Statement of Principles
concerning
MALIGNANT NEOPLASM OF THE BREAST
No. 96 of 2014
for the purposes of the
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
Title
1. This Instrument may be cited as Statement of Principles concerning malignant neoplasm of the breast No. 96 of 2014.
Determination
2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 27 of 2006 concerning malignant neoplasm of the breast; and
(b) determines in its place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about malignant neoplasm of the breast and death from malignant neoplasm of the breast.
(b) For the purposes of this Statement of Principles, "malignant neoplasm of the breast" means a primary malignant neoplasm arising from the cells of the breast, including carcinoma in situ. This definition excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin’s lymphoma and Hodgkin’s lymphoma.
(c) Malignant neoplasm of the breast attracts ICD-10-AM code C50 or D05.
(d) In the application of this Statement of Principles, the definition of "malignant neoplasm of the breast" is that given at paragraph 3(b) above.
Basis for determining the factors
4. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the breast and death from malignant neoplasm of the breast can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
Factors that must be related to service
5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
Factors
6. The factor that 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 is:
(a) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the breast at least five years before the clinical onset of malignant neoplasm of the breast; or
(b) using hormone replacement therapy for at least one year before the clinical onset of malignant neoplasm of the breast, and where the use of hormone replacement therapy has ceased, the clinical onset of malignant neoplasm of the breast has occurred within ten years of cessation; or
(c) using a combined oral contraceptive pill for a continuous period of at least three years where:
(i) use of the combined oral contraceptive pill commenced at least five years before the clinical onset of malignant neoplasm of the breast; and
(ii) where use of the combined oral contraceptive pill has ceased, the clinical onset of malignant neoplasm of the breast has occurred within 15 years of cessation; or
(d) breast feeding for a cumulative period of less than six months before the clinical onset of malignant neoplasm of the breast; or
(e) for females aged over 35 years only, being nulliparous at the time of the clinical onset of malignant neoplasm of the breast; or
(f) being pregnant within the ten years before the clinical onset of malignant neoplasm of the breast; or
(g) having a first live birth after the age of 30 years or having a first full-term pregnancy after the age of 30 years, within the 30 years before the clinical onset of malignant neoplasm of the breast; or
(h) smoking at least 15 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of malignant neoplasm of the breast, and
(i) smoking commenced at least 15 years before the clinical onset of malignant neoplasm of the breast; and
(ii) where smoking has ceased, the clinical onset of malignant neoplasm of the breast has occurred within 20 years of cessation;
(i) drinking at least 40 kilograms of alcohol within the 20 years before the clinical onset of malignant neoplasm of the breast; or
(j) an inability to undertake any physical activity greater than three METs for at least ten years within the 30 years before the clinical onset of malignant neoplasm of the breast; or
(k) for death from malignant neoplasm of the breast only, being prevented from accessing mammographic screening for malignant neoplasm of the breast in accordance with contemporary medical standards at the time, within the ten years before the clinical onset of malignant neoplasm of the breast, and where:
(i) if mammographic screening has been resumed in the interim, there has been no normal test result; and
(ii) the opportunity for subsequent appropriate mammographic screening has not been declined; or
(l) for males and postmenopausal females only:
(i) being obese for at least five years within the 20 years before the clinical onset of malignant neoplasm of the breast; or
(ii) having diabetes mellitus before the clinical onset of malignant neoplasm of the breast; or
(m) using digoxin for a continuous period of at least one year before the clinical onset of malignant neoplasm of the breast, and where use of digoxin has ceased, the clinical onset of malignant neoplasm of the breast has occurred within ten years of cessation; or
(n) being administered diethylstilbestrol while pregnant before the clinical onset of malignant neoplasm of the breast; or
(o) inability to obtain appropriate clinical management for malignant neoplasm of the breast.
Factors that apply only to material contribution or aggravation
7. Paragraph 6(o) applies only to material contribution to, or aggravation of, malignant neoplasm of the breast where the person’s malignant neoplasm of the breast was suffered or contracted before or during (but not arising out of) the person’s relevant service.
Inclusion of Statements of Principles
8. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
Other definitions
9. For the purposes of this Statement of Principles:
"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink;
"being obese" means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.
The BMI = W/H2 and where:
W is the person’s weight in kilograms; and
H is the person’s height in metres;
"combined oral contraceptive pill" means an oral contraceptive compound containing both oestrogen and progestogen;
"cumulative equivalent dose" means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017;
Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.
Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.
"death from malignant neoplasm of the breast" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s malignant neoplasm of the breast;
"hormone replacement therapy" means administration of oestrogen preparations often in combination with progesterone to offset a hormone deficiency following surgically induced or naturally occurring menopause;
"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"MET" means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate;
"nulliparous" means having never given birth to a viable infant;
"pack-years of cigarettes, or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack-year of cigarettes equals twenty tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination;
"relevant service" means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) British nuclear test defence service under the VEA;
(e) warlike service under the MRCA; or
(f) non-warlike service under the MRCA;
"terminal event" means the proximate or ultimate cause of death and includes:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
Application
10. This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.
Date of effect
11. This Instrument takes effect from 17 November 2014.
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
Endnote 2—Abbreviation key
| o = order(s) |
ad = added or inserted | Ord = Ordinance |
am = amended | orig = original |
amdt = amendment | par = paragraph(s)/subparagraph(s) |
c = clause(s) | /sub‑subparagraph(s) |
C[x] = Compilation No. x | pres = present |
Ch = Chapter(s) | prev = previous |
def = definition(s) | (prev…) = previously |
Dict = Dictionary | Pt = Part(s) |
disallowed = disallowed by Parliament | r = regulation(s)/rule(s) |
Div = Division(s) | |
exp = expires/expired or ceases/ceased to have | reloc = relocated |
effect | renum = renumbered |
F = Federal Register of Legislation | rep = repealed |
gaz = gazette | rs = repealed and substituted |
LA = Legislation Act 2003 | s = section(s)/subsection(s) |
LIA = Legislative Instruments Act 2003 | Sch = Schedule(s) |
(md) = misdescribed amendment can be given | Sdiv = Subdivision(s) |
effect | SLI = Select Legislative Instrument |
(md not incorp) = misdescribed amendment | SR = Statutory Rules |
cannot be given effect | Sub‑Ch = Sub‑Chapter(s) |
mod = modified/modification | SubPt = Subpart(s) |
No. = Number(s) | underlining = whole or part not |
| commenced or to be commenced |
Endnote 3—Legislation history
Name | Registration | Commencement | Application, saving and transitional provisions |
Statement of Principles concerning malignant neoplasm of the breast No. 96 of 2014 | 22 October 2014 F2014L01383 | 17 November 2014 | |
Veterans' Entitlements (Statements of Principles—Cumulative Equivalent Dose) Amendment Determination 2017 (No. 58 of 2017) | 22 August 2017 F2017L01067 | 18 September 2017 | |
Endnote 4—Amendment history
Provision affected | How affected |
Clause 9 – ' "cumulative equivalent dose"……' | rs. Instrument No. 58 of 2017 |
