Breast cancer study reveals bleak picture, urgent need to update Canada's screening guidelines

Opinion

Breast cancer study reveals bleak picture, urgent need to update Canada’s screening guidelines

The same guidelines the U.S. Congress deemed too dangerous for American women continue to be used in Canada— putting thousands of Canadian women at risk of later-stage diagnoses, harsher treatments, and death.

BY JENNIE DALE

Anewly released study by Canadian breast cancer experts irrefutably proves the harm caused by Canadian breast screening guidelines. Will our

A new study reveals that provinces that do not screen women in their 40s, like Ontario, have higher rates of advanced breast cancers in women diagnosed in their 40s and 50s. We know women are dying unnecessarily, writes Jennie Dale. Photograph courtesy of Unsplash

federal government continue to risk the lives of Canadian women or will it suspend these dangerous guidelines?

In the United States, the government acted. In 2015, the U.S. Congress suspended breast cancer screening guidelines that recommended against mammograms for women between ages 40 and 49. Congress upheld the moratorium again this year. Why? Because the guidelines would have caused an estimated 6,500 deaths per year if they had been followed. Congress reverted to previous guidelines from 2002, which recommended that mammograms begin at 40.

The same guidelines Congress deemed too dangerous for American women continue to be used in Canada—putting thousands of Canadian women at risk of later-stage diagnoses, harsher treatments, and death. The federal government has so far refused to acknowledge both clear-cut evidence and the deadly errors in the current guidelines—particularly since the decades-old studies

used to develop the guidelines have been proven to be deeply flawed in their design and execution.

The current Canadian guidelines, published in 2011, recommend that screening for average-risk women begin only at age 50. These are sent to 43,000 family doctors around the country and are used by most provincial screening programs to set policy. This means that in seven provinces that have chosen to uphold these guidelines, women in their 40s who request mammograms are often denied—sometimes with deadly consequences.

A new study conducted by Ottawa Hospital’s Dr. Jean Seely and Dr. Anna Wilkinson, in conjunction with Statistics Canada, reveals a bleak picture. The data submitted from provinces to the Canadian Cancer Registry shows that provinces that do not screen women in their 40s, like Ontario, have higher rates of advanced breast cancers in women diagnosed in their 40s and 50s. After the Canadian Task Force on Preventive Health Care’s breast screening guidelines were published in 2011, including the recommendation not to screen women in their 40s, the incidence of stage 4 breast cancer increased by 10.3 per cent over six years in 50-year-old women in provinces that upheld those guidelines.

Will the federal government pay attention when they have already ignored existing evidence, including a 2014 study of 2.8 million Canadian women showing 44 per cent fewer deaths from breast

cancer in women aged 40-49 who were screened? Might they ignore this new evidence, too, considering there are no experts in breast cancer developing the guidelines (rather a group that included a chiropractor, an occupational therapist, a nurse, a psychologist and a kidney specialist)? Or because they don’t recognize that these numbers represent the lives of women we know, love, and respect?

Dr. Martin Yaffe, a senior scientist at Sunnybrook Research Institute, likened the number of avoidable breast cancer deaths in Canadian women not screened in their 40s to a wide-body jet full of women crashing every year. Yaffe and a team of researchers used a model developed with the federal government’s Canadian Partnership Against Cancer to estimate that there would be an additional 400 avoidable deaths each year in Canada if these guidelines were followed. If one considers that the same guidelines have been in effect since 2011, that is potentially 4,400 avoidable deaths. The situation is especially critical for Black, Asian, and Hispanic women due to their earlier onset and peak of breast cancer in their 40s and higher rates of aggressive cancer.

We have the data. We know women are dying unnecessarily. We know the U.S. has suspended their guidelines. What we don’t know is what it will take for the Canadian government to act.

While the hypothetical airplane crashes every year with 400 women on board, the government dithers. That is why we are calling on the federal government to suspend Canadian breast screening guidelines immediately, as the U.S. has done. We call on them to convene a credible panel of breast cancer specialists and patients to produce guidelines based on current evidence. We call on them to stop allowing avoidable deaths of our mothers, wives, sisters, daughters, aunts, grandmothers, colleagues, and friends.

Jennie Dale is co-founder and executive director of Dense Breasts Canada.

The Hill Times