Ontario will be lowering the age for self-referral for breast cancer screenings from 50 to 40 years, making it the latest province to make the change—and spurring questions for whether more provinces will follow suit.
Ontario Health Minister Sylvia Jones said Monday that the change will help with early detection of cancer, and will mean an additional 130,000 mammograms are completed in the province each year.
The move comes after the U.S. Preventive Services Task Force released a draft recommendation earlier this year that suggested regular screenings in the U.S. should start at 40 instead of 50.
Provinces and territories often take their cue for cancer screening from the Canadian Task Force on Preventive Health Care (CTFPHC), whose current guidelines conditionally recommend not screening women aged 40-49 years.
“The Canadian Task Force on Preventive Health Care is aware that Ontario is lowering the age for self-referral for mammograms to 40. The Task Force is currently conducting a comprehensive evidence-based review process to update its breast cancer screening guidelines,” Dr. Guylene Theriault, co-chair of the CTFPHC, told CTVNews.ca in an email statement Monday.
“All available evidence is being reviewed as part of this process. We continue to focus on our evidence-based work and look forward to sharing our results with the goal of providing credible and unbiased recommendations to support the health and well-being of women.”
Starting in the fall of 2024, eligible women, non-binary, trans and two-spirit people in Ontario between the ages of 40 and 74 can self-refer for a mammogram every two years.
So what is the status of breast cancer screening across the rest of the country?
B.C.’s screening program is the oldest in the country, accepting its first patient in 1988. Screening mammograms are available by self-referral in B.C. to those aged 40 years and older, although BC Cancer advises those aged 40-49 to talk to a health-care provider about the benefits and limitation of mammography first.
The screening interval for women aged 40-49 is biennial, unless they have a first-degree family history of breast cancer, in which case they are recommended to receive a mammogram every year.
A year ago, Alberta lowered the recommended age for breast cancer screening, stating that women should begin screening every two years starting at age 45 instead of age 50.
Albertans aged 40-44 who wish to get a mammogram still have to get a referral from their doctor.
Saskatchewan still provides screening mammograms only to women 50 years of age or older, with those of average risk recommended to receive screening every two years.
Residents aged 40-49 who are of average risk can secure a referral to a diagnostic centre through their family physician, according to guidance from the Screening Program for Breast Cancer, which cited the CTFPHC guidelines as helping to shape their policy.
Starting at age 50, Manitobans will receive a letter to make a screening mammogram appointment every two years, with no doctor’s referral needed for this age group.
Breast cancer awareness advocates have been calling for the province to lower the minimum age for self-referral.
The province stated Monday that they will be evaluating whether or not it will lower the age of regular breast screenings to 40 years old.
“The Programme québécois de cancérologie, like other jurisdictions, keeps abreast of new recommendations for cancer screening on an ongoing basis,” the Quebec Health Ministry tells CTV News. “Developments in the scientific literature are monitored on an ongoing basis.”
At the end of September, the province announced that it would be expanding its cancer screening to allow women aged 40-49 to self-refer for a mammogram.
The province noted in a press release that deaths in this age group account for 17.5 per cent of all breast cancer deaths in Canada.
“With early detection comes less aggressive treatments and a better quality of life for the patient and their family,” Sherry Wilson, minister responsible for addictions and mental health services, said in the release. “This will allow women who are diagnosed to return to a normal life sooner.”
According to the release, the program will be “in place early next year.”
Nova Scotia recommends mammography screening for asymptomatic women at least 40 years old. Those aged 40-49 are recommended to receive annual screening, while those aged 50-74 are recommended to receive a mammogram every two years, unless they need an annual frequency due to being of higher risk.
PRINCE EDWARD ISLAND
P.E.I’s guidelines are similar to Nova Scotia’s, with screening recommended annually for those aged 40-49 and screening recommended every two years for those aged 50-74.
Patients can self-refer to the PEI Breast Screening Program.
NEWFOUNDLAND AND LABRADOR
Breast cancer screening is only offered to women aged 50-74 years through the province’s program.
“Eastern Health follows the Canadian Task Force Preventive Health Care (CTFPHC) guidelines, which state that the benefits of mammography screening increases with age, and they recommend not screening women under 50 but to screen women over 50 to age 74 every two-three years,” the health agency states on their website.
The Yukon Mammography Program offers screening mammograms at Whitehorse General Hospital to women aged 40 years or older. Eligible women 40 years or older can make an appointment by calling directly.
“A screening mammogram can be ordered by your physician – or if you are over the age of 40 (and do not have any specific breast concerns) you can self-refer,” the hospital website states.
The territory recommends that women of average risk aged 50-74 are screened every two years. It is possible for residents to start having mammograms in their 40s, but they need a referral from a health-care provider for the first mammogram.
There is no organized screening program for breast cancer in Nunavut currently. Residents have to secure a referral from a health-care provider to receive a mammogram, and while some mammograms can be done in Iqualuit, according to the territory’s Department of Health, residents may be referred to a centre in another province or territory.
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