When do you start getting mammograms in Canada?

(Tina Dawn/ VM Med) — The conventional wisdom has always been that women should get tested for breast cancer at the age of 50. But new guidelines now say women should begin getting regular mammograms every two years starting at the age of 40 if they are at average risk of breast cancer.

Breast cancer affects one in eight women during their lives and one in 34 will die from it. It’s so prevalent that it accounts for approximately 25 percent of new cases of cancer –making it the most common type of cancer in women in Canada— and the leading cause of cancer deaths in this group.

An estimated 28,600 women will be diagnosed with breast cancer every year in Canada.

Old guidelines recommended mammograms after 50

In the past, women of all ages have been encouraged by the medical community to perform self breast exams and be vigilant about noticing any changes that could be a cause for concern. Unless they have a family history of breast cancer that signals a potential genetic predisposition, most women have always been told the mammogram age in Canada was 50. In fact, guidelines by the Canadian Task Force on Preventative Health Care, established in 2018, have been recommending mammograms start at that age.  

These guidelines sometimes influence public policy. In Quebec, for example, the Breast Cancer Screening Program invites women between the ages of 50 to 69 to get a mammogram every 2 years. The government program clearly states that a mammogram is the only screening exam that can reduce the number of deaths from breast cancer.

The Canadian Task Force on Preventative Health Care is now reviewing its current recommendations for breast cancer screening and could possibly change its guidelines to recommend breast cancer screenings sooner.

If it were to do so, it would be following in the footsteps of the U.S. Preventive Services Task Force, which earlier last month changed its guidelines to recommend that all women get screened for breast cancer every other year starting at age 40.

U.S. Task Force recommends earlier mammograms

In its draft recommendation, the U.S. Task Force now recommends that all women get screened starting at age 40. This change, the draft says, could result in 19 percent more lives being saved.

“New and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened every other year starting at age 40,” says the recommendation.

Additionally, medical studies show that more younger women get breast cancer today than in studies conducted back in the ‘60s and ‘70s. Since early detection is crucial, before breast cancer can spread to the lymph nodes and other parts of the body, many medical professionals have publicly made statements in favour of the new guidelines. When breast cancer is detected early, before it metastasizes, the five-year survival rate is 99 percent.

A large British study conducted by The Lancet concluded that mortality from breast cancer could be reduced if the guidelines were lowered to screen from age 40.

With all these changes to the recommendations south of the border, the Canadian Task Force is currently reassessing whether to change its guidelines too.

Patients should weight benefits and risks with their physician

In addition, more research is needed on whether women with dense breasts should have additional screenings with a breast ultrasound or an MRI, and on the benefits and harms of screening in women older than 75.

While mammograms can reduce the risk of death and the additional need for chemotherapy, early screenings also have certain disadvantages.

The risk of overdiagnosis, or the discovery of a cancer that would never have had affected a woman’s health or had any consequences on her life and would never have been detected without screening, are possibilities to consider. Receiving unnecessary treatment and its effects on a woman’s health and life are considerations for the patient to discuss with their doctor.

The advantages and disadvantages should be weighed carefully, and no one is in a better position to consult a patient than their medical practitioner who knows them and their medical history well.

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