Breaking the silence: a national voice for gynaecological cancers

Breaking the silence: a national voice for gynaecological cancers

19 October 2006

© Commonwealth of Australia 2006
ISBN 0 642 71680 3

View the report as a single document - (PDF 1252KB)

View the report as separate downloadable parts:

Membership of the Committee (PDF 108KB)
List of Acronyms (PDF 68KB)
Executive Summary (PDF 75KB)
Recommendations (PDF 96KB)
Chapter 1 - Introduction (PDF 178KB)

Terms of Reference
Conduct of the Inquiry
The Committee’s report
Background to the Inquiry
What are gynaecological cancers?
The types of gynaecological cancers
Risk factors for gynaecological cancers
Prevention of gynaecological cancers
The symptoms of gynaecological cancers
Statistics on gynaecological cancers in Australia
   Incidence of gynaecological cancers
   Projections for new cases of gynaecological cancers
   Deaths from gynaecological cancers
   Survival rates for women with gynaecological cancers

Chapter 2 - A stronger voice for gynaecological cancers in Australia (PDF 181KB)

A national approach
   The need for national coordination
   A self-determining national body for gynaecological cancers
       Benefits of a NGCC
       Support from the Australian Society of Gynaecologic Oncologists
       Support from community organisations
       Relationship with Cancer Australia
       Proposal for a National Women’s Cancer Centre
       A NGCC to be modelled on the NBCC
       Location of a NGCC
       Cost of NGCC
       Improve existing arrangements
   Expansion of the NBCC’s remit to include gynaecological cancers
       The need for a separate identity for gynaecological cancers
The way forward

Chapter 3 - Adequacy of research funding for gynaecological cancers (PDF 245KB)

Gynaecological cancer research
   Clinical trials
       The role of Australia New Zealand Gynaecological Oncology Group
Where is the research money coming from?
   Commonwealth funding for gynaecological cancer research
       Other Commonwealth research funding
       The priority of research funding
   Research and the National Breast Cancer Centre’s Ovarian
   Cancer Program
   Community funding for gynaecological cancer research
       Cancer Councils’ funding of gynaecological cancer research
   Pharmaceutical company funding for gynaecological cancer research
   International funding for gynaecological cancer research
       Australian Ovarian Cancer Study
   Incentives for research contributions
Adequacy of research funding for gynaecological
Barriers to adequate gynaecological cancer research funding
   Duplication and an uncoordinated approach
   Lack of academic research positions
   Lack of clinical trial funding
       The importance of clinical trials
       Australia’s experience with gynaecological cancer clinical trials
       Participation in clinical trials by Indigenous Australians and people
living in rural, remote and regional communities
       Adequacy of funding for clinical trials
       Adequacy of NHMRC funding for clinical trials
   Link between research funding and intellectual interest
Recommended funding levels for gynaecological cancer research
Future gynaecological cancer research needs
   The priority of research
   A commitment to ongoing funding
   The continued need for collaboration
   The need for a national approach
   A screening test for ovarian cancer
   Understanding the symptoms and causes of gynaecological cancers

Chapter 4 - The adequacy of gynaecological cancer care (PDF 340KB)

Gynaecological cancer services
Screening programs
   Cervical cancer
       What is a Pap test?
       Liquid-based cytology
       Adequacy of the existing Pap test for cervical cancer screening
       Indigenous Australians and the Pap test
       Utilising regional and rural nurses to conduct Pap tests
   Human papilloma virus (HPV)
       HPV and cervical cancer
       The difference between HPV DNA testing and the Pap test
       The benefits of HPV DNA testing to cervical cancer screening
       International advancements and HPV DNA testing
       Australia’s experience with HPV DNA testing
       Potential benefits of HPV DNA testing for Australian women
       HPV vaccines
       Benefit of vaccines in Indigenous communities
   The ability to screen for ovarian cancer
Treatment services
   Multidisciplinary treatment
   Adequacy of care and provision of treatment services
   Issues that impact on the adequacy of treatment services
       State and Commonwealth funding for treatment
       Service provision in the private and public health systems
       Lack of funding for database management infrastructure and resources
       Staff shortages and lack of funding
       Extended surgical waiting times
       Inability to access Magnetic Resonance Imaging (MRI)
   Adequacy of psychosocial treatment and services
   Inadequacy of treatment provision to rural and remote areas
       Tele-medicine and satellite clinics
       Psychosocial service provision to rural and remote areas
       The role of regional nurses and specialist nurses
   Adequacy of treatment provision to Indigenous Australians
   Adequacy of treatment for women from multicultural and linguistically diverse populations
       The adequacy of interpreting services
       Cultural differences impacting on treatment services
   The adequacy of treatment to disadvantaged groups in Australia
Patient assisted travel schemes
   Current arrangements
   Accessing patient assistance
Other treatment and health support programs
   Alternative and Complementary
   Support groups
       Support for women during and after treatment

Chapter 5 - Gynaecological cancers education for the Medical Community (PDF 209KB)

The importance of education
The medical community
   General practitioners
       Current education strategies
       Is the current level of education appropriate?
       The way forward
       Current education about gynaecological cancers
       Is the current level of education appropriate?
       The way forward
   Allied health professionals
   Gynaecological oncologists
General issues
   Coordination and communication
   Workforce shortages
   Clinical practice guidelines
   Education on emerging issues
   Communication skills
   Skills enhancement training
   The Internet
Roles and responsibilities

Chapter 6 - Gynaecological cancers education for Women and the Community (PDF 216KB)

The importance of education
   Awareness leads to empowerment
   Improving awareness of the sub-specialty of gynaecological oncology
   Eliminating the stigma associated with gynaecological cancers
Women and the broader community
   Broader community
Current education strategies
   Current activities
       Commonwealth Department of Health and Ageing
       National Breast Cancer Centre’s Ovarian Cancer Program
       Cancer Councils
       Community Organisations
   Success of current activities
       Vagueness of symptoms
       Disproportionate focus on other cancers
       Fragmented approach
       Personal experiences needed
       Misunderstanding about what Pap smears screen for (ie, only cervical cancer)
       Lack of media profile
Strategies for change
   Areas of focus
   Too much education?
   A new, coordinated approach
       National Awareness Campaign
       Broader education about cancer
   Factors to consider
       One size does not fit all
       Overcome stigma and use terminology correctly
       Written information
       Online information and e-medicine
       Face-to-face contact important
       Consideration of population differences
Roles and responsibilities

Chapter 7 - Experience, expertise and representation of gynaecological cancer issues (PDF 197KB)

Experience and expertise in gynaecological cancers
   Medical community and allied health community
   Gynaecological cancer organisations
       Professional bodies
       Community organisations
       The Cancer Councils
National health agencies, bodies and initiatives
   Commonwealth Department of Health and Ageing
   Cancer Australia
       Issues regarding the operation of Cancer Australia
   National Breast Cancer Centre
   Roles and responsibilities in advising the Commonwealth Government
   Policy advisory structures
       Australian Health Ministers’ Conference and Australian Health Ministers’ Advisory Council
       National Cancer Strategies Group and National Health Priority Action Council
       The Australian Screening Advisory Committee
       National Cancer Control Initiative
Representation of gynaecological oncology issues
   The need for greater representation
   Improved coordination and leadership

Appendix 1 - List of Public Submissions and Tabled Documents Authorised for publication by the Committee (PDF 130KB)
Appendix 2 - Witnesses who appeared before the Committee at Public Hearings (PDF 117KB)
Appendix 3 - NHMRC funding for gynaecological cancer in Australia 2000 - 2006 (PDF 121KB)
Appendix 4 - Possible sexuality issues involved with gynaecological cancer surgery (PDF 377KB)

For further information, contact:

Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600

Phone: +61 2 6277 3515
Fax: +61 2 6277 5829