Important update for women in Ontario with Category D density

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Progress for women in Ontario with category D density!
If you have category D density and are interested in supplemental screening, you can speak with your health care provider about the pros and cons. If you want to proceed, you can discuss additional screening with ultrasound and mammography every year OR MRI and mammography every two years. Discuss which test is right for you. A referral is needed from your provider.

Important additional information:
1. MRI and ultrasound will be prioritized according to urgency and capacity, meaning people needing diagnostic imaging for an abnormality will get first priority, then people deemed high risk for breast cancer, and then if there is remaining capacity, MRI or ultrasound will be available for people with category D density.

2. The capacity and access to supplemental screening varies across the province. Not all sites may offer supplemental screening and where it is available, wait times for supplemental screening may be longer than screening with mammography alone. Sites may choose whether to accept referrals for supplemental screening based on their capacity.

3. There have been no changes to Ontario Breast Screening Program (OBSP) recommendations for Category D at this time and the two options above are not part of the OBSP, but they are available if there is capacity. That means the test results and any follow up are managed by your primary care provider. So, right now, health care providers can discuss supplemental screening with patients and refer them for additional testing outside of the program (paid for by OHIP). In the future, the OBSP will offer this directly.

4.Anyone with category D density who has supplemental screening will still be asked to return every year for a mammogram.

5. Please consider taking a moment to complete the IBIS risk calculator so you are aware of your lifetime risk when discussing your screening. Over 25% is considered high risk in Ontario and MRIs may be given.

6.Women in category C can continue to request/advocate for ultrasound (or MRI if high risk).

CONCERNS: Information has been sent to health care providers but we do not know if they are all familiar with it. We recommend you print off the page from Cancer Care Ontario (link below) for your discussion about supplemental screening.

Here is the write up from Cancer Care Ontario to health care providers
• One way to improve cancer detection in people with dense breasts is through supplemental screening, which involves screening with another type of imaging test in addition to mammography. Types of breast imaging tests that can be used for supplementary screening include ultrasound and magnetic resonance imaging.
• Evidence on the benefit of supplemental screening for breast cancer has been evolving. Ontario Health conducted a health technology assessment to review published evidence on the effectiveness and cost-effectiveness of supplemental screening. In December 2023, based on guidance from the Ontario Health Technology Advisory Committee, Ontario Health released a recommendation to the Ministry of Health to publicly fund supplemental breast cancer screening for people with BI-RADS D density. Ontario Health recommended publicly funding supplemental screening for people with BI-RADS D density, but not for people with BI-RADS densities A to C due to insufficient clinical evidence on the benefit of supplemental screening in these populations.
• Primary care providers may choose to discuss the benefits and risks of supplemental screening with their patients who have BI-RADS D density and refer them for supplemental screening outside of the OBSP. For example, the health technology assessment showed that the benefits of supplemental screening in people with dense breasts include improving cancer detection rates and reducing the likelihood of interval cancers, but its harms include higher abnormal recall rates and more people getting additional testing, such as breast biopsies. Read more about the recommendation and health technology assessment on the
• The OBSP will continue to recall participants with BI-RADS D density for a screening mammogram one year after their last mammogram and will continue to recall these participants for regular screening regardless of whether they have had supplemental screening.
• Ontario Health plans to update the OBSP to include supplemental screening for people with BI-RADS D density based on the health technology assessment and expert panel input in the future.