When are Canadians eligible for breast cancer screenings? Guidelines for each province and territory

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The Canadian Task Force on Preventive Health Care updated the national breast cancer screening guidelines this week, saying people in their 40s shouldn’t be routinely screened for the disease but also shouldn’t be stopped from getting a mammogram if they want one, Carly Weeks reports.

This after the Canadian Cancer Society released a new position statement earlier this month calling for breast screening to begin at age 40.

Guylène Thériault, co-chair of the national task force, said panel members and expert advisers didn’t find compelling scientific evidence that would warrant a lowering of the screening age for average-risk individuals. Instead, the new guidelines are focused on providing information to help people at various ages determine if screening is right for them.

Many jurisdictions use the task force’s recommendations to set their own policies, but they are not binding. Some provinces already allow individuals access to mammograms at age 40, citing a push for earlier interventions.

Here’s what you need to know about access to screening across Canada:

What are some main risk factors for breast cancer?

According to the Canadian Cancer Society, a risk factor is “something that increases the risk of developing cancer.” It can be a behaviour, substance or condition.

Here are a list of common risk factors for breast cancer as listed on the Canadian Cancer Society website:

• Personal history of breast cancer
• Family history of breast and other cancers
• BRCA gene mutations
• Dense breasts
• Certain genetic conditions
• Other gene mutations
• Reproductive history – specifically, factors related to pregnancy and the role of estrogen, the main hormone associated with breast cancer
• Previous exposure to radiation therapy to the chest, neck and armpit area
• Hormone replacement therapy
• Oral contraceptives
• Alcohol
• Obesity
• Physical inactivity
• High socio-economic status

When are you not considered eligible for a screening mammogram?

Most women across the country, starting from the age of 50, are able to book a screening mammogram every two years. A mammography is an X-ray of the breasts done by a specially trained technologist. It consists of four images – two of each breast – that look for signs of cancer in those who are healthy with no symptoms and have never had breast cancer.

In some provinces, you are not eligible for a screening mammogram if you

• have a previous history of breast cancer
• have breast implants
• are pregnant or breastfeeding
• have a breast cancer symptom such as a lump, puckered skin, rash or nipple discharge
• have had a mammogram in the past 12 months

People with symptoms require diagnostic mammograms.

What is mammogram access like across Canada?

Choose a jurisdiction

British Columbia

British Columbia’s Lifetime Prevention Schedule recommends breast cancer screenings for women aged 50 to 74 every two years. People from the age of 40 with no symptoms of breast cancer can begin booking their own mammograms, without a doctor’s referral, through the B.C. Cancer Agency’s Screening Mammography Program. Those 40 and older are encouraged to speak to their primary care provider about personal risk factors and the benefits and limitations of breast cancer screening.

Screening is also available for two-spirit, transgender or gender-diverse individuals. The B.C. Cancer Agency outlines further screening guidelines on its website.

People without a primary care provider are recommended to call the Screening Programs Client Services Centre in Northern B.C. or contact virtual clinics such as Telus Health My Care, CanScreenBC or Walk In.

Alberta

The Alberta Breast Cancer Screening Program recommends regular mammograms every two years for individuals aged 45 to 74 – without a referral or requisition. Other forms of breast cancer screenings, including a clinical exam or an MRI, require a doctor.

Routine screening is not recommended for those 40 to 44, and a doctor’s referral is required for those in this age group who’d like to start screening earlier.

In 2022, Alberta became the first province in Canada to lower the recommended age for screenings to 45. The updated guidelines were based on a review by the Alberta Breast Cancer Screening Clinical Practice Guideline Committee.

Saskatchewan

The Saskatchewan Cancer Agency’s Screening Program for Breast Cancer provides routine screening mammograms every two years for women 50 to 74. The program may screen annually for women with increased risk.

Currently, routine screenings are not recommended for women 40 to 49, but they can access screenings with a referral from a health care provider. The province, however, announced that it will expand the age eligibility to include women 40 to 49 starting January, 2025, through a phased approach.

Manitoba

Women aged 50 to 74 in Manitoba are encouraged to get routine mammograms. No doctor’s referral is needed for this age group. The province will mail qualifying Manitobans a letter to make an appointment every two years. Routine breast cancer screenings are also recommended for some transgender, non-binary and gender-diverse people with guidelines listed on the CancerCareManitoba website.

In Manitoba, women in their 40s are unable to self-refer for a mammogram because the province doesn’t recommend screenings for people 40 to 49. If they’d like to get a screening, they require a referral from a health care provider.

Ontario

The Ontario Breast Screening Program (OBSP) now recommends mammograms for women, two-spirit, trans and non-binary people aged 40 to 74. Those individuals do not need a doctor’s referral, and the service is covered by the Ontario Health Insurance Plan (OHIP).

The province announced in October, 2023, that it would expand its cancer screening to people aged 40 to 49. The changes came into effect on Oct. 8, 2024, and allows individuals to refer themselves for breast cancer screening starting at age 40. But the province is still encouraging individuals to have a conversation with their doctors about the risks and benefits of screening for younger than 50. Those who don’t have a family doctor can call 811, a provincial number that connects callers to a registered nurse for health advice.

The OBSP also recommends that people aged 30 to 69 who meet “high risk” eligibility criteria get screened annually with both a mammogram and an MRI. The “high risk” status is based on a family or medical history of breast cancer with confirmation from a doctor.

Routine screening is not recommended for those over 74, but a doctor’s referral is needed if you’d like to get tested.

An Ontario Health website scheduled to go live on Oct. 8 will allow women to search by postal code for the nearest Ontario Breast Screening Program site, check local waiting times and make their own appointment for a mammogram.

Quebec

Women 50 to 74 are eligible for mammogram screenings without a doctor’s referral through the Quebec Breast Cancer Screening Program. The program sends a letter to those who qualify, which can be used to book a mammogram appointment at a clinic or screening centre. A list of designated screening centres is included in the letter.

Women who are under 50 and over 74 are unable to book a mammogram without a doctor’s referral. The Quebec Breast Cancer Screening Program recommends an appointment with a personal care provider to discuss personal risk and the advantages and disadvantages of screening.

Quebec recently expanded the referral-free screenings to those aged 70 to 74 and is considering expanding the program to people aged 40 to 49. Previously, the program was only available to those between the ages of 50 and 69.

New Brunswick

Asymptomatic women aged 50 to 74 in New Brunswick are encouraged to have mammograms every two to three years and can self-refer by contacting one of the screening sites throughout the province by phone.

Women 40 to 49 or over 74 need a referral from a primary health care provider for a mammogram, and the province recommends against screening for those 40 or younger.

PEI

On Prince Edward Island, screening is recommended every two years for people 50 to 74, and it’s available for people 40 to 49 every year through self-referral to the PEI Breast Screening Program. If your parent or a sibling was diagnosed with breast cancer, you can be screened 10 years prior to their age at diagnosis. If you are under 40, a doctor’s referral is required for the initial screening appointment.

Nova Scotia

The Nova Scotia Breast Screening Program recommends a mammogram every two years for individuals aged 50 to 74. Those aged 40 to 49 and 75 and older are encouraged to speak with their family doctor to see if screening is right for them. People over 40 who don’t have a family doctor can contact the Nova Scotia Breast Screening Program directly to book an appointment.

Newfoundland and Labrador

Following the Canadian Cancer Society’s recommendation, the province lowered the age to begin breast cancer screening every two years from 50 to 40, until the age of 74. A doctor’s referral is not necessary. People can self-refer by calling their respective regional health authority’s breast cancer screening program.

Yukon

Yukon offers mammograms to women over 40 at the Whitehorse General Hospital. They can self-refer by calling 867-393-8738. It’s recommended that women 40 to 49 who decide to have mammograms have one every year and at least every two to three years if they are aged 50 to 74. Those over 75 should speak with their health care provider about how often.

Northwest Territories

The NWT recommends that women of average risk aged 45 to 74 have mammograms every two years. It’s recommended that people who are considered high risk be screened yearly. Mammography units are currently located in Yellowknife, Hay River and Inuvik. Residents who live in a community without a mammography unit can be referred to the appropriate facility by their health care provider, with travel costs covered by Medical Travel.

Nunavut

Nunavut has no provincial guidelines for mammography. Baffin Regional Hospital in Iqaluit got its first mammography machine in 2007. Before then, people who needed mammograms had to fly to Ottawa.

With reports from Carly Weeks.

Editor’s note: This article has been updated to clarify eligibility around screening mammograms.