A new statement has just been released from OH-CCO:
The Ontario Breast Screening Program encourages people ages 40 to 49 who are at average risk for breast cancer to make a personal decision about breast cancer screening in consultation with their primary care provider. Based on this discussion, people under age 50 can be screened for breast cancer outside the OBSP with a referral from their primary care provider.
In consultation with our local OBSP lead radiologist Dr. Meredith Lynch, I learned a few factors regarding this stance on screening:
- Women age 40-49 are at risk of breast cancer.
- The US Preventative services task force draft statement released in May 2023 indicates an increased incidence of breast cancer in women age 40-49 since the old 2016 recommendations. USPSTF is now recommending screening mammography for average risk women beginning at age 40.
- Screening mammography is currently recommended for average risk women age 40-49 in many jurisdictions in some organized screening programs in Canada (age 40 in BC, Nova Scotia, PEI, Yukon; Alberta age 45).
- The Canadian Task Force on Preventative Health Care 2018 recommendations against screening mammogram in women age 40-49 are currently under review.
How can we primary care providers best help our patients make this personal decision?
From Dr. Lynch, I learned that unfortunately the Canadian Task Force decision making tools (eg 1000 person pictograph) are not necessarily helpful since they are based on the old recommendations which should be updated in fall 2023. There are some websites that discuss patient values related to screening mammography, however they don’t appear to be particularly evidence based so may or may not be helpful for individual patients eg. mybreastscreening.ca and densebreasts.ca
While we await the updating of the Task Force decision making tool, for now I will be ensuring that any discussions around breast cancer screening are sure to include a suggestion that they read through CCOs Frequently Asked Questions about mammograms. It contains information regarding safety and effectiveness as well as how to get ready and what happens during the mammogram.
Stay healthy!
Dr. Meghan Davis, B. Eng. MD FCFP
Primary Care Lead, HNHB Regional Cancer program