Every week, I see patients with breast symptoms or disease who have had imaging across multiple providers while trying to get answers.
Their care has often been spread across different locations, systems, and time points. By the time they reach a breast clinic or specialist, they are understandably anxious, and sometimes still without clear resolution.
This isn't a reflection of individual providers or institutions — many deliver excellent care. Rather, it reflects how breast imaging services are currently structured and connected in Australia.
A system that doesn't quite support the work
Breast imaging is complex. It is not simply about interpreting images. It involves correlation with prior studies, clinical context, procedures, and often multidisciplinary discussion. It requires time, focus, and experience.
However, the way these services are funded does not always reflect that complexity.
The Australian Diagnostic Imaging Association (ADIA) has highlighted that radiology funding has not kept pace with increasing demand and system complexity, with costs to patients rising, bulk-billing rates falling, and access to services becoming more challenging.
Women's imaging has been identified as an area of longstanding and critical underfunding, with direct impacts on access, workforce sustainability, and service availability. Recent industry submissions highlight that patients may wait weeks to months for time-critical imaging, and that fewer radiologists are choosing to subspecialise in breast imaging.
A workforce under pressure
Breast imaging is a subspecialty that demands a great deal from those who practise it. It is cognitively demanding, carries significant responsibility, and often involves direct patient interaction and procedures.
Despite this, it is not always financially competitive with other areas of radiology.
Workforce data highlights ongoing shortages, particularly outside metropolitan areas, alongside increasing workload pressures. At the same time, fewer radiologists are choosing to subspecialise in breast imaging.
This creates a mismatch between demand and available expertise — one that is likely to become more pronounced over time.
Why experience matters
In clinical practice, breast imaging relies heavily on experience. Recognising subtle patterns, understanding normal variation, and knowing when something does not quite fit are skills developed over time.
Research suggests that radiologists with dedicated breast imaging training demonstrate improved sensitivity and overall diagnostic accuracy in screening mammography.
This does not diminish the important role of general radiologists. However, it does highlight the value of subspecialisation in supporting high-quality care.
Access and fragmentation
Access challenges are often associated with geography, particularly in regional and rural areas. However, even within metropolitan settings, patients can experience delays when care is fragmented.
Distributed reporting models within screening programs have demonstrated that it is possible to maintain diagnostic quality while improving timeliness.
The opportunity is to extend these principles more broadly and apply them in a way that supports both patients and clinicians.
A more connected model
The current model can be quite siloed, with imaging performed in multiple locations and prior studies not always readily accessible.
A more sustainable approach is likely to be hybrid — combining local, in-person care with distributed subspecialist reporting and connected systems that allow access to a patient's full imaging history.
This is not about replacing existing services, but about supporting them to work more effectively together.
Why this matters to us
At Canberra Breast, this is something we have spent a great deal of time thinking about — not only as a service model, but as a clinical challenge.
We see an opportunity to support subspecialist breast radiology, improve access to timely, high-quality reporting, and contribute to a more connected breast imaging network.
Our aim is to complement existing services and help create a more coordinated, efficient, and accessible system for patients and clinicians alike.
References
- Australian Diagnostic Imaging Association. Federal Budget Submission 2026–27. Canberra: ADIA; 2026.
- Australian Government Department of Health and Aged Care. Review of Medicare-funded diagnostic breast imaging services: public consultation paper. Canberra: Commonwealth of Australia; 2023.
- Royal Australian and New Zealand College of Radiologists. 2020 workforce census report. Sydney: RANZCR; 2020.
- Elmore JG, Wells CK, Lee CH, Howard DH, Feinstein AR. Variability in interpretive performance at screening mammography and the role of radiologist characteristics. Radiology. 2009;253(3):641–51.
- Johnston K, O'Connell D, et al. Client perceptions of the BreastScreen Australia remote radiology assessment model. J Med Imaging Radiat Oncol. 2021.