Medicare has been a “game changer” in cancer prevention and treatment over its 40-year lifespan, says head of the heritage project at Cancer Council Victoria.
The dramatic improvements in cancer survivorship in Australia over the 20th century and beyond would not have been possible without Medicare, says historian and head of the heritage project at Cancer Council Victoria Dr Tom Kehoe at Medicare’s 40th birthday party.
“I don’t think that you can think about modern cancer control in this country without talking about it through a Medicare socialised-medicine lens,” Dr Kehoe told the room.
While a “huge part” of Australia’s position as a leader in the field is the result of research into medical technology and treatment, “the other pillar that makes the cancer control story so important and so great in Australia is the expansion of access to all of the services that are required for a cancer patient, like screening and treatment”.
“I’m not going to make the claim that access is perfect, it’s by no means perfect and there are a lot of health discrepancies of course, but it is getting better. And Medicare is that a big part of that expansion of access,” said Dr Kehoe.
According to Dr Kehoe, while it might be “jingoistic” to acknowledge, “I think it’s a relatively uncontentious claim to say that Australia is a leader in cancer control”.
“That’s not just because of the immense amount of money we have put into treatment facilities like the Peter Mac Institute or various hospitals around the country,” said Dr Kehoe.
“It’s also because of the amount of money and amount of effort we have put into primary prevention – so preventing tobacco [use], skin cancer, etc – as well as screening, which is secondary prevention, and also into patient care and treatment.”
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Recognition of the importance of early detection to lower the burden of disease was paramount to this cancer control, added Dr Kehoe.
“Through the 20th century, we see a real dramatic improvement in patient outcomes in survivability for a lot of cancers,” he said.
“Things like testicular cancer go from 95% mortality to 5% mortality, same with childhood leukemia, and other cancers become entirely preventable.”
But with the growth of screening came financial and technological roadblocks.
“You have to reimburse doctors for the for the doing the test and you have to reimburse pathologists for testing the test,” said Dr Kehoe.
“We also need the infrastructure for keeping records of people’s testing.
“This would not have been possible without Medicare, because national screening requires record linkage across the country.”
Medicare was therefore a “huge gamechanger” for screening programs, noted Dr Kehoe, and has facilitated the success of the three population-based cancer screening programs we have today for breast, bowel and cervical cancers.
Dr Kehoe hopes that, with the help of Medicare, Australia will be meeting the WHO’s goal of putting cervical cancer well on the way to elimination by 2030 by facilitating HPV vaccination, backed up by screening and treatment of cervical disease.
When asked about concern over overdiagnosis, Dr Kehoe said that while the “heated argument” continues over overdiagnosis, as well as overtreatment of benign or semi-benign tumours with surgery or radical mastectomy, at the moment on a national scale the problem is “just kind of ignored”.
“The general position on breast screening is that it is net good,” said Dr Kehoe.
“But [the issue of overscreening] is vexed and it has derailed other programs such as prostate screening.”
