The B.C. Cancer Agency is not rushing to adopt changes to its breast cancer screening program recommended by a national task force, until the provincial authority conducts its own policy review.
Canadian Task Force on Preventative Health advised doctors two weeks ago to stop systemic testing of women aged 40 to 49 of average risk of getting the disease because that can lead to false-positive diagnosis and unnecessary procedures.
But Dr. Christine Wilson, medical director of the Screening Mammography Program of B.C. (SMPBC), says it will be another six months before the provincial health authority will make its policy recommendations to the Ministry of Health.
"At the moment we are still proceeding as we always have, but we were involved in doing our own review when these task force finding came out, which is why we have delayed finalizing our own review," said Wilson.
"Obviously this is a controversial topic. We'll be having a robust discussion here at the B.C. Cancer Agency with all the clinicians involved in cancer diagnosis and care. Everyone needs to have a chance to think about it and look at it and give their opinion."
The screening mammography program is for healthy women who do not show any symptoms of breast cancer. But Wilson said if anyone, regardless of age, detects anything abnormal in a breast self-examination, such as a lump, a discharge from a nipple or skin changes, they should see a family doctor immediately.
"We're trying to encourage people to take responsibility for their own health," said Wilson. "Have a discussion with your doctor about your risk factors. Especially if you're in your 40s, consider whether screening is right for you, also considering the fact there may be false-positives (a suspicious test result that follow-up imaging reveals as normal tissue) and you may end up going on to a biopsy."
Wilson said a needle biopsy, rather than a more invasive surgical biopsy, is now becoming the standard of care in breast cancer diagnosis.
One in nine women in Canada will be diagnosed with the disease. Although it ranks second only to lung cancer as the most common cause of cancer deaths, the Cancer Agency says mortality from breast cancer has dropped 30 per cent over the last decade, likely due to a combination of better screening, early diagnosis and innovations in chemotherapy and the use of cancer-inhibiting drugs such as tamoxifen.
Women in the 40 to 49 and 50 to 79 age groups can still self-refer to the mammography program. The only requirement is they have a family doctor, a naturopath or nurse navigator to receive the report. Women younger than 40 and older than 79 will need a doctor's referral to attend a mammography clinic.
For the past one-and-a-half years, Wilson has chaired the Provincial Breast Health Clinical Pathway project, trying to determine ways to reduce the time it takes for mammography patients who have a screening abnormality to receive a conclusive tissue diagnosis.
For that to happen, Wilson said there needs to a more collaborative approach that would bring together breast radiologists, surgeons, oncologists, and health managers to design a clinical system and guidelines that would become the model for the province. The group was in Terrace two weeks ago to gather information at meetings attended by Northern Health physicians.
SIDEBAR
In the 2010-11 fiscal year, SMPBC performed 303,157 examinations and detected 1,271 cancers. From when the program started in 1988 to the end of 2010, it completed more than 1.4 million screening mammograms and detected breast cancers in more than 16,000 women.
Each screen in 2010-11 cost the province $72.34 for a 12-month total of $71.6 million.
Fifty-four per cent of the eligible population of B.C. (50.2 per cent of Northern B.C. residents) have mammograms at least once every 30 months. The B.C. Cancer Agency wants at least 70 per cent of women aged 50 to 69 to attend the clinics by 2013.
The risk of breast cancer increases with age. Other risk factors include high-density breasts, a late age for giving birth to a first child, early onset of puberty, late arrival of menopause, and the use of hormone replacement therapy. Family history and genetics can also play a factor. Women with two or more close relatives who have breast cancer are considered high-risk.
