Malignant neoplasm of the breast — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 84 of 2023

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the breast or death from malignant neoplasm of the breast with the circumstances of a person's relevant service:

1. (1)
   having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the breast at least 5 years before the clinical onset of malignant neoplasm of the breast;

   Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

2. (2)
   taking menopausal hormone therapy for at least 1 year before the clinical onset of malignant neoplasm of the breast, and if the use of menopausal hormone therapy has ceased before the clinical onset of malignant neoplasm of the breast, then that onset occurred within 5 years of cessation;

   Note: menopausal hormone therapy is defined in the Schedule 1 - Dictionary.

3. (3)
   using a combined oral contraceptive pill containing both estrogen and a progestogen: (a) for a continuous period of between 2 and 5 years where: (i) usage commenced at least 5 years before the clinical onset of malignant neoplasm of the breast; and (ii) if usage has ceased before the clinical onset of malignant neoplasm of the breast, then that onset occurred within 10 years of cessation; or (b) for a continuous period of at least 5 years where: (i) usage commenced at least 5 years before the clinical onset of malignant neoplasm of the breast; and (ii) if usage has ceased before the clinical onset of malignant neoplasm of the breast, then that onset occurred within 15 years of cessation;
4. (4)
   taking diethylstilbestrol while pregnant before the clinical onset of malignant neoplasm of the breast;
5. (5)
   receiving estrogen therapy for prostate cancer for at least 15 months before the clinical onset of malignant neoplasm of the breast;
6. (6)
   for male to female transgender persons only, receiving transgender cross-sex hormone therapy containing estrogen for at least the 2 years before the clinical onset of malignant neoplasm of the breast;
7. (7)
   for parous females only, inability to breast feed for a cumulative period of at least 3 months before the clinical onset of malignant neoplasm of the breast;

   Note: The period of breastfeeding could be cumulative over a number of pregnancies.

   Note: parous is defined in the Schedule 1 - Dictionary.

8. (8)
   for females aged over 35 years only, being nulliparous at the time of the clinical onset of malignant neoplasm of the breast;

   Note: nulliparous is defined in the Schedule 1 - Dictionary.

9. (9)
   being pregnant within the 25 years before the clinical onset of malignant neoplasm of the breast;
10. (10)
    having a first live birth after the age of 30 years or having a first full- term pregnancy after the age of 30 years, before the clinical onset of malignant neoplasm of the breast;
11. (11)
    having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of malignant neoplasm of the breast; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the breast; and if smoking has ceased before the clinical onset of malignant neoplasm of the breast then that onset occurred within 30 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

12. (12)
    having been exposed to second-hand smoke: (a) for at least 10,000 hours before the clinical onset of malignant neoplasm of the breast; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the breast; and if exposure to second-hand smoke has ceased before the clinical onset of malignant neoplasm of the breast, then that onset occurred within 30 years of cessation;

    Note: having been exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

13. (13)
    for females only, consuming alcohol: (a) in an amount of at least 40 kilograms before the clinical onset of malignant neoplasm of the breast; and (b) at least 5 years before the clinical onset of malignant neoplasm of the breast; and if consumption of alcohol has ceased before the clinical onset of malignant neoplasm of the breast, then that onset occurred within 40 years of cessation;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

14. (14)
    inability to undertake any physical activity greater than 3 METs for at least 5 consecutive years within the 30 years before the clinical onset of malignant neoplasm of the breast;

    Note: MET is defined in the Schedule 1 - Dictionary.

15. (15)
    for males and postmenopausal females only, being obese for a period of at least 5 years within the 20 years before the clinical onset of malignant neoplasm of the breast;

    Note: being obese is defined in the Schedule 1 - Dictionary.

16. (16)
    for males and postmenopausal females only, having diabetes mellitus before the clinical onset of malignant neoplasm of the breast;
17. (17)
    for death from malignant neoplasm of the breast only, for females aged 50 to 69 years, being prevented from accessing mammographic screening for malignant neoplasm of the breast in accordance with contemporary medical standards at the time, within the 10 years before the clinical onset of malignant neoplasm of the breast, and where: (a) if mammographic screening has been resumed in the interim, there has been no normal test result; and (b) the opportunity for subsequent appropriate mammographic screening has not been declined;
18. (18)
    taking digoxin, digitalis or digitoxin for a continuous period of at least 1 year before the clinical onset of malignant neoplasm of the breast, and if taking digoxin, digitalis or digitoxin has ceased before the clinical onset of malignant neoplasm of the breast, then that onset occurred within 5 years of cessation;
19. (19)
    inhaling ethylene oxide vapour: (a) at an ambient 8-hour time-weighted average concentration of at least 1.5 parts per million for a cumulative total of at least 2,500 hours within a continuous period of 10 years before the clinical onset of malignant neoplasm of the breast; or (b) in an amount greater than 10 ppm-years of cumulative exposure before the clinical onset of malignant neoplasm of the breast; and where the first exposure occurred at least 5 years before the clinical onset of malignant neoplasm of the breast;

    Note: Inhalation of ethylene oxide vapour can occur during the sterilisation of surgical instruments or protective clothing in hospitals.

    Note: 8-hour time-weighted average and ppm-years are defined in the Schedule 1 - Dictionary.

20. (20)
    undertaking night shift work: (a) on at least 3 nights per week for a minimum of 10 hours per shift; and (b) for a continuous period of at least 5 years before the clinical onset of malignant neoplasm of the breast; and if night shift work has ceased before the clinical onset of malignant neoplasm of the breast, then that onset occurred within 3 years of cessation;
21. (21)
    inability to obtain appropriate clinical management for malignant neoplasm of the breast before the clinical worsening of malignant neoplasm of the breast;

Aggravation-only factors: the factors in subsection 9(21) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.