By Catherine Danko
October is Breast Cancer Awareness Month. On Oct. 8, 2024, the Ontario Government lowered the self-referring age to 40 from 50 for publicly funded mammograms through the Ontario Breast Screening Program (OBSP), marking a significant advancement for early diagnosis and patient care at UHN, and across the province.
Dr. Supriya Kulkarni, President of the Canadian Society of Breast Imaging and staff radiologist at UHN's Joint Department of Medical Imaging (JDMI), sat down for a Q-and-A with UHN News to discuss the impact of these new guidelines and their significance for women's health.
Tell us about the new breast cancer screening guidelines in Ontario.
The OBSP lowered the screening age for average-risk women from 50 to 40. Previously, women aged 50 to 74 could receive a screening mammogram every two years without a referral from their family doctor. Now, anyone aged 40 to 74 can access the screening program and self-refer into the program.
Why is this important and who will it impact?
We know from available Canadian data that the incidence of breast cancer is increasing in young women, starting as early as age 20, and in most women no specific cause can be identified. This trend is observed both in Canada and globally, which means we need earlier screening.
Canadian cancer statistics show that 13 per cent of newly diagnosed breast cancer cases occur in women aged 40 to 49, which is significant. Extending screening to this age group means we can improve early detection and diagnosis for those at risk.
What is the benefit of early diagnosis?
Not only are we seeing younger patients in our practice, but we're also seeing them coming with more advanced stages of the disease. The goal of OBSP is to detect cancers when they are small and when they have not yet spread to the lymph nodes and other parts of the body. This means that early diagnosis is crucial for personalized breast cancer treatment.
We know that not all women need chemotherapy or radiation, and that treatment depends on the cancer type and extent. Smaller tumours require smaller surgical intervention and less extensive adjuvant treatment, and catching aggressive tumours early makes treatment easier. Side effects of chemotherapy can be debilitating, especially for younger women with families. Early diagnosis helps minimize long-term side effects and reduces the overall treatment burden, saving lives and improving quality of life.
How does breast cancer impact women from different ethnic backgrounds?
Certain communities are more prone to develop breast cancer at earlier ages, including those in Toronto and across Canada where there is a high multicultural population. The peaking of their cancers occurs earlier than those of Caucasian women. It is a well-known fact that incidence of breast cancer peaks before age 50 in Black and Indigenous people. There are inequities in mammography screening participations in Ontario females aged 40-49, especially in materially deprived, low-income neighbourhoods and ethnically concentrated communities that lead to delayed diagnosis of breast cancer.
How has technology impacted breast screening?
Breast screening uses mammography equipment that emits a small amount of radiation to image breast tissue. Advances in technology over the past few decades have significantly improved the quality of these images. New technologies like digital breast tomosynthesis, which we use at Princess Margaret Cancer Centre, allow clearer views of breast tissue and reduce false positives. Contrast-enhanced mammography, similar to MRI, uses injected contrast for clearer images. The advancements are really becoming mainstream with further use of AI tools enhancing mammography.
How can women access this service and book a mammography appointment?
Women can visit any designated Ontario Breast Screening Program site or clinic for mammograms. Locations and other details are available on the OBSP website, where you can enter your area code to find nearby clinics and check wait times. Those who don't have internet access can call 811 for assistance in scheduling appointments. For those without family doctors, results are sent to a designated physician at each OBSP site, ensuring continuous care. The process is designed to be very easy and accessible.
