A radiologist uses a magnifying glass to check mammograms for breast cancer.Damian Dovarganes/The Canadian Press
The federal Health Minister is “extremely disappointed” by a national task force’s decision not to lower the starting age for routine mammograms to 40 and will speed up an external review of the expert panel, which some critics say should be disbanded.
Mark Holland and several advocacy organizations, including the Canadian Cancer Society, said on Thursday that they disagreed with the long-awaited draft mammography recommendations from the Canadian Task Force on Preventive Health Care, a federally funded but independent organization that provides advice to primary-care doctors and nurses.
“We know that if you don’t get screened and you do have cancer and it isn’t caught early, that it kills you,” Mr. Holland said. “All the women that I’ve spoken to, both in my professional and personal life, have said they’d rather deal with a false positive than miss the opportunity to get cancer diagnosed early.”
The task force’s new recommendations emphasize that average-risk women in their 40s who want a mammogram should be able to get one every two to three years, ideally after a clear discussion of the benefits and risks with a doctor.
The task force stopped short, however, of lowering the threshold to 40 from 50 for proactively offering screening to all women, as a similar panel in the United States first recommended last year.
The U.S. change sparked a fresh round of scrutiny of Canada’s position, which was last updated in 2018. The public drumbeat for earlier breast-cancer screening grew loud enough that several provinces, including Ontario, Saskatchewan, and Newfoundland and Labrador, announced plans to lower the age rather than wait for the task force’s advice.
Henry Siu, a Hamilton family doctor and member of the task force, said the impact of screening on breast cancer death for women in their 40s isn’t as significant as many people assume, which contributed to the panel’s recommendations for that cohort.
Extrapolating from more than 160 studies, the task forced concluded that if 1,000 average-risk women in their 40s underwent mammograms every two or three years for a decade, 19 cases of cancer would be discovered, compared with 17 cases among 1,000 women who were not screened. In the screened group, between one and two women would be expected to die from breast cancer, while two would be expected to die of the disease in the unscreened group.
When women hear those numbers, some conclude the stresses of a possible false positive outweigh the potential benefits of screening, Dr. Siu said. “We felt that the recommendation that people should know what the information is and make a choice based on their values and preferences is the best recommendation that we can give.”
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Experts deriding the draft recommendations said some of the panel’s evidence was out-of-date and that its conclusions incorrectly played down the benefits of screening. The draft recommendations, which now go out for public consultation, apply only to women with no known risk factors – such as a family or personal history of breast cancer – and no symptoms of the disease.
“It’s a sad day for Canadian women and it’s a sad day for health science in Canada,” said Martin Yaffe, a senior scientist at the Sunnybrook Research Institute in Toronto whose research focuses on digital imaging in breast cancer. “The task force has done it again – they’ve completely missed the boat.”
The Canadian Cancer Society is disappointed that the task force didn’t lower the threshold to 40, as the society recommended in its own policy statement earlier this month, said Elizabeth Holmes, the society’s director of health policy.
While it is a “meaningful improvement,” that the new document makes it clear that Canadian women who want a mammogram should be able to get one, Ms. Holmes said that approach risks excluding some women, including those who don’t have family doctors.
“It really puts the onus on the individual to advocate for their own early detection and screening and get access to a referral rather than being automatically invited to provincial and territorial programs,” she said.
Other organizations, including the Ontario Association of Radiologists, urged Ottawa to disband the task force, calling it an “archaic organization trapped in old concepts.”
The panel, which also issues recommendations for preventing other types of illnesses, didn’t deliver its new breast cancer screening guidance before the end of last year as promised, despite an extra $500,000 from the federal government to expedite the recommendations.
“I share their concern and disappointment,” Mr. Holland said of the Ontario radiology group. “I have not been impressed by this process, but I also recognize that it is an independent process and we must treat it with rigour.”
He said it would set a bad precedent if he disbanded the 12-member panel of physicians and nurse practitioners without first asking the Public Health Agency of Canada to expedite the launch of an external review of how the task force operates.
In the meantime, Jennie Dale, co-founder and executive director of Dense Breasts Canada, said she fears many women in their 40s won’t get access to a mammogram, even if they would like one.
“Family doctors see the guidelines as their bible,” Ms. Dale said. “If the task force says 50, they are not likely to have a discussion with women who come for physicals in their 40s.”
With a report from Carly Weeks