Medical Journal of Australia最新文献

{"title":"Special issue on gender and health: listening to the voices of patients","authors":"Elizabeth Zuccala","doi":"10.5694/mja2.70064","DOIUrl":"https://doi.org/10.5694/mja2.70064","url":null,"abstract":"<p>In their 2024 work <i>Who's afraid of gender?</i>, Judith Butler<span><sup>1</sup></span> charts the rise of an international so-called anti-gender ideology movement, in which the concept of gender operates as “phantasm”. That is, a site where disparate contemporary fears — be they around the future of work, family life, or other aspects of the world — gather and become weaponised for political ends. This weaponisation of gender is having far-reaching impacts across the globe, including on public health policy and the practice of medicine.<span><sup>2</sup></span> In one of the most striking recent examples, the United States under the Trump Administration is undertaking extraordinary attacks on sexual and reproductive health and rights, in part under the guise of “defending women from gender ideology extremism and restoring biological truth”.<span><sup>3, 4</sup></span> Australia too is seeing its share of backlash against gender equity in the sphere of health, including use of anti-gender ideology discourse to mobilise opposition to health care access for transgender (trans) people.<span><sup>5, 6</sup></span></p><p>It is against this backdrop that the <i>Medical Journal of Australia</i> dedicates a special issue to the topic of gender and health. In doing so, we do not seek to prescribe specific definitions of “sex” or “gender” for adoption across health and medicine. These are often contested terms subject to evolving and varied scholarship, including growing recognition that they might defy efforts to map them neatly onto a “biological” and “cultural” binary.<span><sup>1</sup></span> In line with the Sex and Gender Equity in Research (SAGER) guidelines,<span><sup>7</sup></span> which the journal endorses, these terms should be clearly defined by authors and used with precision and consistency throughout their work. The goal of this special issue is to provide a platform for research and analysis that engage with what gender means for Australian health care in a manner informed by evidence, scientific rigour, a quest for equity and justice and, fundamentally, respect for the rights, dignity and perspectives of affected populations. Its curation was premised on an understanding of gender as “the structure of social relations and practices that are organised in relation to reproductive bodies”.<span><sup>8</sup></span></p><p>The articles in this issue cover diverse ground. Harsha Ananthram and colleagues<span><sup>9</sup></span> seek to unpack the term “obstetric violence” in the context of findings from recent inquiries into birth trauma in Australia and the United Kingdom. In Australia, practitioners who refuse to participate in abortion care should refer their patients onwards to a willing provider. Shelly Makeleff and colleagues<span><sup>10</sup></span> argue that not enough attention has been given to how these referrals are carried out and propose strategies to promote person-centred abortion referrals. The potential to improve the ca","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"329-330"},"PeriodicalIF":8.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An autoethnographic critique of a past report of inpatient psychiatric treatment for gender diverse children","authors":"Jayne McFadyen, Timothy W Jones, Rowena Koek, Fintan Harte, Brendan Jansen, Megan Galbally, Warren Kealy-Bateman, Catherine Wall, Quinnehtukqut McLamore, Anja Ravine","doi":"10.5694/mja2.70037","DOIUrl":"https://doi.org/10.5694/mja2.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review reporting on a case series of “inpatient therapy” administered to pre-pubertal children presenting with gender expansive behaviours previously published in the <i>MJA</i> and to compare this reporting to the adulthood recollections and past contemporaneous medical records of a person who had received such treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective analysis of autoethnography, archived mental health records, and patient details published in a 1987 <i>MJA</i> case series of eight children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Stubbs Terrace Hospital, a Western Australian state-funded child and adolescent psychiatric hospital, no longer in operation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participant</h3>\u0000 \u0000 <p>Jayne McFadyen (J), a transgender woman whose recollections align with the clinical details supplied for Case 5 in the case series, and an author of this article.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Concordance and discordance among details documented in the published case series, J's autoethnography of her hospital treatment, and archived childhood psychiatric records obtained through freedom of information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>J's recollections align closely with details in the archived records. Both align with many, but not all, published details, most notably the following published statement: “No conscious attempt was made by the staff members to encourage masculine or feminine role behaviours.” Some of the verified recollections are of psychologically coercive and aversive practices typical of sexual orientation and gender identity and expression change or suppression efforts (SOGICE). Despite inpatient treatment aimed at suppressing or changing her transgender identity and expression, J's sense of whom she understood herself to be remained steadfast.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A retrospective review of “inpatient treatment” intended to re-direct gender expansive identity formation revealed pseudo-psychological strategies reliant on denial and repression. These were directed towards extinguishing childhood behaviours deemed to be socially undesirable. These practices are indistinguishable from th","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 7","pages":"359-364"},"PeriodicalIF":8.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using generative artificial intelligence in clinical practice: a narrative review and proposed agenda for implementation.","authors":"Ian A Scott, Sandeep Reddy, Tanya Kelly, Tim Miller, Anton van der Vegt","doi":"10.5694/mja2.70057","DOIUrl":"https://doi.org/10.5694/mja2.70057","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective cross-sectional analysis of the economic impact of environmental risk factors on inpatient hospital separations in the Northern Territory.","authors":"Geetanjali Lamba, Danielle Esler, Yuejen Zhao, Tracy Ward, Christine Connors, Michael Spry Marranunggu","doi":"10.5694/mja2.70053","DOIUrl":"https://doi.org/10.5694/mja2.70053","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the cost of hospital separations attributable to environmental risk factors in the Northern Territory, including for Indigenous and remote subgroups.</p><p><strong>Study design: </strong>A retrospective cross-sectional secondary data analysis of hospital separations data. Data collection, analysis and presentation were guided by our Indigenous Steering Committee.</p><p><strong>Setting and participants: </strong>All episodes of care from 1 July 2021 to 30 June 2022 with an inpatient separation (discharge, transfer, death) from NT public hospitals were included. Non-inpatient episodes of care (outpatient, emergency department and primary care presentations) were excluded.</p><p><strong>Major outcome measures: </strong>Individual hospital separations were classified as environmentally attributable if the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM) code for their primary diagnosis matched an included disease. Included diseases were based on environmental attributable fractions previously generated for the Kimberley region, contextualised to the NT. Costs were assigned to individual hospital separations based on activity-based funding allocations.</p><p><strong>Results: </strong>Environmental risk factors contributed more than $72 million to inpatient hospital costs in the NT over 1 year. Environmental risks disproportionately affected children aged 0-4 years ($10.9 million), Indigenous people ($47.2 million) and those in remote areas ($41.7 million). Skin disease made up the largest contribution by a single disease ($26.4 million). The two largest categories of environmental risk were \"water quality, sanitation and hygiene\" and \"home condition\", together contributing $37.3 million in costs.</p><p><strong>Conclusions: </strong>Quantifying the economic impact of preventable environmental risk in the NT bolsters the argument for strengthening environmental health initiatives. Health disparities between groups reflect the interconnectedness of environmental, social and cultural determinants of health. Targeted interventions to reduce inequities in housing, sanitation and water quality are needed. Delivering on existing environmental health commitments through meaningful partnerships and coordinated action across sectors such as housing and education is essential, particularly within the Northern Territory Implementation Plan on Closing the Gap.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of universal child and family health services for equitable early development","authors":"Anna MH Price,&nbsp;Elodie O’Connor,&nbsp;Sharon R Goldfeld","doi":"10.5694/mja2.70067","DOIUrl":"10.5694/mja2.70067","url":null,"abstract":"&lt;p&gt;In Australia, growing political interest in the first 2000 days of life (from conception to five years) reflects the profound impact of early childhood on long term health, development and eventual societal participation.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Recent national initiatives (eg, Early Years Strategy,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Measuring What Matters framework&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;) and state-level efforts (eg, New South Wales First 2000 Days Framework,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Putting Queensland Kids First Plan&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;) seek a coordinated health and education system, prioritising prevention and early intervention. Broader early years advocacy includes a guarantee ensuring all children and families have access to the holistic supports necessary for optimal health and development.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The best way to support children and families to thrive is by promoting positive experiences and preventing negative ones. Across Australian jurisdictions, child and family health (CFH; also abbreviated as CaFHS, or known as Child Health and Parenting Service [CHaPS], or as Maternal and Child Health [MCH]) services provide free, high quality, non-stigmatising, well child health care from birth to school entry. As universal primary health care, they have a critical role in health promotion, prevention, and early identification, and should be accessible regardless of geographic location or socio-economic status (Box 1).&lt;/p&gt;&lt;p&gt;Despite growing political recognition of the importance of early childhood, Australia has primarily focused on early childhood education and care (ECEC); specifically, universal preschool at three and four years.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; CFH services are essential for engaging and supporting families from birth but have received less attention. Although a national framework was developed by state and territory representatives in 2011, it was not subsequently endorsed.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; As such, the sector lacks nationally consistent guidelines, as well as training and delivery standards.&lt;/p&gt;&lt;p&gt;This perspective article highlights CFH services as the health backbone — alongside ECEC — of a universal early childhood development system. It emphasises the importance of monitoring and equity in CFH services, and presents a pragmatic conceptual model for delivering universal, equitable CFH services in Australia.&lt;/p&gt;&lt;p&gt;For 30 years, the Centre for Community Child Health (CCCH) has worked with families, communities, practitioners and policy makers to improve children’s health and development. As research and evaluation partners of CFH services, the authors are committed to strengthening CFH capacity and impact. CCCH partnerships include developing and evaluating CFH practice frameworks, supporting CFH providers in identifying early developmental risks, and supporting the implementation and evaluation of models of care that address the social determinants of health, such as sustained home visiting and Ch","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"387-390"},"PeriodicalIF":8.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NOTIFICATION: Chronic Fatigue Syndrome","authors":"","doi":"10.5694/mja2.70066","DOIUrl":"10.5694/mja2.70066","url":null,"abstract":"<p>\u0000 <b>NOTIFICATION:</b> <span>V. Toulkidis</span>, \" <span>Chronic Fatigue Syndrome</span>,\" <i>The Medical Journal of Australia</i> <span>176</span>, no. <span>S9</span> (<span>2002</span>): <span>S17</span>-<span>S55</span>, https://doi.org/10.5694/j.1326-5377.2002.tb04499.x.\u0000 </p><p>This notification is for the above guidelines, published online on 6 May 2002 in the Medical Journal of Australia (MJA; AMPCo Pty Ltd) and in Wiley Online Library (wileyonlinelibrary.com), and has been issued by agreement between the MJA and John Wiley &amp; Sons Australia. The notification has been issued to inform readers of concerns that the information contained therein is outdated.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The forgotten pandemic: Hong Kong influenza in Australia (1968–1970)","authors":"Matthew Brown,&nbsp;Alan W Hampson,&nbsp;John Gerrard","doi":"10.5694/mja2.70039","DOIUrl":"10.5694/mja2.70039","url":null,"abstract":"&lt;p&gt;As Australia emerges from the coronavirus disease 2019 (COVID-19) pandemic, and H5 avian influenza approaches global spread, it is instructive to reflect on past Australian pandemic experiences. This is underscored by the recent Australian Government’s &lt;i&gt;COVID-19 Response Inquiry Report&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Within just over a century Australia has been affected by five respiratory virus pandemics: four influenza pandemics and the recent coronavirus pandemic. The deadliest was the Spanish influenza pandemic (1918), followed by the moderately severe Asian (1957) and Hong Kong (1968) influenza pandemics, the mild influenza pandemic originating in North America (2009), and then the COVID-19 pandemic (2020).&lt;/p&gt;&lt;p&gt;The Hong Kong influenza pandemic arose midway between the Spanish influenza and COVID-19 pandemics, during the momentous events of the late 1960s. It spanned Vietnam War protests and Woodstock, and affected United States presidents and Apollo astronauts. However, there are relatively few published accounts of Australia’s experiences. This article reviews historical literature and contemporaneous news reports to extract insights for future pandemic responses. This forgotten pandemic has some notable similarities and differences to Australian experiences of the Spanish influenza and COVID-19 pandemics (Box 1).&lt;/p&gt;&lt;p&gt;Only type A viruses cause pandemic influenza, and they are defined by the two surface antigens haemagglutinin (H) and neuraminidase (N). Both undergo antigenic variation, which sustains virus epidemic potential, and serve as targets for the protective antibody response, with haemagglutinin being the major and more significant antigen. Pandemic influenza is associated with a virus possessing a novel haemagglutinin. Influenza A viruses were initially subtyped as A0, A1 and A2 (H0, H1 and H2) based on haemagglutination-inhibition tests.&lt;/p&gt;&lt;p&gt;The revised 1971 World Health Organization nomenclature recognised distinct antigenic forms of neuraminidase, retrospectively designating the Hong Kong virus as A(H3N2) and its A2 predecessor as A(H2N2), with distinct haemagglutinin but shared neuraminidase. Genomic sequencing now supplements antigenic tests in characterising these viruses. Antigenic variants of the initial A(H3N2) virus continue to circulate alongside A(H1N1) and type B viruses and result in the highest rates of influenza-related morbidity and mortality.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The Hong Kong influenza virus probably originated in China in early 1968 during the Cultural Revolution, with unclear reports of an epidemic involving Chinese cities including Wuhan, Shanghai and Guiyang.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In July 1968, a respiratory illness outbreak was identified in Hong Kong, with about half a million cases reported by the end of that month.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;On 16 August 1968, the Hong Kong epidemic was attributed to an influenza virus significantly different from previous strains. Init","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":"400-403"},"PeriodicalIF":8.5,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent use of hormonal long-acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021","authors":"Aaron E Boyce,&nbsp;Tony Caccetta,&nbsp;Jo-Ann See,&nbsp;Rosemary L Nixon AM","doi":"10.5694/mja2.70058","DOIUrl":"10.5694/mja2.70058","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent use of hormonal long-acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021","authors":"Michelle KY Chen,&nbsp;Adrian Lim,&nbsp;Deshan F Sebaratnam","doi":"10.5694/mja2.70063","DOIUrl":"10.5694/mja2.70063","url":null,"abstract":"","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"223 8","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in patient management after preoperative MRI for newly diagnosed breast cancer: a multicentre prospective observational study.","authors":"Michael L Marinovich, Nehmat Houssami, Andrew Spillane, Gregory B Mann, Donna Taylor, Michelle Reintals, Nadine Phillips, Max K Bulsara, Patsy Siok Hwa Soon, Tracey Dickens, Christobel M Saunders","doi":"10.5694/mja2.70051","DOIUrl":"https://doi.org/10.5694/mja2.70051","url":null,"abstract":"<p><strong>Objectives: </strong>To understand whether and how breast magnetic resonance imaging (MRI) at cancer diagnosis influences treatment planning, and whether subpopulations of patients with newly diagnosed breast cancer benefit in terms of most appropriate management.</p><p><strong>Design: </strong>Multicentre prospective observational study.</p><p><strong>Setting: </strong>Seven centres across New South Wales, Victoria and Western Australia during the period 15 September 2020 to 14 July 2022.</p><p><strong>Participants: </strong>Patients with newly diagnosed early breast cancer meeting predefined criteria for whom multidisciplinary team normal practice deemed MRI would aid treatment planning.</p><p><strong>Intervention: </strong>Preoperative contrast-enhanced MRI.</p><p><strong>Main outcome measures: </strong>Reasons for requesting MRI; pre-MRI versus post-MRI changes in treatment plans; changes justified by pathology findings.</p><p><strong>Results: </strong>387 eligible participants were enrolled. MRI was most frequently requested for dense breasts (252 [65%]), clinical and/or radiological size discrepancy (161 [42%]), multifocality (108 [28%]) and young age (105 [27%]). Change in treatment plan after MRI occurred for 198 participants (51% [95% CI, 46-56%]), including a change in breast surgery plan for 119 participants (31% [95% CI, 26-36%]). More mastectomies were planned after MRI (15% v 28%; absolute risk difference [RD], 13 percentage points [95% CI, 9-17]; P < 0.001), including unilateral mastectomy (14% v 24%; RD, 10 percentage points [95% CI, 6-14]; P < 0.001) and bilateral mastectomy (1% v 4%; RD, 3 percentage points [95% CI, 1-5]; P < 0.001). No increases in planned mastectomies occurred for women aged ≥ 70 years (RD, -3 percentage points [95% CI, -15 to 9]; or in those for whom neoadjuvant therapy was planned (RD, 2 percentage points [95% CI, -11 to 14]). Change in surgery was deemed justified by pathology findings in 75 of 88 women who experienced a change (85% [95% CI, 75-91%]).</p><p><strong>Conclusions: </strong>Preoperative MRI findings led to changes in surgical management for a third of selected women with early breast cancer, increasing the mastectomy rate. In most cases, the changes were deemed appropriate. MRI findings did not change planned mastectomy in those aged ≥ 70 years, indicating that these women may not experience changes in surgical plans after such testing.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}