People should be able to get a mammogram starting at age 40 but it shouldn’t be routinely offered to women under 50 who are of average risk, new Canadian screening guidelines suggest.
The Canadian Task Force on Preventive Health Care is an organization created by the federal government to develop clinical practice recommendations in areas like cancer to guide family physicians and their patients. The members include family doctors, nurse practitioners as well as cancer specialists and patient partners.
The task force “does not recommend regular screenings for women under 50 who are of average risk,” a spokesperson said in an email to CBC News on Thursday. “However, the task force believes breast cancer screening is a personal choice, and that any woman who wants a screening should be able to get one.”
The task force said if someone of average risk age 40 and over understands the benefits and harms of early screening and wants to have it, they should be able to get a mammogram every two to three years. It noted the risk of harms such as unnecessary tests and anxiety.
Screening aims to catch a disease like breast cancer before it causes any problems that are noticeable by the patient. In contrast, diagnostic tests are done when someone shows symptoms, such as a lump.
Earlier this month, the Canadian Cancer Society called for breast screening to routinely begin at age 40, a target many provinces and territories are moving toward.
When researchers at the University of Ottawa compared breast cancer statistics from provinces that screened women in their 40s to data from provinces that followed the task force guidelines, they concluded earlier screening led to significantly improved survival rates.
Women aged 40 to 49 can self-refer to a breast screening program in Yukon, British Columbia, Nova Scotia, Newfoundland and Prince Edward Island, according to the Canadian Cancer Society. Ontario will start covering screening mammograms for women in their 40s this fall.
The Northwest Territories and Alberta have recently lowered program start age from 50 to 45, and Saskatchewan recently announced that it will lower its program start age to 40, using a phased-in approach beginning in 2025, the society said.
New Brunswick is also moving toward earlier screening with self-referral.
Dense breasts questions raised
Breast cancer is a major health concern in Canada, with one in eight Canadian women diagnosed in their lifetime.
Dense Breasts Canada, a group that advocates for better screening and awareness of optimal breast screening, is disappointed in the task force recommendations.
The breast is made up of fat and normal breast tissue composed of glands, fibrous tissues and more. Breast cancer looks white on a mammogram, as does normal breast tissue. When a woman has a larger proportion of normal dense tissue, it can be more difficult to spot cancer on a mammogram, Dr. Paula Gordon, a breast radiologist and a clinical professor in the University of British Columbia’s radiology department, has said.
A new study suggests that artificial intelligence is showing major promise in detecting breast cancer, but researchers admit there are limitations. The technology can produce false positives — flagging too many mammograms as abnormal when there’s actually no cancer.
Other risk factors for breast cancer include age, a family history and genetic mutations, oncologists say.
The task force “up-played the risks and they downplayed the benefits,” said Gordon, a medical adviser to Dense Breasts Canada.
“Of all the women who are recalled [for more imaging], only about five per cent end up being diagnosed with cancer. And of course that’s bad news but the good news is we’re finding it early,” Gordon said in an interview with The Early Edition in Vancouver.
Minister calls for review
Physicians have found that in Black women, particularly women of West African descent and Central African descent, there is a risk of more aggressive breast cancer, known as triple negative, that presents at younger ages compared to Caucasian women.
The Black Physicians’ Association of Ontario said a “one size fits all” approach doesn’t work, noting racialized women, especially Black, Hispanic and Asian women, have an earlier onset of breast cancer than Caucasians.
The Ontario Association of Radiologists called Thursday for the task force to be disbanded, calling it an archaic organization, trapped in old concepts.
Health Minister Mark Holland said Thursday he’s asked for an accelerated external review of the independent task force by the chief medical health officers from across the country.
The task force’s recommendations do not apply to people who aren’t of average risk, like those with a strong family history.
Public comments welcome
Dr. Kate Miller, a member of the task force and family physician in Ontario, said they recognize the recommendations are unfair to some populations, but they don’t have the evidence needed yet to make race- or dense breast-specific guidelines.
“I think we want screening to work better than it actually does,” Miller said in an interview. “We want to believe that it saves a lot of lives — and it saves lives, but not maybe not a lot.”
The recommendations will be open for public comments for at least 60 days, Holland said.
Two years ago, Fernanda Domingues Perdicaris of Toronto pushed for a mammogram at age 49. She was diagnosed with Stage 2 breast cancer that’s been treated with surgery as well as multiple rounds of chemotherapy and radiation.
Domingues Perdicaris said where we live in the country shouldn’t dictate access to a standard of care of medicine.
“My one year anniversary is coming up and I am still out of the workforce,” she said. “I do not have the energy to volunteer on my children’s field trips because I spend more than half of my day in bed recovering from chemo. It’s not just about life and death.”
