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'overdue, but really welcome': cancer patients, advocates applaud news that ontario to start breast cancer screening at age 40
when amanda cosgrove turned 40, she asked her family do...
nov 1 2023
4 minute read
three years after amanda cosgrove, at age 40, asked to get a mammogram but was told she didn't qualify, she found a lump.
tony caldwell
/
postmedia
when amanda cosgrove turned 40, she asked her family doctor if she could get a mammogram as an early screening tool for breast cancer. her doctor asked a few questions about her family history and told her she didn’t meet federal guidelines, and didn’t qualify for the screening in ontario until she turned 50.
cosgrove was surprised and confused, but “just let it go”.
three years later, she discovered a lump, which would be diagnosed as breast cancer. by the time it was diagnosed, it had spread to her lymph nodes.
when her cancer was confirmed, cosgrove mentioned to the physician in charge that she had tried to get a mammogram three years earlier, but was told she didn’t meet the guidelines.
“(the doctor) looked at me and said, ‘those guidelines are totally out of date. tell all your girlfriends to get a mammogram.’ i was dumbfounded.”
those federal guidelines, which are currently under review, still recommend routine breast cancer screening begin at age 50, but this week ontario became the latest province to begin routine mammograms at age 40, based on growing evidence that waiting until 50 is costing lives.
this week’s announcement by ontario health minister sylvia jones that the province would lower the age for regular, publicly funded breast cancer screening to 40, had cosgrove thinking about “what ifs”, something she tries not to do.
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after difficult treatments that included a double mastectomy, months of chemotherapy and radiation, cosgrove says she is confident if she had been given a mammogram when she initially asked for one, her cancer would have been discovered significantly earlier and that would have meant less harsh treatment.
dr. jean seely, head of breast imaging at the ottawa hospital and professor at uottawa’s faculty of medicine, said she is delighted with this week’s announcement. ‘i have been advocating for this for over 20 years. this is going to save lives.’
julie oliver
/
postmedia
“i feel pretty strongly that i probably wouldn’t have had to go through chemotherapy if the screening was open.”
she and other patients, and advocates applauded ontario’s move this week.
“it is overdue, but really a welcome announcement,” said ottawa’s carolyn holland, 45, who was also diagnosed with breast cancer in her 40s. “my hope is this will mean many women in their 40s will not go through what i went through.”
when she was 43, holland discovered lumps in both breasts. her doctor’s first assessment was that it was probably not breast cancer, in part because of her age.
despite that, she sent holland for testing, which, after months-long waits, revealed she had two different types of cancer, including invasive ductal carcinoma in the left breast.
holland began chemo immediately and then, after eight sessions, underwent a double mastectomy and removal of some lymph glands. she later underwent radiation treatment and remains on the drug tamoxifen, which is a hormone suppressant aimed at preventing a recurrence.
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it has been a long, difficult process that has left holland with some lingering after-effects. holland says she hopes other women can avoid later diagnosis because routine mammograms are now available at 40.
holland said she was shocked when she learned women in their 40s had been routinely turned down for mammograms.
“i find it shocking. women have pap tests (a diagnostic tool to screen for cervical cancer) from the age of 16 or 18. we do this to catch cervical cancer early. the fact that we didn’t treat breast screening the same way to me was confusing.
“had it been caught earlier, the likelihood is that i wouldn’t need a bilateral mastectomy or even chemo.”
dr. jean seely, head of breast imaging at the ottawa hospital and professor at uottawa’s faculty of medicine, is among leading researchers on breast screening and a key advocate for beginning routine mammograms at age 40.
“i am delighted,” she said of this week’s announcement about lowering the age for routine mammograms in ontario, allowing eligible women, non-binary, trans and two-spirit people between the ages of 40 and 74 to self refer to a mammogram every two years beginning in the fall of 2024.
“i have been advocating for this for over 20 years. this is going to save lives.”
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among other things, seely’s research has shown that there were significantly lower numbers of women living with advanced stage breast cancer diagnoses in provinces that had lowered the age for routine screening from 50 to 40.
ontario joins british columbia, prince edward island, nova scotia, new brunswick and yukon as provinces and territories where screening begins at 40. in alberta, it begins at age 45.
seely is also involved in a yet-to-be published study showing rates of breast cancer among women in their 40s has increased significantly in the past five years. she said the incidence of breast cancer in women in their 40s is now higher than it was for women in their 50s in 1989 when routine screening began.
the canadian task force on preventive health care currently recommends women between 40 and 49 who are not high risk not be routinely screened for breast cancer. the guidelines do allow some women in that age group to be screened if they wish after a consultation with their physician, but seely and others say women almost always have been turned down.
“we know hundreds of women were denied a screening because their family doctor refused,” she said.
the task force is currently conducting a comprehensive evidence-based review to update its cancer screening guidelines.
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“all available evidence is being reviewed as part of this process,” said co-chair dr. guylène thériault, who is a family physician and professor in the outaouais.
but seely said she does not believe the task force’s guidelines will change, which will put them at odds with the practices in ontario and other provinces, and the guidelines in the u.s.
the task force has, in the past, relied heavily on older randomized control trials, including one that critics have analyzed and say is seriously flawed. more recent observational research supports the life-saving benefits of earlier screening, says seely.
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