Ontario exploring beginning breast screening ten years earlier — at age 40 — something advocates have long pushed for

Article content

Just days after a U.S. task force recommended breast cancer screening begin at age 40, the Ontario government says it is looking at a similar move.

“The Ministry of Health is currently exploring a similar change regarding breast cancer screening,” said Hannah Jensen, spokesperson for Ontario’s Health Minister Sylvia Jones. She was responding to a question about the closely watched recommendations from the United States Preventative Services Taskforce.

Routine breast screening currently begins at age 50 in Ontario. Researchers and advocates have long pressed Ontario and other provinces to begin routine testing at age 40, saying the move would save lives and reduce the number of cancers being detected at later stages when treatment is more complex and risks are higher. It would also save millions in health dollars, they say.

Earlier screening could have made a life-changing difference for uOttawa law professor Jennifer Quaid.

She was diagnosed with Stage 3 breast cancer in late 2019 at age 50. With a family history of breast cancer, she had tried to get a mammogram earlier but was unable to because guidelines recommend screening beginning at 50 in Ontario. By then, she had nine tumours and cancer had spread to her lymph nodes. If she had been screened at age 40, she believes her outcome would have been very different.

“It probably would have been caught at Stage 0. I wouldn’t have had surgery. I wouldn’t have had chemo, lost my hair, gone through menopause early and lost a year of my working life and family life,” she said. “Yeah, it definitely would have benefitted me.”

Researchers, including Ottawa’s Dr. Jean Seely, who heads the breast imaging section at The Ottawa Hospital and is president of the Canadian Society of Breast Imaging, say the decision to begin routine screening at age 50 — recommended by the Canadian Task Force on Preventative Health Care — is based on flawed Canadian research. Seely was among authors of a research paper pointing out flaws in the influential study. A number of provinces already begin routine breast cancer screening at age 40, but Ontario and Quebec, the provinces with the largest populations, are not among them.

Seely called the U.S. recommendations “tremendously good news.”

In Ontario, the breast cancer screening program, which automatically contacts women to book screening, begins at age 50. Women can get a mammogram at age 40 with a doctor’s referral, but that seldom happens because many people don’t know or don’t have a family physician and doctors are often reluctant to do so. Under the Ontario breast screening program, patients don’t require a referral.

Just four per cent of women in Ontario in their 40s get screened, compared to around 25 per cent in British Columbia, where screening begins at age 40, says the advocacy organization Dense Breasts Canada.

Seely’s own research has shown that beginning routine mammograms a decade earlier would save lives. It would also save millions of health care dollars, she said.

Among research by Seely and others is a recent study showing that Canadian provinces that screen patients beginning at age 40 instead of 50 have a 44 per cent reduction in breast cancer mortality.

“It would save lives,” said Seely.

Advocates say Ontario has been conducting an evidence review on the issue. Jennie Dale, executive director of Dense Breasts Canada, which advocates for earlier screening, said her organization would like to see Ontario move quickly on the issue, since other provinces have reviewed the evidence and lowered the age of routine mammogram screening.

“Why reinvent the wheel? We would like to see them move just a little bit faster.”

In Canada, Nova Scotia, PEI and Yukon all begin annual breast cancer screening at age 40. Screening also starts at age 40 in British Columbia, but it is not done annually. Alberta begins routine screening at age 45.

Canada’s two most populous provinces, Ontario and Quebec, still begin routine screening at age 50.

That guideline is based on 2011 recommendations of the Canadian Task Force on Preventative Health Care, which used a Canadian study that research strongly suggests was flawed.

After the Canadian Task Force guidelines were published in 2011, the incidence of stage 4 breast cancer increased by more than 10 per cent over six years in 50-year-old women in jurisdictions, including Ontario, where women are not screened in their 40s.

Advocates say women of colour are more likely to be diagnosed with breast cancer, often aggressive, while in their 40s. Without routine screening, those cancers are often not detected until they are advanced.

And Seely notes that the cost of treating advanced breast cancers has increased sharply in recent years, partly because of new therapies that make a difference but are costly. According to research not yet published, the cost of treating advanced breast cancers has risen 15 to 20 times in the past 10 years, said Seely.

Quaid, meanwhile, noted that Ontario has not acted yet, despite evidence of benefits to individuals and the health system.

“It is a move in the right direction, but Ontario hasn’t done it yet. Ontario seems to be very reticent.”