Conversation is important for breast cancer screening

Brenda Wilson, Wendy Levinson, Jennifer Young

October is Breast Cancer Awareness Month, and information about screening can be confusing. At what age should anyone have a screening mammogram? What are the benefits? Are there any drawbacks? We need clear information about breast cancer screening.

However, there is no single answer to these important questions, as personal medical history and patient preferences and values ​​are important parts of the decision-making process. is required. This is called shared decision making.

More than 28,000 women in Canada are expected to develop breast cancer and 5,500 will die this year. The good news is that more effective treatments have improved the outlook for patients diagnosed with breast cancer.

What does breast screening include?

Breast cancer screening involves checking the breasts for signs of cancer before symptoms of the disease appear. This can be done with a special x-ray called a mammogram.

As a group that provides guidance to primary care providers, including primary care physicians, nurses, and other health care professionals, we seek to clarify mammography screening as another potential way to reduce the risk of dying from breast cancer. I’m here.

So what’s the latest advice? In 2018, the Canadian Task Force on Preventive Care released guidelines for breast cancer screening for average-risk individuals aged 40 to 74 years. The guidelines are intended to help people understand both the benefits and harms of screening and to provide best evidence-based recommendations. Simply put, after age 40, screening or not screening is always a personal choice, based on personal preference and discussion with a trusted healthcare provider.

In developing these guidelines, the Task Force always takes into account patient values ​​and preferences regarding screening. This guideline does not apply to individuals with a personal or strong family history of breast cancer, or those at increased risk of breast cancer, such as carriers of genetic mutations. Breast cancer risk increases with age. Up to age 74, the older you get, the more likely the benefits of screening outweigh the harms.

In Canada, different provinces and territories have different recommended age ranges for breast cancer screening. For example, some states recommend screening at age 40, while others recommend starting at age 50.

So why not just take a mammogram? Isn’t screening obviously better?

Not always. At the very least, screening can lead to false positives. This is a test that is positive when in fact there is no disease. It can also lead to more invasive tests, such as biopsies. And science shows that not all early cancers actually progress as we used to think. For some people, this means life-changing treatments that were never needed, and sometimes unavoidable complications.

Visualizing the benefits and harms of breast cancer screening can be helpful, so the task force has created a number of resources to help patients and providers have conversations: https://canadiantaskforce.ca/ tools-resources/breast -cancer update/.

New scientific research is evolving our knowledge of the harms and benefits of screening. As such, the Task Force reviews his guidelines every five years to provide new and updated information. Mammography guidelines will be reviewed in 2023.

But for now, the guidance is valid. If a person prefers to have a mammogram, it should be done on the basis of an informed conversation with a healthcare provider.
Brenda Wilson is Co-Chair of the Canadian Task Force on Preventive Health Care.

Wendy Levinson is Chair of Choosing Wisely Canada.

Jennifer Young is a medical advisor at the Canadian College of Family Physicians.

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