Breast Cancer
Screening Guidelines
Across Canada
Environmental Scan
July 2015
July 2015
Background
• Quarterly, the Canadian Partnership
Against Cancer collects information from
the provinces/territories and
international organizations on the status
of population-based breast cancer
screening programs and/or strategies.
• This information compares current
guidelines and evidence-based
recommendations in order to identify
leading practices.
July 2015
Presentation Outline
 Canadian Task Force on Preventive Health Care
Guidelines
 Provincial and Territorial Screening Guidelines
 Breast Cancer Screening Programs in Canada
 Recall Following a Normal Mammogram
 High Breast Density Recommendations
 High Risk Screening Guidelines (Breast MRI)
 Quality Assurance Measures
July 2015
Canadian Task Force on Preventive
Health Care Guidelines
The Canadian Task Force on Preventive Health Care (2011)
recommends the following for breast cancer screening
amongst average risk women:
Mammography
• For women aged 40-49, routine screening not
recommended (Weak recommendation; moderate quality
evidence)
• For women aged 50-69, routine screening every 2 to 3
years (Weak recommendation; moderate quality evidence)
• For women aged 70-74, routine screening every 2 to 3
years (Weak recommendation; low quality evidence)
Magnetic Resonance Imaging
• Routine screening not recommended (Weak
recommendation; no evidence)
July 2015
Canadian Task Force on Preventive Health
Care Guidelines, cont’d
Clinical Breast Exam
• Routine screening for breast cancer is not
recommended when performing clinical breast
exam alone or in conjunction with mammography
(Weak recommendation; low quality evidence)
Breast Self Exam
• Routine practice of breast self exam is not advised
by the Task Force (Weak recommendation; moderate
quality evidence)
For more information please visit:
http://canadiantaskforce.ca/
July 2015
Breast Cancer Screening Programs: Provincial
and Territorial Clinical Practice Guidelines
For asymptomatic women at average risk:
Start Age
Nunavut*
Interval
Stop Age
Current guidelines under review
Begin at age 50 (age 40 – 49
accepted by physician referral for
initial screen but not actively recruited)
For women aged 40-49 – annual recall
For women aged 50-74 - biennial recall
75
Yukon
Begin at age 50 (age 40-49 accepted
by self referral but not actively
recruited)
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall
75+
British Columbia
Begin at age 50 (age 40-49 accepted
by self referral but not actively
recruited)
For women aged 40-49 - biennial recall
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall
For higher than average risk women aged 40-74 –
annual recall
Alberta
Begin at age 50 (age 40-49 accepted
with physician referral for the first
screen)
For women aged 40-49 - annual recall
For women aged 50-74 - biennial recall**
Saskatchewan
Begin at age 50 (age 49 accepted on
the mobile if turning 50 in same
calendar year)
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall (only if
previously enrolled in the program)
Manitoba
Begin at 50 (ages 40-49 accepted to
mobile unit only with physician
referral)
For women aged 40-49 - biennial recall
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall
74 (age 75+ accepted by
self referral but not actively
recruited or recalled)
For high risk women aged 30-49 - annual recall
For high risk women aged 50-69 – annual recall
For women aged 50-69 - biennial recall**
For women aged 70-74 - biennial recall**
74 (75+ only with a primary
care provider referral)
Northwest Territories
Ontario
Begin at age 50 (ages 30-49 accepted
if high risk and referred by physician)
*No screening program available in Nunavut but guidelines are under review
**Women who meet specific criteria that may put them at increased risk for breast cancer will be recalled annually
74 (age 75+ accepted by
self referral but not actively
recruited or recalled)
75+ **
(Since September 2013)
75+
Breast Cancer Screening Programs: Provincial and
Territorial Clinical Practice Guidelines, cont’d
For asymptomatic women at average risk:
Start Age
Québec
New Brunswick
Begin at age 50 (accept ages 35-49
only with physician referral, at a
program designated screening or
referral center)
Interval
For women aged 50-69 - biennial recall
Stop Age
69 (age 70+ only with a
physician referral, at a program
designated screening or referral
center)
Begin at age 50 (age 40-49 accepted
only with physician or nurse practitioner
referral)
For women aged 50-74- biennial recall
74 (age 74+ only with a
physician or nurse practitioner
referral)
(Since June 1, 2013)
Nova Scotia
Begin at age 40
For women aged 40-49 - annual recall
For women aged 50-69 - biennial recall
70+
Prince Edward Island
Begin at age 40
For women aged 40-49 - annual recall
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall
74
Begin at age 50 (age 40-49 accepted
only with physician referral)
For women aged 50-74 - biennial recall
Newfoundland &
Labrador
74 (age 74+ only if previously
enrolled in the program)
Distribution of mammography and CBE
among breast screening programs
Province/Territory
(Program Distribution)
Yukon
Territory
(1990)
British
Columbia
(1988)
Mammography alone
Northwest
Territories
(2003)
Clinical Breast Examination
& Mammography
No Organized Program
Nunavut
Newfoundland
& Labrador
(1996)
Alberta
(1990)
Saskatchewan
(1990)
Manitoba
(1995)
Quebec
(1998)
Ontario
(1990)
Prince Edward
Island (1998)
New
Brunswick
(1995)
Nova
Scotia
(1991)
Breast Cancer Screening Programs in Canada
Program Start Date
Program Name
Agency Responsible for Program
Administration
Nunavut*
Northwest Territories
2003
2008
Breast Screening Program, Stanton Territorial
Health Authority
Breast Screening Program, Hay River Health
and Social Services Authority
Stanton Territorial Health Authority
Hay River Health and Social Services
Authority
Yukon
1990
Yukon Mammography Program
Government of Yukon (Yukon Hospital
Corporation)
British Columbia
1988
Screening Mammography Program of British
Columbia
BC Cancer Agency
Alberta
1990
Alberta Breast Cancer Screening Program
Alberta Health Services
Saskatchewan
1990
Screening Program for Breast Cancer
Saskatchewan Cancer Agency
Manitoba
1995
BreastCheck
CancerCare Manitoba
Ontario
1990
Ontario Breast Screening Program
Cancer Care Ontario
Québec
1998
Programme québécois de dépistage du cancer
du sein (PQDCS)
Ministère de la Santé et des Services sociaux
New Brunswick
1995
New Brunswick Breast Cancer Screening
Services
New Brunswick Cancer Network (NB
Department of Health)
Nova Scotia
1991
Nova Scotia Breast Screening Program
Government of Nova Scotia
Prince Edward Island
1998
PEI Breast Screening Program
Government of Prince Edward Island
Newfoundland and
Labrador
1996
Breast Screening Program for Newfoundland
and Labrador
Eastern Health, Cancer Care Program
*No screening program available in Nunavut but guidelines are under review
Recall Following a Normal Mammogram
Send out
recall letters
Coordination of recall for women following
a normal screening episode performed by
Any additional follow-up
to first recall letter after
no reply
Age group
for recall
Nunavut*
Northwest
Territories

Regional Coordination Centres
Yukon

Screening centre
British Columbia

Centralized management (Program or Agency)

40-74
(AHS Screen
Test only)
Centralized management (Program or Agency)

40-74
Saskatchewan

Centralized management (Program or Agency)

50-74
Manitoba

Centralized management (Program or Agency)

50-74
Ontario

Centralized management (Program or Agency)

50-74**
Québec

Regional coordination centres

50-69
 (not all
regions)
Screening centre

50-74
 (postcard)
Centralized management (Program or Agency)

40-69
Prince Edward
Island

Screening centre

40-74
Newfoundland and
Labrador

Screening centre

50-74
Alberta
New Brunswick
Nova Scotia
*No screening program available in Nunavut
**includes ages 30-49 if part of the high risk screening program

40-74
40-74
High Breast Density Recall and
Recommendations
Five provinces and territories recall women based on high breast density.
Recommendations following a high breast density reading varies across the
country.
Automatic annual
recall based on breast
density
Value considered high
breast density
Recommendation for high breast
density levels

> 75%
Annual recall

>75%
Annual recall

> 75%
Annual recall
Nova Scotia

>75%
Annual recall
Newfoundland and Labrador

>75%
Annual recall
Northwest Territories
Saskatchewan
Ontario
July 2015
High Risk Screening: MRI Referral Guidelines
Currently there are five provinces (British Columbia, Alberta, Ontario, Nova
Scotia, Newfoundland and Labrador) that have developed standard guidelines
for MRI referral.
Table: The criteria or evidence that MRI referral is based upon per province
Self-reported
family history
(>=2) of breast
cancer (first
degree relative)
Selfreported
family
history of
BRCA 1/2
Alberta
ⱡ

(>=3)
Chest
irradiation
between the
ages of 10
and 30 years
Li-Fraumeni
syndrome, Cowden
syndrome, or
Bannayan-RileyRuvalcaba
syndrome

**





***

****
*****
ⱡ

****




Nova Scotia
Newfoundland and
Labrador
Risk of breast
cancer >20%
(scored by
validated
assessment
tools)
*
British Columbia
Ontario
Genetic
testing
BRCA 1 or
2


*British Columbia allows women with a 50% risk of BRCA mutation who have not yet received their BRCA testing
** British Columbia includes the following syndromes: Li Fraumeni Syndrome, Cowden’s Syndrome, HDGC (CDH-1), Peutz-Jegher’s Syndrome
***First degree relative, and have declined genetic testing themselves
**** ≥25% using validated assessment tool
***** Chest irradiation before age 30 and at least 8 years prior to the screen
ⱡ Upon confirmation of high risk status after genetic assessment
e-cadherin
mutation
ⱡ

High Risk Screening: MRI Referral Guidelines,
cont’d
Ontario has implemented an MRI screening component to its
organized screening program for women considered at high
risk for breast cancer.
British Columbia, Nova Scotia and Alberta have established
guidelines for the use of MRI among women considered to be
at high risk (i.e. in British Columbia the women considered are
confirmed cases of BRCA1 and BRCA2 mutation only). For
more information on MRI guidelines for Nova Scotia please
visit http://breastscreening.nshealth.ca/guidelines.pdf
Newfoundland and Labrador is exploring the appropriateness
of using MRI among women considered to be at high risk
July 2015
Quality Assurance:
Client Satisfaction Surveys
Northwest Territories, British Columbia, Alberta, Manitoba, Nova
Scotia and Newfoundland and Labrador evaluate client satisfaction
on an ongoing basis.
Table: Specific information collected when evaluating client satisfaction per province/territory
Mammography exam
Particular Screening
Centre
Organized Screening
Program
Northwest Territories (STHA site)



British Columbia



Alberta


Manitoba



Nova Scotia



Newfoundland and Labrador



July 2015
Quality Assurance:
Evaluation of Radiologist Performance
Most provinces and territories evaluate radiologists on their level of
performance on an annual basis with the exceptions of Yukon and Prince
Edward Island. New Brunswick collects this data but does not report on it.
Table: Specific information collected when evaluating radiologist performance per province/territory
Positive
Predictive Value
(PPV)
Abnormal call
rate
Cancer
detection rate
Interval
cancers
Specific
volume
requirements
for radiologists
Northwest Territories
(STHA site)ᶲ



British Columbia



Alberta



Saskatchewan




1,000 / year
Manitoba




1,000 / year**
Ontario




1,000 / year*†
Québec



480 / year

2,500 / year
480 / year*†
750/ year
New Brunswick***
1,200/ year*
Nova Scotia



Newfoundland and
Labrador



2,000 / year

2,000 / year
*Includes diagnostic and screening mammograms
**All radiologists greatly exceed this number
*** New Brunswick program policies stipulate that the RHAs must have a system for the annual review of mammography screening outcome data with Radiologists
† This figure is currently under review and will likely be changed to align with CAR MAP requirements.
ᶲ For Northwest Territories, the level of performance is done on the program as a whole (not specific radiologist) due to small volume numbers.
Reference Slide
Please use the following reference when citing
information from this presentation:
Cancerview.ca. Breast Cancer Screening Guidelines
Across Canada: Environmental Scan. Toronto:
Canadian Partnership Against Cancer; [enter date].
Available from: [enter URL link]
July 2015