Breast Cancer Screening

I wrote this OPED piece in response to an article in the Globe and Mail earlier this year; it wasn't printed, but I want to share it with the community because screening is under attack for both breast and prostate cancer.

We have been told repeatedly and clinicians and researchers agree that early detection of breast cancer is key to positive outcomes. The new guidelines proposed by the Canadian Task Force on Preventive Health Care (Screening for Breast Cancer, Summary of recommendations for clinicians and policy-makers, 2011) are a step in the wrong direction. The Task Force should be part of the solution of finding a better mass screening tool for the early detection of breast cancer rather than attempting to cut costs on the health of women.

Approximately one quarter of the 23,000 women diagnosed with breast cancer every year in Canada are under 50 (CCS). By declaring that women 40 to 49 should not be included in provincial and territorial breast screening programs unless they are at high risk because of familial or genetic factors, the Canadian Task Force on Preventive Health Care and the Public Health Agency of Canada in which it is housed, has decided that about 5,000 women under 49 diagnosed with breast cancer every year in Canada don’t matter. It seems too that columnist Andre Picard and the Editorial Board of the Globe and Mail have written them off as well.

It is clear that reality for the clinicians, scientists, academics and researchers who sit on the Canadian Task Force on Preventive Health Care is not the same reality of women diagnosed and living with breast cancer, and unfortunately, there are no trained cancer survivors on the Task Force to bring that reality to the table.

The reality is that mammography is the only mass screening program we have in Canada and although I agree with Margaret Wente that the “test is lousy” (Cure for cancer at any cost, G&M, November 26, 2011), there is no alternative available and in use today. So, do we throw the baby out with the bathwater? 

Women of all ages with no known risk factors are diagnosed through mammography. What will happen if provincial and territorial breast screening programs across the country offer women between 50 and 74 mammograms every three years instead of the current two and drop women 40-49 from their programs? How many women’s tumours will go undetected for longer periods of time, be diagnosed at later stages and thus require more invasive, longer and more painful treatments and possibly have poorer outcomes?

Breast self-examination is no longer being recommended or taught in Canada, but many women of all ages with no known risk factors find their own tumours by doing regular breast self-exam. Most if not all breast cancer survivors know other women who have done the same.  Critics of breast self-exam state that women find non-cancerous lumps that then must be screened and sometimes biopsied to determine whether they are cancerous or not, and that these medical interventions are both stressful and costly. And yet I do not know one woman who would not go through these diagnostic procedures to discover whether a lump is cancerous: it’s our lives at risk, after all!

Canadian women are being encouraged by the Canadian Task Force on Preventive Health Care to discuss breast care and breast cancer screening with their family doctors, conveniently ignoring the fact that 4.4 million Canadians are without a family doctor (Canadian Community Health Survey 2010).

 Women know that what used to be considered the triad of breast care – regular mammograms, clinical breast exams and breast self-exam – was not perfect. With mammography, tumours are missed or occur between mammograms; there are a lot of false positives (but thankfully, not false negatives); mammograms are not as effective on very large breasts or dense breasts. These facts are not a secret; women know they can happen. But we also know that there are no other screening options in Canada today.

Until something better is found, efforts must be made to make the diagnostic tools we already have as effective as possible.