‘Outdated’ breast cancer screening guidelines fail among Canadian women: report – National

Annie Slight fought breast cancer for eight years.

Since her diagnosis in April 2013, the Montreal resident has undergone 16 chemotherapy treatments, a bilateral mastectomy, a complete hysterectomy and two reconstructive surgeries. Although she is now in remission, she still has two years of hormone therapy left.

It’s an ordeal that could have been avoided had it been diagnosed earlier, Slight says.

“If I had received the appropriate screening, in addition to the mammogram, the cancer would have been discovered at least a year and a half earlier. So it’s a long time for the cancer to progress, ”the 51-year-old man who works in special education told Global News.

Slight had her first mammogram at the age of 40, which came back safely. However, what she was not 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 also more difficult to detect with a standard mammogram.

Slight’s case is not unique. A new investigation non-profit Dense Breasts Canada showed that 30 percent of women who had a mammogram were unaware of their breast density. The survey was part of a report released September 27 before Breast Cancer Awareness Month.

Currently in Canada, six provinces – British Columbia, Alberta, Manitoba, New Scotland, New Brunswick and Prince Edward Island – add density information to mammography results. In five other jurisdictions – Ontario, Saskatchewan, Northwest Territories, Yukon, and Newfoundland and Labrador – only women in the highest density category receive this information from radiologists.

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

George didn’t decide to get tested again until after he found a lump during a self-exam lying in bed one night.

“I think 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-old high school teacher told Global News.

“It was really my own luck that I decided to do a self-examination and found it and followed my instincts.”

Experts say “inconsistencies” in breast cancer screening practices put women at risk and many are denied screening because of “outdated guidelines.”

According to the Dense Breasts Canada survey, in which 2,530 women participated, 42 percent of respondents did not know the eligible age for mammography screening – which varies by province.

Ideally, all women should have an annual mammogram starting at age 40, as the risk of breast cancer increases at this age, said Dr. Paula Gordon, breast radiologist in Vancouver and clinical professor at the University of Colombia. -British.

“Although it is less common for young women to have breast cancer, when they do, it grows faster and spreads faster, so we want to detect breast cancer early in women. youth. “

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

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Dr. Jean Seely, head of breast imaging at The Ottawa Hospital, advised women at high risk to start screening even earlier in their 30s.

In Canada, only four jurisdictions – British Columbia, Nova Scotia, Prince Edward Island and the Yukon – allow women to book their own mammograms in their 40s. Elsewhere, a requisition by a doctor is required, but this raises concerns as many women are denied.

“Unfortunately, I probably hear every week about a woman who was asking her health care provider to refer her for a mammogram in her 40s and couldn’t show up because of the guidelines,” Seely said. , who is also the president of the Canadian Breast Imaging Society.

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

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The survey showed that 11 percent of respondents, aged 40 to 49, said their health care provider refused them a mammogram request.

The Canadian Task Force on Preventive Health Care, which publishes national guidelines, conditionally advises against mammography screening in women aged 40 to 49, who are not at 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 beyond 74 years.

Seely said it “falsely reassures” women that they won’t get breast cancer when they are in their 40s or late 60s.

“What we are finding… is that women who fall into these two age groups – in their 40s and older in the 70s – are the ones who present… with a diagnosis at a later stage.”

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

She highlighted a 2014 study published in the Journal of the National Cancer Institute, including 2.8 million Canadian women, who found that those who had mammograms at age 40 were 40 percent less likely to die from breast cancer than women who did not have mammograms.

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Gordon stressed that there is a great need for education of women and physicians on the best breast cancer screening practices.

“Women need to know that it’s okay to be assertive and stand up for what you need. “

There are also various myths surrounding breast cancer and screening.

A common misconception is that women don’t have to worry if there isn’t a history of breast cancer in the family. Gordon and Seely both rejected this request.

In fact, over 75 percent of women with breast cancer have no family history of the disease, according to the National Breast Cancer Coalition.

In the future, better communication and a greater investment of resources will be required, Seely said.

“I think we really need to 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 problem for all of us. “

Signs of breast cancer and how to self-examine: https://www.youtube.com/watch?v=NKhIvufyji0

Canadian Cancer Society: 1-888-939-3333

Dense Breasts Canada: 416-809-7976

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

Canadian Breast Imaging Society: 778-883-4373

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