Mrs JILLIAN SKINNER (North Shore—Deputy Leader of the Opposition) [6.57 p.m.]: It is appropriate that we should discuss breast cancer awareness today. Many members of this House are wearing pink ribbons. Yesterday the National Breast and Ovarian Cancer Centre held a pink ribbon breakfast in Sydney, and other functions are being held across the State. Tomorrow, a breakfast is being held in Parliament House for members of Parliament. At the breakfast yesterday the National Breast and Ovarian Cancer Centre, in conjunction with the Australian Institute of Health and Welfare, released a report on breast cancer in Australia. As was pointed out at the breakfast by the Director of the centre, Dr Helen Zorbas, on an average day in 2006, 35 Australian women were diagnosed with invasive breast cancer and seven women died from the disease.

The report, "Breast cancer in Australia: an overview, 2009" can be found through the Australian Institute of Health and Welfare website, and I commend it to everyone. The problem is that the data is not new. In particular, there is little data about what happens in New South Wales. In the past I have done some research. The report entitled "Cancer in New South Wales: Incidence and Mortality 2006" indicates that there were 4,169 new cases of breast cancer in women in New South Wales in that year. I presume this is the same data to which the 2009 report refers. This amounted to 27 per cent of all female cancers. In 2006, 954 women in New South Wales died from breast cancer, which accounted for 16 per cent of female cancer deaths.

The incidence of breast cancer has declined since 2002. However, it remains the most prevalent cancer in women. Death rates from breast cancer have also declined by 15 per cent over the past 10 years, and reflect the use of breast screening and research-based medical advancements. These death rates would decline further if more women over 50 years had a bilateral screening mammogram every two years. I am really surprised that members are conducting private conversations and not showing an interest in this debate. Breast cancer is one of the most devastating diseases not only for those who suffer it but also their families. The establishment of BreastScreen as a national program in the early 1990s has been an important element of the bilateral screening program, targeting "well women without symptoms aged 50-69, although women aged 40-49 and 70 years and older are able to attend for screening" according to the BreastScreen Internet website.

The aim of the program is to achieve a participation rate of 70 per cent among women aged 50 to 69 years. At present the program is screening 56.2 per cent of women in that age group nationally, which is alarming considering the amount of publicity about the benefits of early detection and treatment. The State budget papers show that the participation rate of women in the target age group in New South Wales who have had breast cancer screening has dropped from a high of 60 per cent in 2001 to 54.3 per cent in 2008-09, which is even more alarming. Even though breast screening is targeted at women in the 50 to 69 age group, 23 per cent of breast cancer cases were in females aged under 50 at diagnosis. Most females diagnosed with breast cancer—2,757, or 66.1 per cent—were aged between 50 and 79 years. However, 10.7 per cent were aged 80 years and over at diagnosis. I made a chart on breast cancer incidence based on the document "Cancer in New South Wales Incidence Mortality Report". It shows that women outside the target group accounted for 47.9 per cent of all breast cancer cases, which is also a real worry to me.

I understand that it is more difficult to detect lumps in breasts of younger women because of mass. Nevertheless, that is still a matter of concern. The message from some older people that "I won't get breast cancer now I am over 70" worries me enormously. A lot more needs to be done to advance breast screening for people who perceive themselves to be at risk because the impact of breast cancer on women is profound. A very close friend of mine had a double mastectomy and the removal of lymph glands last year. She has had chemotherapy and radiotherapy—she is one of the lucky ones who had access to radiotherapy—and she is just an inspiration. She is now a member of the dragon boat racers who are on the harbour on Saturday mornings, which is wonderful. I am thrilled that she has become a member of Cancer Voices and is working with others to try to raise awareness and to pressure the Government into providing much greater treatment options, particularly radiotherapy for those who could benefit from it.

Recently much has been said about the need for greater radiotherapy services, particularly in parts of the State where women sometimes are choosing to have radical surgery because they cannot afford to leave their families alone while they come to Sydney for treatment. The Opposition has already indicated that it will give priority, in discussions with the Commonwealth, for placing radiotherapy equipment in the South Coast, the Central Coast and in the Hunter-New England as recommended by the Cancer Council and the Auditor -General. I commend to the House an interest in raising awareness in breast cancer.

Dr ANDREW McDONALD (Macquarie Fields—Parliamentary Secretary) [7.04 p.m.]: I thank the member for North Shore for raising this matter of public importance, for her advocacy of breast screening and her efforts, like so many members from all sides of politics, to increase awareness of breast cancer. Breast cancer is the most common cancer in women, with 1 in 11 women developing the disease by the age of 75 and 1 in 9 developing the disease by the age of 85. Approximately 12,000 women are diagnosed with breast cancer every year in Australia. Of those, about 4,200 live in New South Wales. Breast cancer accounts for 27 per cent of all cancer in women and 16 per cent of all cancer deaths in females. However, there is now a very high over 90 per cent, five-year chance of survival in localised breast cancer, if the cancer is detected early. Deaths from breast cancer have declined by 14 per cent in the past 10 years.

Prevention of breast cancer is vital, which is why age-appropriate screening is so vital. However, primary prevention issues such as obesity and a lack of exercise are also risk factors for breast cancer. All over the State breast cancer survival has increased with new therapies and the use of informed multi-disciplinary teams that use the latest evidence and techniques has also improved survival. Those units that have a high volume of cases are also able to offer other vital services such as psychologists and breast care nurses, courtesy of the magnificent McGrath Foundation. These centres also network with other centres to share their research, and are often involved in clinical trials. This is world's best practice.

The breast screening service in New South Wales is jointly funded by the New South Wales and Australian governments. Breast screening is crucial for the detection of breast cancer and, for that reason, the reduction of mortality from the disease. This financial year $42 million is being invested in BreastScreen NSW, as part of BreastScreen Australia, which is a population-based screening program aimed at enabling the early detection of breast cancer through mammographic screening. The program is open to all women over 40 years. However, women aged between 50 and 69 are specifically targeted for screening. For women less than 40 years mammography is more difficult, as the denser breast means that there is a higher rate of false-positive test. A false-positive test is where normal variants are felt to be suspicious, leading to a high rate of recalls for further testing, always causing considerable distress to the women involved.

In this younger age group there is also the risk of false-negative screens, where small cancers can be missed in the dense breast tissue on mammogram. For this reason, targeted campaigns such as "Know Your Breast" and being aware of any changes are advocated, rather than the older technique of breast self-examination. This difficulty with the diagnosis of breast cancer also applies for women aged 40 to 49, which is why the age group of over 50 is the most suitable for population-based screening. Of course, it is still offered to women aged between 40 and 49. More than 70 per cent of breast cancers occur in women aged 50 and over. Last year more than 400,000 New South Wales women in the target 50 to 69 age group had a biennial breast screen by July this year. In New South Wales the participation rate in the target age group is 54.7 per cent and is short of the Australia-wide target of 70 per cent. That is why we welcome this debate tonight.

We have also improved techniques with digital radiography, with a $23 million rollout of more than 40 digital mammography screening clinics located around the State. More clinics are located in convenient spots, such as local shopping centres. There has been an extension of out-of-hours appointments, including late nights and early mornings, to help working women. Since July 2005 there has been an increase of more than 55,000 New South Wales women participating in biennial screening using the BreastScreen facilities. Digital mammography will provide clearer images, faster reading rates, meaning faster results, better early detection and ultimately save lives. This new technology will enable high-quality breast screen images to be transmitted electronically from screening centres to central X-ray reading rooms for analysis by experienced radiologists. The rollout of digital mammography equipment is now almost complete.

I stress the importance of educating women about screening, particularly the fact that a full recovery from breast cancer is almost always possible if it is detected early enough. New South Wales has some of the best outcomes for cancer patients in the world. Cancer death rates have fallen by 14 per cent in men and 8 per cent in women over the past decade, but we can always do more to reduce mortality rates. That is why the previous measures I spoke of with regard to breast cancer are so important. There are now 13 public radiotherapy treatment services across New South Wales, including Port Macquarie and Coffs Harbour.

Also there is an additional linear accelerator at both Royal Prince Alfred Hospital and Coffs Harbour Base Hospital, and there are two additional machines at the Calvary Mater Newcastle Hospital. The New South Wales Government is proud of its achievements pertaining to cancer. A patient's doctor will recommend a course of cancer treatment that may include surgery, chemotherapy or radiotherapy, or a combination of those treatments. Radiotherapy services are highly specialised and require a large investment for the initial establishment of the services, due to the specialised buildings required to house the complex equipment.

The Government has supported significant investment in these services and is committed to further infrastructure development to respond to future growth in demand for cancer services. Planning is progressing well for the establishment of radiotherapy services at Lismore and Orange. This investment in new facilities and services is on top of an ongoing asset replacement strategy for these high-cost and complex treatment machines, with 24 machines being replaced since 1995. In 2008 three machines were replaced: at Royal North Shore Hospital, St George Hospital and the wonderful Liverpool Hospital, which I have visited. In 2009-10 a further four were replaced: at Wollongong, Prince of Wales, Calvary Mater and St George hospitals.

The recent Federal budget commitment of $560 million to build a network of up to 10 regional cancer centres across Australia is welcome news. The New South Wales Government will be well placed to submit applications for these centres once the process is finalised. The New South Wales Government is working closely with the Federal Government to improve the treatment options available to cancer sufferers across New South Wales. Awareness, detection and treatment are the three elements of the fight against cancer. I encourage all members to work in their communities to raise breast cancer awareness. I thank the member for North Shore for bringing this matter to the attention of the House.

Mrs JUDY HOPWOOD (Hornsby) [7.11 p.m.]: I support the member for North Shore 100 per cent in raising awareness of breast cancer. For quite a long time I have had an interest in this area and have had many associations with organisations, research and otherwise, that work hard to continue to promote the importance of woman and men having breast cancer checks. Men can suffer from breast cancer too. I have heard many tragic stories involving men who suffer from breast cancer. In my nursing training I looked after a man who had breast cancer, which shocked me at that time. Members have already stated many statistics concerning breast cancer. I add to that the statistics involving the indigenous population. The executive summary of a report by the Australian Institute of Health and Welfare entitled "Breast cancer in Australia: an overview, 2009" states:

While breast cancer is the most commonly reported cancer in Indigenous women in the four jurisdictions for which data were available, Indigenous women were significantly less likely to be diagnosed with breast cancer than non-Indigenous women in 2002 to 2006 (69 and 103 new cases per 100,000 women, respectively).

A table in that report is distressing: it contains no data from New South Wales. Table D2.9, entitled "Incidence of breast cancer by Indigenous status, females, Queensland, Western Australia, South Australia and the Northern Territory, 2002-2006" does not include indigenous New South Wales women. I call on the Government to take seriously the absence of that data; it is certainly not acceptable. About two weeks ago I had my regular two-yearly mammogram and last Friday I received a letter that stated that there were no visible signs of cancer. I was quite nervous during those two weeks while waiting for the results, wondering whether I would be called back. Luckily for me that was not the case.

Fifty-four per cent of women undergo mammography, but that is certainly not enough; it is certainly not the national standard. The Government has to think more extensively about how it can improve that number, which seems to be decreasing rather than increasing. I have had many experiences of looking after patients and also my family with breast cancer or breast cancer scares. Last Christmas, following a mammogram, my sister-in-law was diagnosed with breast cancer. She has had a mastectomy, which really reverberated through the family. I have had a lot to do with organisations, including the McGrath Foundation, for which I have actively raised funds. I pay tribute to the Berowra Lions Club, which has an ongoing association with fundraising.

I have had a close relationship with the Cancer Council and was involved in one of its projects, the Relay for Life. Some of the executive of the Cancer Council are not pleased with the gaps in radiotherapy availability in New South Wales; indeed they are very displeased. I will gather more information regarding those gaps, because all women should be able to access radiotherapy. Indeed, many women are required to travel long distances to undergo radiotherapy. The McGrath Foundation has raised more than $12 million towards providing more breast care nurses. Sadly, Jane McGrath was diagnosed with breast cancer when she was 31 years old and she died at 42. Jane and her husband, Glenn, provided a lot of focus on the need for early intervention. Screening and self-examination, and the regular yearly examination by a doctor, are so important to early intervention. The McGrath Foundation goes from strength to strength and provides care following cancer diagnosis and surgery. I will continue to work very hard in that area. I pay tribute also to Sarah Murdoch, who has made excellent statements promoting the need for women to attend their doctors for investigation so that breast cancer can be detected early.

Mrs JILLIAN SKINNER (North Shore—Deputy Leader of the Opposition) [7.16 p.m.], in reply: I thank the member for Macquarie Fields and the member for Hornsby for their contributions to this debate on a very important topic. I reiterate the importance for all members of this House, as the member for Macquarie Fields did, to continue to raise awareness of breast cancer in their communities and to continue to press for greater access to BreastScreen New South Wales for people for whom it could be a benefit. I note that the member for Macquarie Fields referred to the new digital mammography, which is a great improvement, and also to access provided by shopping centres to mammography, which is commendable.

However, I have had contact with people from country New South Wales who say that they have difficulty in obtaining appointments for breast screening when they phone to do so. The number of places visited by the mobile screening service has been cut back. It is impossible for many people to get to their nearest regional centre to have a mammogram. If screening is not readily available sometimes people forget or do not make the extra effort. Yet I have received a number of letters saying that women in country areas are worried about the withdrawal of services that were previously provided in their area.

I again reiterate that this is an important debate. A large number of people are diagnosed with breast cancer. The increase in that diagnosis is probably due to the increase in testing, either self-testing or mammography, and results in saving lives that previously may have been lost. However, breast cancer is still the greatest cause of cancer deaths for women. As my colleague the member for Hornsby said, it is a disease that affects men also, but to a lesser degree. I commend all the groups that are working to raise awareness of breast cancer and to improve services for breast cancer. In particular, I commend the McGrath Foundation and those who have supported it in relation to cancer nurses. That is an important initiative for those who have been diagnosed with breast cancer.

The young woman to whom I referred earlier—a very articulate, well-informed and well-educated young woman—spoke to me about the fact that no-one took charge of her case. Yes, the oncologist was exceptionally good in treating her cancer and, yes, the people doing the radiotherapy were great, and so on, but she developed other complications through her treatment and there was nobody to tell her what she should do and which medications might counter another. This whole question of getting cancer support nurses as proposed by the McGrath Foundation is extremely important. They can coordinate and assist people with the variety of treatments and processes they must go through.

In conclusion, there is no more important task particularly for the women in this Chamber but, as the Prime Minister's wife said at the breakfast I attended yesterday, for all people. There was a fantastic presentation at the Pink Ribbon breakfast yesterday by a young couple who talked about the woman being diagnosed with breast cancer when she was feeding her first baby. She had a mastectomy and then discovered while she was undergoing chemotherapy that she was pregnant. After having that baby she subsequently had a second mastectomy. The entire discussion was about the importance of the male—the husband or partner—not only in supporting their partner who has been diagnosed with breast cancer but in understanding how to deal with it themselves. The grief that some of them experience means they need just as much support in many respects as the women. It is also a matter of raising awareness among the whole community. Women need to make sure they have early mammograms and men need to understand they have a very important role to play in the unfortunate circumstance of their partner being diagnosed with breast cancer.

Discussion concluded.