There’s been a swell of advocacy lately around breast density, which increases cancer risk while reducing the sensitivity of mammograms.

The FDA in the US has recently mandated that women be notified by mammogram providers if they have dense breasts, giving them the opportunity to arrange supplemental testing.

But BreastScreen Australia’s 2020 position statement does not recommend the routine recording of breast density or the provision of supplemental testing for women with dense breasts.

Professor Vivienne Milch, the government’s medical advisor on screening policy, and Professor Bruce Mann, a breast surgeon and researcher, are two of our guests today in the Tea Room – the last Tea Room before we become The Medical Republic Podcast and go from weekly to fortnightly episodes.

We also talk to two patients about their experiences with breast density and cancer, who find the lack of notification baffling – and a little bit 1950s.

Dr Sandy Minck, a GP by training and a breast cancer survivor, said she was “dumbfounded” by the BSA position statement.

“As a consumer I'm outraged. As a health professional, I'm dumbfounded. I just don't understand it.”

Professor Milch says the program will conduct an evidence review on supplemental screening for women with dense breasts some time this year, although there is no guarantee of a policy change.

“We're aware of the growing momentum of advocacy and of also some women's desire to know their breast density,” Professor Milch says, adding that different states have different policies.

“Western Australia has been telling women about their breast density for some time, and then there are pilots in some services in [Queensland and South Australia].

“We may or may not have a policy change. But we'll be looking at the evidence.”

Professor Bruce Mann, who works with the Roadmap to Optimising Screening in Australia (ROSA) project, says there is enough evidence to justify a change to BSA’s screening regimen.

“As women and the community becomes more informed, there is a danger that what is offered by BreastScreen will be seen as insufficient,” he said, which will lead to women opting out of BreastScreen and going private.

“What we don't want in this country is a two-tiered system where those who know and can get the best, do, and everyone else gets what's offered to them. That's what we are working to avoid.

“If you can show that by doing something different you are finding more cancers, fewer cancers are being diagnosed between screening rounds, and the stage, the size and the nodal status of cancers that are diagnosed is moving in a favourable direction, I believe that's sufficient to encourage implementation with a planned review in 10 years when the mortality information's there.”

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South Australia’s long covid clinic loves GPs and keeps them close.

Dr Angela Molga is a clinical pharmacologist and geriatrician at the long covid clinic at Royal Adelaide Hospital.

“We engage the GPs very early on, from the moment we receive the referrals. The patients are kept updated on the length of the waitlist and we also send them out resources specifically around self-rehabilitation,” she says.

Dr Molga says the average age of the patients who were seen in the South Australian clinic last year was 47 years old.

“These were previously healthy people. Little contact with the healthcare system, but now have multiple chronic issues. They have to change their lifestyle significantly, and then this also impacts their mental health,” she says.

Also on The Tea Room medical reporter Cate Swannell shares the nitty gritty details of the long covid parliamentary inquiry report.

Although long covid fails to get a mention in the federal budget Cate says the long covid parliamentary inquiry is pushing for $50 million. She says the RACGP has welcomed the recognition of GPs in the report.

“They also have pointed out that many recommendations reflect what the RACGP has been calling for, for a long time. Particularly around data collection and research,” Cate says.

Cate says the report seemed to hinge on the establishment of a national Centre for Disease Control which we saw confirmed in this week’s federal budget.

“They're also talking about expanding the list of eligibility for antivirals and there is a call for the establishment of a multidisciplinary advisory body to oversee the impact of poor air quality and ventilation on the economy,” Cate says.

Join The Medical Republic at an interactive live webinar that will equip you with the knowledge and tools to treat long covid patients.

Ask questions about including diagnostics and assessment, guidelines, billing and item numbers, and how to create a long covid clinic in a community practice.

The expert panel include doctors treating long covid in family practices, leaders of tertiary care teams, clinical researchers and public health specialists.

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What do you get when you cross advice from a health economist with that from a leading physiotherapist? Increased revenue and a better patient experience, say our guests on today’s episode of The Tea Room.

Scott Willis is president of the Australian Physiotherapists Association and a proud Palawa man. He says better results come from general practices who genuinely embrace allied health as part of the team.

“If you have social events, invite them. Let them be part of your strategy of the practice. They might sometimes see things from a different angle and add value to where practice is heading,” he says.

Mr Willis also says the business relationship amplifies when it wraps around the needs of the patients.

“The number one thing is that both parties – GPs and allied health - believe that it's a partnership to make the patient journey better. I know it's a business transaction in terms of hiring a space or having some type of input within general practice, but it has to be viewed as more than that,” he says

Tracey Johnson, health economist and CEO of Inala Primary Care, also favours multidisciplinary team care for patients. She also has a robust economic rationale for engaging allied health within a general practice.

“Given the rents that people are now paying in this sector, it will be incredibly hard for you to survive if you don't have onsite allied health or pathology or pharmacy that you are subleasing to,” she said.

Ms Johnson says that many doctors work part time and that hot-desking their rooms makes perfect economic sense.

“Some doctors might work from 8:00am in the morning until 2:30pm and pick their children up from school. So, bring in some allied health who might to use those rooms from 3:00pm until 7:00pm. You get more utilization around those rooms, more marginal return, and generally things come together better for the patients as well,” she says.

For more tips on how to optimise your allied health arrangements listen to the full episode.

News flash: The Tea Room podcast is moving! In a few weeks we will stop being The Tea Room and broadcast instead as The Medical Republic podcast.

Today’s episode is already available on The Medical Republic podcast and can be found on Apple Podcasts, Spotify or your favourite podcast player. Subscribe now so you won’t miss out on any new episodes.

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