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breast cancer screening before age 50 linked to better survival rates: study

this latest study joins the growing body of evidence that earlier access to breast cancer screening translates to better health outcomes.

by emma jones
published aug 04, 2023
last updated apr 03, 2024
read time 5 minute read
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read time 5 minute read
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breast cancer screening before 50 linked to better survival
the ten-year survival rate of women aged 45-49 who were diagnosed with breast cancer and lived in areas with access to screening programs in their 40s was 2.6 per cent higher than those who did not. getty
a new study indicates that provinces which allow women to access yearly breast cancer screenings from the age of 40 have significantly higher survival rates than provinces that rely on physician-referred screenings starting at 50 years of age. the study, published in the journal of clinical oncology, used data from the canadian cancer registry to compare survival rates of women aged 40-49 years and 50-59 years who were diagnosed with breast cancer between 2002 to 2007. overall, of women who were diagnosed with breast cancer in their 40s, 84.8 per cent of women who had access to screening in their 40s survived for ten or more years, compared to 82.9 per cent of women who lived in areas where routine screening begins in the 50s (a 1.9 per cent increase). when looking specifically at women aged 45-49, the ten-year survival rate of women who were diagnosed with breast cancer and lived in areas with access to screening programs in their 40s was 2.6 per cent higher than those who did not.
anna n. wilkinson, primary author on the study and gp oncologist at the ottawa hospital cancer centre, says this increase in survival rate is similar to the increase that was seen when tamoxifen, one of the most widely used treatments for breast cancer, was added to oncologists’ arsenal.

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canadian task force updating breast screening guidelines, amid push for screening at age 40
currently, the task force recommends routine screening begin at age 50, although some provinces begin it earlier
dr. jean seely, a researcher and radiologist at the ottawa hospital, says changes to the age that routine mammograms begin cannot come quickly enough in canada.

gail kelpin had to wait six months for breast cancer surgery. by then, her cancer had doubled in size.
she believes the long wait contributed to her worsening cancer prognosis and the need for a second surgery. her surgeon conceded she was probably right.
gail kelpin believes her long wait for breast cancer surgery contributed to her worsening prognosis and the need for a second surgery.
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“if you look at tamoxifen for five years, that’s a 3.3 percentage point improvement in survival and for women 45 to 49, we founded 2.6 [percentage point] improvement in survival,” she says. “it’s a survival advantage that’s on par with one of the widely used cancer treatments that we know of.”
previously, the team looked at screening ages and the impact it has on advanced breast cancers. their research indicated provinces that did not screen women in their 40s had higher rates of breast cancer in women in their 50s. wilkinson says it is likely screening women in their 40s allows physicians to catch pre-cancerous lesions and other concerning abnormalities, preventing them from becoming cancerous later on.

catching breast cancer early can impact survival

catching cancer before it spreads can have major implications. if breast cancer is caught when it is only localized to the breast, the five-year survival rate is 99 per cent, according to the canadian cancer society. if the spread is regional, for example, spread to nearby lymph nodes but no farther, survival rate decreases to 86 per cent. and if the cancer has a distant spread to other parts of the body, five-year survival rate plummets to 29 per cent.
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kimberly carson, ceo of breast cancer canada, says the data is clear — earlier screening will save lives.
“without any question, the sooner we can catch it the better the results are,” says carson. “and now, with precision medicine and precision screening and detection, we’re going to have — hopefully in the near future — a lot of options for screening and detection. so why wouldn’t we do it at an earlier age and try to catch it sooner?”
carson points to the advancements in screening technology that allows health-care providers to catch cancer in earlier stages. mammograms are considerably more sensitive than they were even five years ago, mris are being evaluated for use in dense breast tissue, and blood tests have also shown promise in catching cancers in early stages. the widespread adoption of ai technology also means the rate of advancements will likely speed up and will allow researchers to pinpoint who is at risk of early onset and start their screenings accordingly — maybe even in their 30s.
understanding early onset risk is also key to promoting health in diverse communities. research indicates black, hispanic, and asian women are more likely to be diagnosed with breast cancer before the age of 50 than white women. women of african or asian ancestry are also disproportionally affected by triple-negative breast cancer, an aggressive form of the cancer more likely to appear before the age of 40. (in response to these findings, love & nudes, an undergarment brand catering to women of colour, launched a petition asking the canadian government to reduce the age of breast cancer screenings.)
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reducing barriers to screening improves survival rates.

the ottawa hospital team also found “self-referral” programs, where women were invited to book a screening appointment without needing a referral from a primary care provider, increased survival rates.
“there’s many provinces and territories where women cannot access screening without a physician or primary care provider referral,” says wilkinson. “this is a huge barrier to lots of women who perhaps don’t have a primary care provider.”
for every barrier that exists to getting access to breast cancer screenings — like finding a doctor and then waiting several months for an appointment to get the referral — there’s a drop off in the population that will eventually access screenings. ideally, women would be able to book screenings directly, wilkinson says, with an annual letter or notification from the government reminding them of their ability to do so.

early screenings could be more cost effective.

wilkinson says her team is now looking into the overall cost of earlier screenings, and the unpublished results indicate the upfront cost of screening women earlier may mean a reduction in overall expenditure for treating breast cancer.
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“we have a paper submitted that looks at the cost of breast cancer treatment by stage, and the cost of breast cancer treatment goes up exponentially as the stage goes up,” she says. “when you’re talking about treating [pre-invasive breast cancer], you’re talking about $15,000; when you’re talking about a stage one, it’s probably about $30,000. but when you’re up around stage 3, it’s $90-100,000, and stage 4, you’re over half a million.
“we’re taking our numbers and putting them into modelling, but the cost for a woman for a mammogram for her 40s is about $2600 for those ten years.”
requiring less invasive treatments could also mean fewer health-care costs in the future as well as — more importantly — better overall health, as patients would not be dealing with side-effects of stronger medications or invasive surgeries.
“i think there would be a cost savings if we could catch it early, certainly. your survival rate is much better,” says carson. “and, you know, if we can catch it early there’s less invasive treatments and then there’s less drugs.”
emma jones is a multimedia editor with healthing. you can reach her at emjones@postmedia.com or on instagram and twitter @jonesyjourn.
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