Ontario is joining several other provinces with early breast cancer screening by lowering the age for publicly funded mammograms.
Starting next fall, Ontarians will be able to self refer for a mammogram once they turn 40, a decade earlier than the current age of 50. This comes in advance of updated guidelines on breast cancer screening that are expected to be released this fall from a national task force.
"This change of course will allow for up to an additional one million Ontarians to self refer for a mammogram if they decide screening is right for them," Health Minister Sylvia Jones said on Monday morning at Women's College Hospital just down the street from Queen's Park.
"Nearly 12,000 Ontarians are diagnosed with breast cancer each and every year. We know early detection through regular screening mammograms can save lives, detecting breast cancer before it has the chance to spread," she added.
Finance Minister Peter Bethlenfalvy called the move "game-changing."
All of us have a mother ... and this is such an important day for all the mothers and the daughters, sisters in this world," he said. "Make no mistake, this is a measure that will save lives and make the health-care system stronger."
Currently, the Ontario Breast Screening Program recommends that most women, two-spirit, trans and non-binary people aged 50–74, considered average risk, be screened for breast cancer through a mammogram every two years. There are exceptions where individuals with a history of ovarian cancer, for example, could get a mammogram done after just a year.
Under the program, it's recommended that those aged 30 to 69 who are considered at high risk for breast cancer — if you or an immediate relative have a gene mutation known to increase risk, a family history of breast or ovarian cancer or had radiation to the chest before 30 and eight or more years ago — get both a mammogram and a breast MRI, or an ultrasound if an MRI can't be performed, each year.
It's estimated that 18 out of every 200 people screened in the program will be sent for additional tests, and one will have breast cancer. Cancer Care Ontario, which was folded into Ontario Health and oversees the province's screening program, recommends regular mammograms "because it can find cancer early when it is less likely to have spread to other parts of the body." Treatment can also work better when a cancer is found early.
Most people whose breast cancer is discovered early will survive for at least five years, according to statistics on Cancer Care Ontario's website. But found later, only 30 per cent of people are expected to survive for five or more years.
The question of whether or not to lower the age of breast cancer screening for the general population has been a discussion in various jurisdictions across Canada and in the United States, with some pointing to the risk of false positives and subsequent biopsies or other follow-ups to justify starting screen at 50.
The Canadian Task Force on Preventive Health Care, which was established by the Public Health Agency of Canada, said this summer that it would speed up its review of breast cancer screening recommendations and release updated guidelines late this fall. The task force doesn't recommend mammograms for the general population until the age of 50.
The task force's announcement came after its American counterpart released a draft recommendation in May "that all women get screened for breast cancer every other year starting at age 40."
Asked why the Ontario government decided to make the change ahead of the national task force's recommendation, the health minister's spokesperson, Hannah Jensen, said "the change comes as a result from consultations with and feedback from healthcare partners and experts." She also pointed to other provinces that have made a similar move.
Provinces like Nova Scotia, British Columbia, Alberta and P.E.I. have lowered the age for self-referrals for screening mammograms, while others like New Brunswick are making the change next year.
Liberals in Ontario criticized the Progressive Conservative government on Monday for not specifying any funding alongside its plan to lower the age for breast cancer screening.
"While this announcement may feel like a welcome surprise, the devil is in the details," said Bonnie Crombie, who is one of four candidates in the Liberal leadership contest, in a statement. "The announcement comes with no additional funding."
The Ontario government said in a press release on Monday that an additional 130,000 mammograms will be able to be completed each year. It said the locations participating in the province's program will increase capacity over the next several months and work with the government "to develop a public reporting tool that allows people to view appointment wait times across the province."
Jones' spokesperson, Jensen, said the cost of this policy change will depend on the required increase in capacity and how many staff need to be hired.
But Liberal MPP Adil Shamji, who worked as an emergency room doctor, said without details on staffing and costs, "this is just another announcement that isn't backed up by any sort of implementation plan."
Shamji and Crombie also said many Ontarians are waiting for breast and cervical cancer screenings, with Crombie noting "and the waitlist keeps getting longer."
The Ontario Medical Association said last October that more than 400,000 fewer mammograms had occurred during the pandemic, and that while "screenings have returned to forecasted levels," there were concerns about undiagnosed cancers and longer wait times for surgeries once breast cancer is diagnosed.
Shamji said he hasn't seen updated wait list statistics, but there's been "no indication whatsoever that there has been a meaningful improvement in that number."
He said while the government's announcement was a step in the right direction, he has additional concerns.
“Most guidelines in North America, when they do suggest that women between 40 and 50 should get mammograms, usually say that the decision should be made together with the physician, and the announcement today says simply that women can self-refer,” Shamji said, adding that this highlights the lack of access to family doctors across the province. "They should have the opportunity to speak with a physician and be able to make an educated decision."
Meanwhile, Sherry Wilcox, who was diagnosed with breast cancer last year at the age of 44, applauded the government's move.
Wilcox, a mother of three who joined provincial officials for the announcement, said she had asked her doctor about a mammogram when she turned 40, but "parked the topic" when she was told she wasn't eligible, until she found a lump in her breast.
She recalled a meeting in Jones' office earlier this year with the Ontario Association of Radiologists, thanking the minister "for listening and for prioritizing women's health" with the upcoming change.
"To all the women who are breast cancer survivors and patients and to the families of those who have passed, this announcement is a recognition of what you have endured," Wilcox said. "While it may be too late for us, this is an incredible opportunity for others going forward that hopefully will not have to bear the negative consequences of a later diagnosis.
"If you are a woman in your 40s, go please and get a mammogram. And for everyone else, tell your daughters, sisters, mothers co-workers to get screened," she added. "Early detection saves lives."
