new breast cancer screening guidelines go against expert recommendations: what this means for canadians
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new breast cancer guidelines fail to "reflect the latest evidence and prioritize the lives of canadians."
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the canadian task force on preventive health care released new breast cancer screening guidelines, ignoring calls from cancer societies and patient advocacy groups that younger and more widespread screening is necessary for canadians.
according to current research conducted in ottawa surrounding breast cancer statistics, screening women in their 40s can significantly change the course of a breast cancer diagnosis and improve survival rates.
however, the guidelines fail to recognize these statistics and found that women under 50 don’t need to be included in the guidelines given to family physicians and nurse practitioners who use them in preventive care measures—with one caveat. they can ask to be screened themselves if they choose, regardless of whether they have reached the age of 50.
according to jennie dale, executive director at dense breasts canada, these guidelines are “dangerous and harmful to canadians.”
the updated breast cancer screening guidelines
the last update to the breast cancer screening guidelines was completed in 2018. the recommendations state that there is an emphasis on shared decision-making regarding breast cancer screening, putting the onus on women to push for their own preventive care. a verbatim summary of the current 2018 guidelines is as follows:
- women aged 40-49 (and aged 50-74) who want to be screened for breast cancer should talk to their doctor or other health care professional.
- this conversation should consider the pros and cons of screening, as well as their personal values and preferences.
- if a woman wants a mammogram after this discussion, she should have a mammogram.
- we believe in empowering women to make informed decisions about their health. this is the fundamental foundation of shared decision-making.
- the recommendations only apply to women who are at an average risk of developing breast cancer, as well as those without family history, genetic markers, or signs or symptoms of the disease.
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as various experts note, the updated guidelines continue to leave out the data that shows changes are needed, such as failing to:
- lower the screening age to 40 or extend it past age 74
- recommend against self-examinations
- encourage additional screening for women with dense breasts
according to the task force, the risks of over-screening far outweigh the benefits. however, when those outlined risks come down to increased anxiety and unnecessary tests, for many, they pale in comparison to an earlier breast cancer diagnosis and, ultimately, a better chance of survival.
these guidelines also continuously put the onus on women to take control of their health. while it is up to the individual, canadians deserve guidance based on the latest scientific data that reflects the current state of breast cancer in the country, as well as how preventive care measures make a difference.
breaking down the data
while the task force has its own ways of making decisions, many patient advocacy groups and cancer societies feel that the latest data is seemingly ignored in their decision-making process. current research has found that when people aged 40-49 are screened, it significantly reduces mortality rates in breast cancer. in the same breath, more screening did not lead to an increase in breast cancer diagnoses.
as breast cancer is the “most common cancer diagnosed in canadian women in their 40s”, as well as the leading cause of death in women in their 40s, the lack of adjustment to the guidelines appears to consider this data to be null and void.
according to radiologist dr. paula gordon oc, whose comments were included in a press release from dense breasts canada, there is significant concern that “canadians will continue to face unnecessary later stage breast cancer because of these guidelines. there is good evidence that when breast cancers are detected earlier through screening, there is less need for harsh debilitating treatments such as mastectomy, axillary dissection, and chemotherapy.”
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black women, especially, are more likely to feel the weight of the guidelines because they are more likely to experience death from breast cancer and, according to research, are under-screened when compared to other ethnic groups.
“the risk of a later stage breast cancer is a particularly urgent concern for black women,” says dr. ify mckerlie, principal radiologist at calgary’s women’s imaging centre, in a press release to healthing. “black women are 40 per cent more likely to die from breast cancer, underscoring the urgent need for improved screening and early detection. i am troubled that these new guidelines do not ensure that my patients get the kind of care they need to live healthy, productive lives.”
the issues with self-advocating for preventive care
the current guidelines suggest that women can ask for breast cancer screening if they so choose. however, getting the proper care through self-advocacy isn’t always that simple.
given the current state of the healthcare system and wait times for appointments and tests, many women who are told that breast cancer screening is not needed are more likely to forgo it simply because advocating for themselves is not always a priority.
also, according to research, when healthcare professionals say a test is unnecessary, canadian women believe them, leading to less push-back from patients who could benefit from early screening, even if they don’t fall into a high-risk group. according to the world health organization, “roughly half of all breast cancers occur in women with no specific risk factors.”
another issue with the guidelines is that breast cancer cases in women under 50 are rising. data collected by a canadian research team found that breast cancer rates have increased in women in their twenties, thirties, and forties by 45.5 per cent, 12.5 per cent, and 9.1 per cent, respectively.
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these numbers, while alarming, help paint a picture that proves, through scientific evidence, that changes in the guidelines to reflect canadian women’s experiences with breast cancer diagnosis need to be implemented.
“we are beyond disappointed in the recommendations. the guidelines should reflect the latest evidence and prioritize the lives of canadians. the task force has failed us, and we ask canadians to tell minister holland to suspend these guidelines and use modern science to save lives,” dale said in a press release.
what you can do to protect yourself
many provinces have implemented screening programs to reflect what they believe is right when it comes to diagnosing breast cancer in canadian women. british columbia, nova scotia, newfoundland, prince edward island, and the yukon all have self-referred breast cancer screening available for women aged 40-49. ontario will introduce a similar program this upcoming fall.
while this doesn’t change the perceived failures in the current guidelines, it does help more canadians bypass recommendations in a way that could help prevent them from developing advanced breast cancers. with these programs in place, more women can have easier access to screening if they choose, giving them the tools they need to practice preventive care, even if the task force needs time to catch up to reality.
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