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Breast

Eligibility

British Columbia’s Breast Screening Policy reflects the latest evidence and our commitment to reducing breast cancer deaths by finding cancer at an early stage. Key policy recommendations include:

Breast screening

Average risk, ages 40-49

Health care providers are encouraged to discuss the benefits and limitations (found in the Guidance tab) of screening mammography with asymptomatic women in this age group.

If screening mammography is chosen, it is available every two years. Patients will be recalled every two years. A health care provider’s referral is not required but is recommended.

Average risk, ages 50-74

Routine screening mammograms are recommended every two years for asymptomatic women at average risk of developing breast cancer. Patients will be recalled every two years. A health care provider’s referral is not required.

Average risk, ages 75+

Health care providers are encouraged to discuss the benefits and limitations (found in the Guidance tab) of screening mammography with asymptomatic women in this age group.

Health care providers should discuss stopping screening when there are comorbidities associated with a limited life expectancy or physical limitations for mammography that prevent proper positioning.

If screening mammography is chosen, it is available every two to three years. Patients will not be recalled by the Screening Mammography Program of BC. A health care provider’s referral is not required but is recommended.

Higher than average risk, ages 40-74 with a first-degree relative with breast cancer

Routine screening mammograms are recommended every year. Patients will be recalled every year. A health care provider’s referral is not required.

High risk, with a known BRCA1 or BRCA2 mutation or prior chest wall radiation or strong family history of breast cancer

Age 40-74: please refer to recommendation for "Higher than average risk" women.

Under age 40: The Screening Mammography Program accepts women at high risk of developing breast cancer with a health care provider’s referral, provided they do not have breast implants or an indication for a diagnostic mammogram. Please discuss patient with a screening program radiologist before referral.

Other procedures

Routine breast self examinations (when used as the only method to screen for breast cancer) are not recommended for asymptomatic women at average risk of developing breast cancer.

Women should be familiar with their breast texture and appearance and bring any concerns to their health care provider. 
 
There is insufficient evidence to either support or refute routine clinical breast exams (in the absence of symptoms) alone or in conjunction with mammography. The patient and her health care provider should discuss the benefits and limitations of this procedure to determine what is best for the patient.

This excludes women with prior breast cancer history.
 
Routine screening with breast MRI of women at average risk of developing breast cancer is not recommended.

Exceptions are higher than average risk groups include: BRCA1 and/or BRCA2 carriers, first degree family relatives of BRCA1 and/or BRCA2 not tested, and prior Hodgkin’s disease (or other lymphoproliferative diseases) at a young age (between the ages of 10-30 years old) treated with chest radiation.
 

For details on screening in other age groups and government clinical practice guidelines and protocols, see the "Screening" section of "Breast Disease and Cancer: Diagnosis" at BC Guidelines.



Guidance

Talking to patients

Women may hear conflicting information about screening. It’s important for them to be aware of the benefits and limitations of screening mammography so that they can make an informed decision. The Screening Mammography Decision Aid is available to support women in making an informed decision to screen for breast cancer using mammography.

Just the facts

  • The strongest risk factor for breast cancer is being female and getting older.
  • About 1 in every 9 Canadian women will develop breast cancer in her lifetime. 1 in 28 women is expected to die from the disease.
  • The Screening Mammography Program of BC (SMP) encourages eligible women to have a routine screening and sends reminder letters when women are due for their next screen.
  • The first mammogram is a baseline – returning regularly gives us the ability to compare images and find subtle changes that can occur over time.
  • Women can call 1-800-663-9203 directly to book an appointment.
  • SMP has 37 fixed locations and 3 mobile services visiting over 120 communities across BC.
Benefits & limitations

  • Mammograms save lives. Studies of screening programs around the world have demonstrated a 25% reduction in deaths from breast cancer among women who are screened.
  • Mammograms can usually find lumps earlier. Mammograms can show a breast lump 2 or 3 years before a woman or her primary care provider can feel it.
  • Detecting cancer at an early stage can make it easier to treat. Finding breast cancer early on may result in simpler treatment, more treatment options, and more positive outcomes.
 
  • Mammograms are not perfect. Factors like age and breast density may result in false-negative or false-positive mammograms.
  • Mammograms in younger women can be difficult to interpret. The dense breast tissue found in younger women can make it more difficult to find abnormalities.
  • Having a mammogram may lead to additional testing. Among women of all ages, about 7% of mammograms require diagnostic work up, which may include more imaging and/or biopsy.
  • Most abnormal findings detected on mammograms are not cancer. While 7% of women will need further testing after a screening mammogram, only 0.4% of screening mammograms in the Screening Mammography Program of BC result in a diagnosis of breast cancer.
  • Screening mammography cannot detect all cancers. Mammograms find 4 in 5 cancers but some cancers that are detected by physical examination may not be seen on the mammogram. These cancers are often too small or in an area that is difficult to view, such as the axilla.
  • Mammograms expose women to low dose radiation. For most women, the benefits of regular mammograms outweigh the risks posed by this amount of radiation. 
 

Fast Track

Fast Track is a province-wide initiative aimed at reducing the time between an abnormal result and further testing. To speed up the process, SMP sends results directly to the primary care provider (doctor, nurse practitioner or naturopathic doctor) and facilitates the referral for the first round of diagnostic testing. Once complete, the diagnostic results are sent to the primary care provider. Contact with the Fast Track centre usually occurs within 1 week and participants typically receive their diagnostic tests more quickly; on average 1.1 weeks versus 2.4 weeks. The Fast Track centre will contact the primary care provider if unable to reach the participant directly.

  1. When your patient comes for a screening, she is told about the Fast Track system.
  2. You and/or your patient can choose a preferred clinic.
  3. If a preferred clinic is not selected, a default Fast Track clinic will be assigned. This is the closest Fast Track diagnostic imaging centre to the screening site; which is often the same location as the screening site.
  4. If further tests are needed (from an “abnormal”/recalled screen), SMP faxes the Fast Track request with the SMP mammography report to the designated Fast Track centre. A copy is also faxed to the primary care provider office.
  5. The SMP sends the images and the radiologist’s recommendation for further imaging work up to the designated Fast Track centre.
  6. The SMP sends a result letter and the name of the Fast Track centre conducting further tests on your patient to the health care provider.
  7. The Fast Track centre contacts your patient to book the diagnostic imaging tests, usually within 1 week. The Fast Track centre will contact you (primary care provider) if the patient cannot be reached.
  8. You will receive a diagnostic imaging report from the Fast Track centre. The imaging work up will conclude with 1 of 3 outcomes:
    • All is clear, woman can return to regular screening
    • Probably benign: under these circumstances the woman is put on a “surveillance schedule” that may involve follow-up at 6 months, for 1 to 3 years
    • Recommend a biopsy, either percutaneous fine needle aspiration or core biopsy or open biopsy. If an open biopsy is recommended, you will be notified by phone or fax so that you can arrange referral for a surgical consultation.
 
 


Resources

Education materials for health care providers and patients are available at no charge from the Screening Mammography Program (SMP). To obtain resources, download the materials below, email the order form to screening@bccancer.bc.ca or fax it to 604-660-3645.

Brochures

Guidelines

Promotional materials

Reports

Scientific publications

Videos

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