Vancouver - The Screening Mammography Program of B.C. (SMPBC) is making changes to recruit twice as many women between 50 and 74 years of age. The program's goal is to regularly screen 70 per cent of women in this group at least every 24 months. Currently, less than 35 per cent of this group participates in screening every 12 to 18 months. 

"We're making these changes so that as many women as possible who could benefit from screening mammography will participate regularly," says Dr. Ivo Olivotto, medical leader of the SMPBC. "We expect these changes will improve our ability to reduce the number of women dying from breast cancer."

The SMPBC reviewed international and provincial data and consulted with its staff, participants, screening staff, the BC Cancer Agency and the Ministry of Health to evaluate the program's effectiveness. The review precipitated the following steps to increase the number of women screened yearly:

• Be more active to recall previous SMPBC participants.    
• Enhance recruitment to reach 70 per cent of the target population.    
• Improve access to SMPBC service.    
• Provide better information about screening mammography for women aged 40 to 49.

"Our data supports results from international studies," Olivotto says. "These studies show the benefits of screening healthy women are similar, in terms of reducing deaths from breast cancer, whether screening is done yearly or every two years." He says that since annual screening is not necessary for most women, the system of annual reminder letters will be replaced by a more active recall program to ensure that women return every 24 months.

The SMPBC has several strategies to support recruitment efforts. The program staff will send letters to all B.C. women aged 50 to 74 years old who have never attended the screening program. A health promotion specialist will lead an effort to enlist community partners and family doctors across the province to encourage women to participate in screening mammography. Staff will send reminder letters to women and follow-up with those who don't respond, in an effort to ensure women are screened at least every 24 months. The SMPBC will also launch a public education campaign to inform women and their families about the importance of early detection and screening mammography.

The SMPBC will continue to improve access for women in B.C. during the next few years, as resources allow.

The SMPBC works with several partner organizations to share the message of promoting regular mammograms and to deliver its service, in particular the Canadian Breast Cancer Foundation and the Canadian Cancer Society.

"Screening mammography is an emerging field. We must take advantage of data as it becomes available. It is our best chance to detect breast cancer early," says Judy Caldwell, president of the Canadian Breast Cancer Foundation. "We are most concerned about the number of women in B.C. who are eligible for screening mammography who have never even had their first one done. We are very supportive of increasing efforts to reach these women."

"Screening mammography is a critical aspect of an overall breast health program," says Barbara Kaminsky, CEO, Canadian Cancer Society (BC&Yukon Division). "We continue to encourage women to make mammograms a regular part of their health care, and we also remind women to perform breast self-examination and have regular physician checkups," Kaminsky adds the Cancer Society contributes funds to the Canadian Breast Cancer Research Initiative to support further studies in this important area of women's health.

The Screening Program will continue to accept women who are 40 to 49 years old who choose to have screening mammograms. The benefit of regular screening for women of this age remains controversial and the SMPBC has produced a new pamphlet to help women weigh the advantages and disadvantages of screening in this age group.

The mandate of the SMPBC is to reduce breast cancer deaths in this province through early detection. It is a program of the BC Cancer Agency, which provides a comprehensive system of cancer control for the province.

Contact: Libby Brown, Public Relations, BC Cancer Agency, at 877-6107.

Screening Mammography Program of B.C. - Background

Screening mammography is an X-ray of the breasts used to detect breast cancer early in healthy women who have a normal breast physical examination. The mandate of the SMPBC is to reduce breast cancer deaths in B.C. by making screening mammography available to women. The program's goal is to screen regularly at least 70 per cent of women aged 50 to 74. The SMPBC provides service in 99 communities in BC.

Just 32 per cent of B.C. women aged 50- to 74 (the group that benefits most from screening mammography) attended an SMPBC facility in a recent 24-month period. The participation rate for women outside this age range is even lower. Moreover, women from various education and ethnic backgrounds from various parts of the province are not taking full advantage of the SMPBC. Research studies have shown that targeted recruitment initiatives - such as direct personal letters of invitation, the recommendation of a woman's family doctor and the use of community development workers - can improve participation rates.

The SMPBC recently reviewed international evidence and its own data from eight years of operation to determine how often healthy women should undergo screening. There have been eight randomized trials of breast screening with different designs regarding mammogram techniques, screening interval and age inclusion. An analysis of data from all eight studies shows the following:

• The magnitude of benefit from screening at one-year or two-year intervals is the same - 23 per cent fewer deaths from breast cancer among women age 50 or older invited for screening at either interval (Kerlikowske K et al, JAMA 1995;273:149-154).   
• For women between 50 to 69 years, who had cancer detected through a screening visit, SMPBC data shows there is no significant difference in the proportion of cancers which were small (<1.5 cm) or node negative at diagnosis whether the women returned before 18 months or returned between 19 to 30 months after a previous normal examination.   
• Similarly, there was no difference in the size of tumours or percentage of women who had lymph node spread at diagnosis for cancers which showed up in the first 12 months or second 12 months after a SMPBC examination with normal results.