Why is it important?:Early detection is the discovery of a disease or condition at an early stage of its development or onset, usually prior to the development of symptoms. Early detection may occur for individual patients, where clinically indicated, or for all members of a population through screening programs. In Australia, primary health care providers, including Aboriginal and Torres Strait Islander health services, and GPs, are a key element in early detection and early treatment programs. Early detection and treatment programs are most effective when there are systematic approaches to ensuring assessment and screening occurs regularly, at recommended intervals.
Breast, bowel and cervical cancer screening programs are designed to detect cancer early (breast and bowel cancer) or prevent its occurrence in the first place (cervical cancer). National programs for breast and cervical screening were implemented in Australia in the early 1990s, and have been followed by reductions in mortality for these cancers. Cancer mortality rates are higher for Aboriginal and Torres Strait Islander peoples than for other Australians (Condon et al. 2004). For jurisdictions in which data are available, in the period 2004–08, Aboriginal and Torres Strait Islander women were 4 times more likely to die from cervical cancer than other Australian women. For breast cancer, the rates were similar for the two populations. Indigenous Australians in the Northern Territory have lower cancer survival for most cancer sites than other people. Compared with non-Indigenous Australians diagnosed with the same cancer, Indigenous Australians are doubly disadvantaged because they are not only diagnosed later, with more advanced disease, but also have lower survival for every stage at diagnosis (Condon et al. 2005; Cunningham et al. 2008). Indigenous patients were less likely to have had treatment for cancer (surgery, chemotherapy, radiotherapy) and waited longer for surgery than non-Indigenous patients (Valery et al. 2006).
Findings:MBS items for health checks for Indigenous children aged 0–14 years were introduced in 2006. During 2008–09 there were 14,160 health assessments undertaken, representing around 7% of children in the target group. This may understate the coverage for Indigenous children. Between July 2007 and June 2009, there were approximately 10,000 Child Health Checks provided or funded as part of the Northern Territory Emergency Response which were not captured in the Medicare dataset.
Two-yearly health checks for Indigenous Australians aged 15–54 years were introduced in 2004. In 2008–09, there were 18,370 health checks performed, representing around 6% of the target group. MBS items for health assessments for Indigenous Australians aged 55 years and older were introduced in 1999. In 2008–09, health assessments were undertaken for 5,253 Indigenous Australians aged 55 years and over, around 12% of the target population. This is half the rate for the equivalent MBS items for annual health checks for the general population aged 75 years and over. Rates of use of the health checks and health assessment items have been increasing since their introduction.
In 2007–08 an estimated 36% of Indigenous women aged 50–69 years participated in mammography screening for breast cancer compared with 55% for other Australian women. Participation was highest in Queensland (47%) and lowest in the Northern Territory (24%). Participation by Indigenous women has increased significantly from 32% in 1999–2000.
In 2004–05, 58% of Aboriginal and Torres Strait Islander women aged 18 years and over reported having a regular Pap smear test. This compares with an estimated 61% of all Australian women aged 20–69 years who were recorded in the national cervical screening register in 2004–05 (AIHW 2008b). Indigenous women living in remote areas were more likely to report having a regular Pap smear test than those in major cities (65% vs 54%).
In 2008, 159,839 Australians participated in the National Bowel Screening Program. Of these, 945 identified as Indigenous. The rate of people responding to an invitation to participate in the program was significantly lower for Indigenous Australians (10.6% vs 23.5% for non-Indigenous). Of the people with positive results, follow-up colonoscopies were reported for 50% of the Indigenous group, compared with 64% for the non-Indigenous group.
Most Aboriginal and Torres Strait Islander primary health care services provide early detection and early intervention services. In 2008–09, these services reported providing regular well persons’ checks (80%), and screening for cervical cancer (80%), diabetes (78%), sexually transmissible diseases (73%), hearing problems (72%), eye disease (69%), cardiovascular disease (66%) and renal disease (54%).
Implications:Early detection and early treatment through primary health care has significant benefits for those at risk of disease. Not all primary health care services for Aboriginal and Torres Strait Islander peoples have established systems for screening and early detection, suggesting opportunities to extend systematic approaches. This is a challenge shared with mainstream general practice. The take-up of annual health assessments for Indigenous Australians aged 55 years and over is low but increasing. A number of studies have found that only a minority of mainstream GPs identified which of their patients were Aboriginal and/or Torres Strait Islander (Norris et al. 2004; Riley et al. 2004). Those GPs who do not identify their Indigenous patients are then not in a position to offer any of the Aboriginal and Torres Strait Islander-specific health initiatives, including the additional MBS, PBS and immunisation programs available.
The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (COAG 2008c) aims to improve early detection and management of chronic diseases. In November 2009, the MBS was amended to allow Practice Nurses and Aboriginal Health Workers to provide additional follow-up care after an Aboriginal and Torres Strait Islander Health Assessment, with an increase from 5 to 10 MBS rebated items per year per person. In May 2010 a new Practice Incentive Program was introduced to support health services to provide better health care, including early detection and treatment of chronic disease. Achieving better participation rates in screening programs could have important positive impacts on Indigenous health. There is evidence that population-based programs such as the National Bowel Screening Program need to develop better ways of ensuring vulnerable minorities, particularly Indigenous people, are encouraged to participate (Christou et al. 2010) and that screening occurs more regularly. Up to 90% of the most common form of cervical cancer could be prevented through regular screening. The HPV vaccination provides a new opportunity to reduce the excess in cervical cancer mortality. However, screening through Pap smears will remain vital for many decades, as the current vaccines are not effective against all types of HPV that cause cervical cancer.
Figure 142 – Rate per 100 persons in target group receiving Medicare Benefits Schedule Health Checks, Aboriginal and Torres Strait Islander people aged 0–14 years and 15–54 years, 2008–09
Source: AIHW analysis of Medicare data
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Figure 143 – Rate per 100 persons in target group receiving Medicare Benefits Schedule Health Assessments, Aboriginal and Torres Strait Islander people aged 55 years and over, all Australians aged 75 years and over, 2008–09
Source: AIHW analysis of Medicare data
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Figure 144 – Participation rates for BreastScreen Australia, Women 50–69 years by Indigenous status, 1999–2000 to 2007–08
Source: AIHW analysis of BreastScreen Australia data
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Figure 145 – Aboriginal and Torres Strait Islander women aged 18 years and over who had regular pap smear tests by remoteness, 2004–05
Source: AIHW analysis of the 2004–05 National Aboriginal and Torres Strait Islander Health Survey
Text description of figure 145 (TXT 1KB)