Medical personnel use a mammogram to examine a woman's breast for breast cancer. Ontario Health Minister Sylvia Jones announced last fall that the province would allow women to refer themselves for breast cancer screening starting at age 40.Michael Hanschke/Reuters
Ontario women in their 40s can now begin booking their own mammograms, with Canada’s most populous province joining the growing ranks of jurisdictions making breast cancer screening more readily available to a younger age group.
Ontario Health Minister Sylvia Jones announced last fall that the province would allow women to refer themselves for breast cancer screening starting at age 40 – a change from the past policy of requiring women aged 40 to 49 to get a doctor’s referral to access the procedure. Ontario women aged 50 to 74 already receive letters in the mail inviting them to book a mammogram every two years.
An Ontario Health website scheduled to go live Tuesday 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.
“It’s great that we’re seeing barriers removed for women,” said Anna Wilkinson, a general-practitioner oncologist at The Ottawa Hospital who advocated for the changes. “Women are going to have more autonomy in their choices. If they want to book for a mammogram, they can.”
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The question of when to start offering screening mammograms has been hotly debated in Canada for years. Breast cancer risk increases with age. Those in favour of beginning at age 40 say rates are high enough in the 40-to-49 age bracket to justify the possible downsides of screening, which can include unnecessary biopsies and the stress of an abnormal finding on a scan that turns out to be harmless.
In May, the Canadian Task Force on Preventive Health Care, a federally funded but independent panel that provides advice to primary-care doctors and nurses, released new guidelines that stopped short of lowering the threshold to 40 from 50 for proactively offering mammograms to all women, as a similar panel in the United States first recommended last year.
However, the Canadian expert panel said women in their 40s who wanted a mammogram should be able to get one, ideally after discussing risks and benefits with a doctor.
British Columbia, Nova Scotia, Prince Edward Island, New Brunswick and Yukon already permit women to self-refer for mammograms starting at 40. Alberta and the Northwest Territories start at age 45.
Saskatchewan and Manitoba have both announced plans to lower their threshold over time, with the former saying it will lower the age to 47 in January, and the latter promising to drop the starting age to 45 by December, 2025. Newfoundland and Labrador have promised to lower the age as well but have yet to release a timeline. Quebec’s starting age is under review.
When are Canadians eligible for breast cancer screenings? Guidelines for each province and territory
Ontario currently performs about 700,000 screening mammograms a year, according to Judy Linton, Ontario Health’s executive vice president for clinical institutes and quality programs. Screening mammograms are those performed on women who don’t have any symptoms of cancer.
The province has committed $19-million to expand the Ontario Breast Screening program. Ms. Linton, who is also Ontario Health’s chief nursing executive, said the agency estimates lowering the age for self-referral will lead to an additional 177,000 screening mammograms annually.
That, in turn, is expected to lead to 30,000 more ultrasounds, 28,000 more diagnostic mammograms and about 5,500 additional tissue biopsies. Ms. Linton said the program expects to detect 845 additional cases of cancer a year after expanding eligibility.
Ontario is still encouraging women to have a conversation with their doctors about the risks and benefits of screening for women younger than 50. Women who don’t have a family doctor can call 811, a provincial number that connects callers to a registered nurse for health advice.
“Screening is not without risk,” Ms. Linton said. “We do know that there will be some false positives that arise out of this. We’re estimating that number to be somewhere in the 500 range.”
Jennie Dale, executive director of Dense Breasts Canada, an advocacy group, said she is generally “thrilled” about Ontario’s policy change but worries that asking women to consult a doctor before booking a mammogram could hamper access.
“Women are going to still face a figure of authority giving them this message, and behind the doctor is the task force,” she said, referring to the expert panel’s view that routine mammograms for average-risk women need not begin until age 50.