Breast Cancer Screening Guidelines Across Canada

1. Breast Cancer Screening Guidelines Across Canada Environmental Scan January 2014

2. 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.

3. 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

4. Canadian Task Force on Preventive Health Care Guidelines The Canadian Task Force on Preventive Health Care (2011) recommends the following for breast cancer screening: 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)

5. 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/

6. Breast Cancer Screening Programs: Provincial and Territorial Clinical Practice Guidelines • *No screening program available in Nunavut • **New provincial Breast Cancer Screening Clinical Practice Guidelines released early September 2013 recommend expansion of the target age range from 50-69 to 50-74

7. Breast Cancer Screening Programs: Provincial and Territorial Clinical Practice Guidelines, cont’d • *No screening program available in Nunavut • **New provincial Breast Cancer Screening Clinical Practice Guidelines released early September 2013 recommend expansion of the target age range from 50-69 to 50-74

8. Distribution of mammography and CBE among breast screening programs Province/Territory (Program Disribution) Mammography alone Yukon Territory Clinical Breast Examination & Mammography (1990) Northwest Territories No Organized Program Nunavut (2003) British Columbia Newfoundland & Labrador (1988) (1996) Alberta (1990) Saskatchewan (1990) Manitoba Quebec (1995) (1998) Prince Edward Island Ontario (1998) (1990) New Brunswick Nova Scotia (1995) (1991)

9. Breast Cancer Screening Programs in Canada *No screening program available in Nunavut

10. Recall Following a Normal Mammogram *No screening program available in Nunavut **includes ages 30-49 if part of the high risk screening program

11. 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.

12. High Risk Screening Guidelines: MRI 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 *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 ago

13. High Risk Screening Guidelines: MRI 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 www.breastscreening.nshealth.ca. Newfoundland and Labrador is exploring the appropriateness of using MRI among women considered to be at high risk

14. 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

15. 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 *Includes diagnostic and screening mammograms **All radiologists greatly exceed this number *** NB program policies stipulate that the RHAs must have a system for the annual review of mammography screening outcome data with Radiologists

16. 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]