Breast Cancer Screening Programs and Strategies in Canada environmental scan

1. Breast Cancer Screening Programs and Strategies in Canadaenvironmental scan March 2013

2. Background • Quarterly, the Canadian Partnership Against Cancer collects information from the provinces/territories on the status of population-based breast cancer screening programs and/or strategies. • The information is collected through provincial and territorial leads represented on the National Committee of Canadian Breast Cancer Screening Initiative supported by the Canadian Partnership Against Cancer.

3. Presentation Outline • Canadian Task Force on Preventive Health Care Guidelines • Provincial and Territorial Guidelines • Breast Cancer Screening Program Distribution and Administration • Recruitment and Recall • Quality Assurance • Breast Cancer Data Reported • Breast MRI (High Risk Screening Guidelines)

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)

6. Breast Cancer Screening Programs: Provincial and Territorial Guidelines

7. Breast Cancer Screening Programs: Provincial and Territorial Guidelines (Cont’d)

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) Alberta (1996) (1990) Saskatchewan Manitoba Quebec (1990) (1995) (1998) Ontario Prince Edward Island (1990) (1998) New Brunswick Nova Scotia (1995) (1991)

9. Breast Cancer Screening Program Administration

10. Participant Recruitment * NS initially started sending out letters of invitation; however, they have since stopped due to capacity issues.

11. Recall Following a Normal Mammogram

12. 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 P/Ts

13. Association of Screening Program/Centre with Diagnostic Follow-Up

14. Quality Assurance: General *Classify cancer as either true interval or missed at screening **Alberta Health Services Screen Test sites only ***NS review of all interval cases 1991 to 2004 and CD of various cases are sent to all screening radiologists. Now with full field digital this will be competed electronically.

15. Quality Assurance:Client Satisfaction Surveys NWT, BC, AB, MB, NS and NL evaluate client satisfaction on an ongoing basis Table: Specific information collected when evaluating client satisfaction per province/territory

16. Quality Assurance:Evaluation of Radiologist Performance • Most P/Ts evaluate radiologists on their level of performance on an annual basis with the exceptions of YK and PEI. NB collects this data but does not report on it Table: Specific information collected when evaluating radiologist performance per province/territory Table: Specific volume requirement for radiologists per province/territory *All radiologists greatly exceed this number **Includes diagnostic and screening mammograms

17. Quality Assurance:Vital and Cancer Registry-Linkages with Provincial Registries *Through provincial client registry **Decreased lists are provided to WGH monthly ***linkage for post-screen cancer information only

18. Mammography Screening Program:Vital and Cancer Registries – TNM or Collaborative Stage For the provinces and territories that do not currently link with provincial cancer registries to collect cancer stage (TNM or Collaborative Stage) or other cancer variables, it may still be possible: • For the collection of post-screen cancer information (BC, QC, NS*) • For the collection of cancer and stage information (BC, NS*) • *Note: Both linkages are possible in NS; however, an agreement has not yet been established • For YK it is unknown if this is possible

19. Breast MRI: High Risk Guidelines Currently there are five provinces (BC, AB, ON, NS, NL) that have developed standard guidelines for MRI referral Table:The criteria or evidence that MRI referral is based upon per province * First degree relative ** >25% using validated assessment tool *** Chest irradiation before age 30 and at least 8 years ago **** BC includes the following syndromes: Li Fraumeni Syndrome, Cowden’s Syndrome, HDGC (CDH-1), Peutz-Jegher’s Syndrome

20. Future Implementation of MRI Ontario has implemented an MRI screening component to its organized screening program for women considered at high risk for breast cancer. BC, NS and AB have established guidelines for the use of MRI among women considered to be at elevated risk (i.e. in BC the women considered are confirmed cases of BRCA1 and BRCA2 mutation only). For more information on MRI guidelines for NS please visit www.breastscreening.ns.ca NL is exploring the appropriateness of using MRI among women considered to be at elevated risk

21. Reference Slide • Please use the following reference when citing information from this presentation: Breast Cancer Screening in Canada: Programs and Strategies. Cancer View Canada. Available at: [Enter Link], Accessed: [Enter Date Accessed].