‘Outdated’ breast cancer screening guidelines failing Canadian women: report

Click to play video: 'Canadian imaging experts say changes are needed to guidelines for breast cancer screening'
Canadian imaging experts say changes are needed to guidelines for breast cancer screening
WATCH: Canadian imaging experts say changes are needed to guidelines for breast cancer screening – Oct 14, 2020

Annie Slight has been battling breast cancer for the past eight years.

Since her diagnosis in April 2013, the Montreal resident has undergone 16 treatments of chemotherapy, bilateral mastectomy, a full hysterectomy and two reconstructive surgeries. Although now in remission, she still has two more years of hormonal drug therapy to go.

It has been ordeal that could’ve been prevented if she was diagnosed earlier, Slight says.

“If I had been given the proper screening, additional to the mammogram, the cancer would have been found at least a year and a half earlier. So that’s a long time for cancer to progress,” the 51-year-old who works in special education told Global News.

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Slight got her first mammogram at the age of 40, which came back clear. However, what she wasn’t told at the time, was that she had dense breasts, which not only puts women at an increased risk of breast cancer, but cancer is more difficult to detect with a standard mammogram.

Annie Slight is the first one in her family to get breast cancer. Photo supplied

Slight’s case is not unique. A new survey by non-profit Dense Breasts Canada showed that 30 per cent of women who had a mammogram were not informed of their breast density. That survey was part of a report published on Sept. 27 ahead of Breast Cancer Awareness Month.

Currently in Canada, six provinces – British Columbia, Alberta, Manitoba, Nova Scotia, New Brunswick and Prince Edward Island – add density information to mammogram results. In five other jurisdictions – Ontario, Saskatchewan, Northwest Territories, Yukon and Newfoundland and Labrador – women only in the highest density category are given that information by radiologists.

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Ontario mom Nicola St. George was diagnosed with breast cancer in September 2019 – a year and half after her first mammogram, which did not detect anything at the time. She too wasn’t informed that she had dense breasts.

George only decided to get screened again after finding a lump while doing a self-exam lying in bed one night.

“I do think that women need to know that they have dense breasts because you should have follow-up mammograms and you should also do self-exams,” the 43-year high school teacher told Global News.  

“It’s really just my own luck that I decided to do a self-exam and actually found it and followed through with my instincts.”

Nicola St. George finished her last chemotherapy treatment in March 2020, right before Ontario went into COVID-19 lockdown. Photo supplied

Experts say “inconsistencies” in breast screening practices are putting women at risk and many are being turned away from screening because of the “outdated guidelines.”

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According to the Dense Breasts Canada survey, in which 2,530 women participated, 42 per cent of respondents were unaware of the eligible age for mammography screening – which varies by province.

Ideally, all women should have an annual mammogram starting at 40 years, because the risk of breast cancer increases at that age, said Dr. Paula Gordon, a breast radiologist in Vancouver and a clinical professor at the University of British Columbia.

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“Although it’s less common for younger women to get breast cancer, when they do get it, it grows faster and it spreads faster, so we want to catch breast cancers early in younger women.”

And those with dense breasts should be offered supplemental screening, either with an ultrasound or MRI, she said.

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Late diagnosis

Dr. Jean Seely, the head of breast imaging at the Ottawa Hospital, advised that high-risk women should start getting screened even earlier in their 30s.

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In Canada, only four jurisdictions – British Columbia, Nova Scotia, Prince Edward Island and Yukon – let women book their own mammogram in their 40s. Elsewhere, a requisition by a physician is required, but there is concern as many women are being refused.

“Unfortunately, I hear probably every week about a woman who was asking for her health-care provider to refer her for a mammogram in her 40s and was unable to get in because of the guidelines,” said Seely, who is also the president of the Canadian Society of Breast Imaging.

It’s a worrying trend seen across the country that is leading to late diagnosis and women losing lives from breast cancer, she told Global News.

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Breast Cancer Awareness

The survey showed that 11 per cent of respondents, aged 40-49, indicated that they were denied a requisition for a mammogram by their health-care provider.

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The Canadian Task Force on Preventive Health Care, which issues national guidance, conditionally recommends against mammography screening for women aged 40 to 49, who are not an increased risk.

“If women in this age group wish to be screened, they should have a discussion with their health-care provider to decide if screening is best for them,” according to the guidelines that were updated in 2018.

There are no recommendations for screening over the age of 74.

Seely said this “falsely reassures” women that they won’t get breast cancer when they’re in their 40s or in their late 70s.

“What we find … is that women who are in those two age groups – in the 40s and older in the 70s – are the ones that are presenting … with a later-stage diagnosis.”

Raising awareness

Gordon said the guidelines were based on old research done 30 to 50 years ago and should take into consideration more recent data.

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She pointed to a 2014 study published in the Journal of the National Cancer Institute, including 2.8 million Canadian women, that found that those who have mammograms starting at age 40 were 40 per cent less likely to die of breast cancer than women who don’t have mammograms.

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Gordon stressed there was a great need for education of women and physicians as to what the optimal breast screening practices are.

“Women need to know that it’s OK to be assertive and advocate for what you need.”

There are also various myths around breast cancer and screening.

A common misconception is that women don’t need to worry if there’s no history of breast cancer in the family. Both Gordon and Seely dismissed that claim.

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In fact, more than 75 per cent of women with breast cancer have no family history of the disease, according to the National Breast Cancer Coalition.

Going forward, better communication and greater investment of resources will be needed, said Seely.

“I think that we need to really focus on this as a health-care priority, because losing a woman’s life doesn’t just affect the woman, it affects the whole community and the family.

“So it’s a health-care issue for all of us.”

Breast Cancer Resources

Signs of breast cancer and how to do a self-exam:

Canadian Cancer Society: 1-888-939-3333

Dense Breasts Canada: 416-809-7976

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Canadian Breast Cancer Network: 1-800-685-8820

Canadian Society of Breast Imaging: 778-883-4373


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