Time For Change: Breast Screening Programs Must Start At Age 40

The Canadian Cancer Society (CCS) is urging provinces and territories to lower the start age for breast screening programs to 40 for individuals at an average risk of developing breast cancer. CCS is changing its position on screening to reflect evolving evidence and calls for action from patients who are frustrated that many women aged 40 to 49 are being excluded from breast screening as well as the national guidelines developed by the Canadian Task Force on Preventive Health Care (CTFPHC).

In Canada, 1 in 8 women is expected to be diagnosed with breast cancer in their lifetime. Access to breast screening is important to find breast cancers early when chances of successful treatment are better. Regular mammograms help find cancer early and lower the risk of dying from breast cancer.

“The issue of breast screening is complex and there has been a debate among experts on the best age to begin screening,” explains Dr Sandra Krueckl, Executive Vice President, Mission, Information and Support Services. “Over the last several years, there has been a groundswell of support for screening to begin at a younger age and for a more inclusive system – one that empowers people between the ages of 40 and 49, no matter where they live, to access screening without barriers,” explains Dr Krueckl. “We need to heed that call, as well as ensure there is clear guidance for people who have an elevated or high risk of developing breast cancer, such as people with genetic mutations, family history or dense breasts.”

CCS would also like to see all provinces provide the option for self-referral for individuals at high risk of breast cancer with a risk assessment even if age is outside of breast screening program window to address immediate gaps in provincial program access.

While the CTFPHC is expected to release new breast screening guidelines later this month for consultation, it is provincial and territorial governments that set their respective breast screening program’s start and stop ages. There are a growing number of provinces across Canada who already provide access to breast screening services starting at age 40. As provinces and territories consider the new national guidelines, CCS calls for remaining jurisdictions to reduce the start age to 40 for women and trans, non-binary and gender diverse people at average risk of breast cancer. This would align with recently released guidelines in the United States that have recommended expanded breast screening access for people aged 40 to 49. It also reflects new evidence that has been published since the Canadian guidelines were last updated in 2018.

For Cassidy London, lowering the age of breast screening programs nationwide would be welcome news. When Cassidy was 40, she approached her doctor about having a mammogram but was told she wasn’t eligible. Four years later, she found a lump in her breast and shortly after was diagnosed with breast cancer.

“It appeared out of nowhere and I wasn’t checking because I didn’t think I needed to,” explains Cassidy. “Maybe if I had been screened starting at age 40, it would have been caught earlier. If we can help even one person detect their cancer earlier, and make their cancer experience easier, or even save their life, why wouldn’t we?”

A February 2024 Ipsos Poll commissioned by CCS found that 90% of Canadians support the expansion of access to breast screening to include women aged 40 to 49, even if it results in an increase to their taxes.

“Lowering the start age is an important step, allowing more breast cancers to be found earlier, when treatment is likely to be more successful,” explains Dr Krueckl. “We also need more research to expand knowledge of screening and risk, we need to address data gaps so we have a better understanding of the impact of breast cancer in Canada, and we need a collaborative approach across the country and entire breast screening community to prioritize this issue together.”

As access to screening expands, all governments must invest in prevention, early detection, screening, diagnosis and treatment, and address current critical health workforce shortages, especially in rural and remote areas. This includes making new investments to accommodate lowering the screening age and increase overall participation. Culturally safe approaches must be adopted along with strategies to improve screening participation for communities who experience barriers and inequities accessing breast cancer screening. Solutions must be co-designed with communities that are underserved, including First Nations, Inuit, Métis, racialized, rural, remote, and 2SLGBTQI+ communities.

It is also crucial to improve breast screening data so that policy makers and the healthcare system can better monitor the health of the population, improve healthcare quality and delivery, and inform research and practice. The Pan-Canadian Cancer Data Strategy and Pan-Canadian Health Data Charter outline important opportunities to enhance data in the country.

Global understanding of breast cancer has continued to shift and expand, and provinces, territories, the federal government and the CTFPHC all have an obligation to ensure screening programs keep pace with the changing environment.

CCS strongly recommends comprehensive action in the following areas to ensure equitable and timely access to breast screening:

• Investing in research
• Enhancing data collection
• Developing guidelines for people who have elevated and higher risk
• Updating screening eligibility for average risk including lowered age
• Enhancing breast cancer screening programs to address distinct population needs
• Building awareness about existing breast screening programs
• Co-developing solutions to increase participation in communities that are underserved
• Investing in health human resources

To learn more about when you should be screened for breast cancer, visit cancer.ca.