opinion: are canada's breast cancer screening guidelines working?

breast screening plays an essential role in detecting breast cancer early. this is vitally important because the earlier a cancer is detected, the higher the chances are that treatment will be successful. while canada’s breast screening programs, along with improvements in research, technology and treatments, have contributed to reducing the breast cancer death rate by nearly half since 1986, the dire and sustained impact of breast cancer is undeniable. we have more work to do.  

our understanding of breast cancer has evolved

since the national breast screening guidelines were first introduced by canadian task force on preventative health care (ctfphc) over 25 years ago, our understanding of breast cancer has greatly evolved. this includes our awareness of systemic barriers in access to breast screening that impact underserved communities, occurrences and commonalities of breast cancers in younger women, as well as our knowledge of high-risk factors for developing breast cancer such as family or personal history, carriers of gene mutations like brca1 or brca2 or those with dense breasts. it’s important to ensure that individuals eligible for breast screening feel included and represented in guidelines so that they have the information they need to discuss with their health-care provider about whether getting screened is right for them.

the ctfphc guidelines were last updated four years ago and, in that time, our understanding has continued to shift, deepen and expand. consider a recently published article in the journal current oncology which sheds light on new canadian evidence on the relationship between breast screening and breast cancer stage at diagnosis in women aged 40 to 49 and 50 to 59.    

rethink breast cancer, the canadian breast cancer network and the canadian cancer society all supported the guidelines when they were last updated by the ctfphc four years ago. specifically, we supported empowering people to be able to make informed decisions about breast screening based on their personal values, preferences and cancer risk. we complemented the guidelines with evidence-based information and tools to help people understand their own risk and to support their conversations about screening with their health-care providers. we also recognize that the guidelines were developed using high standards of scientific rigour and were designed for people at average risk of breast cancer.

it’s time to examine new breast cancer screening evidence

but four years have passed. and, as we’ve learned from our recent experience living through a pandemic, a lot can change in that amount of time. we have an obligation to ensure that the guidelines are keeping pace with the changing environment and new research findings to ensure canadians are supported and helped in the best way possible. if people need support to have shared decision-making conversations with their health-care provider and the research community is uncovering new data, findings or learnings that could shift our approach, should we not listen?  

that’s why we are collectively calling on the ctfphc to review and examine all new and available evidence on breast cancer screening to determine if any changes or updates to the current guidelines should be made. together, we have written a joint letter to the ctfphc with this request, asking it to assess the impact and effectiveness of the current guidelines and ensure they are meeting the needs of canada’s diverse population.  

reviewing and considering the latest evidence is an important step toward building a healthier society for people in canada ensuring that individuals are empowered to make an informed decision about breast screening whether they are at a low, average or high risk of breast cancer, and helping everyone to detect breast cancer at the earliest possible opportunity. we must do what we can to improve breast cancer outcomes and help people live long, healthy lives.