagnosis will likely make her ineligible for permanent residency”. Policies such as these can create significant harm for migrants like Lisbett whose skills and contributions are sorely needed and valued and leaves them with limited healthcare options.
Moving beyond the barriers that exist in accessing screening and healthcare services, public campaigns and education about breast screening often also fall short in meeting the needs of migrant and refugee women and communities and are mostly presented in English. As one study indicates, some migrant and refugee women are more likely to attend screening after learning about it from informed friends, family members, or health professionals. This example illustrates the importance of building the capacity of health professionals to engage with migrant and refugee women in a culturally appropriate way, as well as strengthening community knowledge. The latter can be achieved through targeted, in-language health campaigns like MCWH’s Screening Saves Lives program that reaches migrants and refugees by providing information in their preferred language and through trained accredited bilingual health educators about the importance of cancer screening.
Finally, while breast cancer screening is commonly associated with older cohorts, growing evidence suggests that certain population groups may experience breast cancer at a younger age. This suggests that a one-size-fits-all approach to screening may not be adequate and that further research is required to ensure migrant and refugee women and gender diverse people’s risks are better understood. Australian screening programs need to take various population and individual needs into consideration and be reflective of Australia’s diverse population.
With an estimated 21,000 people diagnosed with breast cancer per year, it is clear that we need to work toward universal access to free screening and healthcare. Government, health promotion organisations, healthcare workers, policy makers, and researchers all have a role to play to ensure that everyone, regardless of their postcode, cultural background and visa status, has access to adequate and timely healthcare.
This article was first published in edition #138 of The WRAP on October 2024.