When I first saw this picture of Violet, many things went through my mind. First it was Violet, you’re gorgeous. Then it was, oh that phone! I remember that phone from the 60s. Mine wasn’t red, but I spent hours daily on a phone just like that.
I then remembered the analogy that breast screening experts sometimes use, comparing the rotary phone to the cell phone, to show how far we’ve come with science and technology. I also thought of Dr. Anna Wilkinson, an Ottawa family doctor and oncologist, who pointed out that we continue to base decisions on breast cancer screening in 2021 on a study that was started in 1963- six years before we landed on the moon.
So here we are…… with a Canadian Task Force making breast screening guidelines using studies from 30- 50 years ago intentionally trying to show mammography is not that effective – well that’s because the x-ray technology used decades ago in the studies was not that effective – but now we have digital mammography and it’s like night and day compared to the past.
However, the Task Force ignores current evidence using modern technology that clearly shows mammograms are effective and save lives. The Task Force recommends against mammograms for women in their 40s. And yet, 3300 women a year in Canada in their 40s get breast cancer.
In Canada, we have a Task Force that ignores the input of breast cancer screening experts. Instead – and this always shocks me to write- we have a psychologist, a chiropractor, and OT and kidney doctor who have never seen a mammogram making up breast screening guidelines for 8 million Canadian women.
Violet’s mom, Libby, has Stage 4 breast cancer. The system failed her and many other women we speak with. The Task Force negates the importance of dense breasts, technology like MRI and 3D mammo for dense breasts, the importance of self-exam and the need for risk assessment for women in their 20s and 30s, and as mentioned, mammograms for women in their 40s.
1,000 more woman can be expected to die of breast cancer yearly in Canada, if the Task Force guidelines are followed.
We’re speaking to as many political representatives as we can to tell them Canadian women’s lives are at risk and that we need experts making our guidelines. Experts are a given on the COVID-19 Task Force, why not for breast screening guidelines?
Please use your voice to tell your MP the Task Force on Preventive Health Care needs to be disbanded and replaced with experts. JD.
If you’d like to read more…. Here is a more detailed look, including references, showing how the Canadian Task Force on Preventive Health Care (CTF) breast cancer screening guidelines put the lives of Canadian women at risk.
No experts: The panel making the recommendations had no breast cancer screening experts. Instead, it consisted of family doctors, nurses, a chiropractor, an occupational therapist, and kidney specialist. Expert input was ignored.
Benefits of screening underestimated due to sole use of Randomized Control Trials: The CTF deliberately chose to ignore observational studies done with modern mammography equipment, in favour of Randomized Control Trials (RCTs) from the 1960’s to 1990’s, which show only a 15-20% mortality reduction. A 2014 study of screening in Canada of almost 3 million women showed 40% fewer deaths among women who had screening mammograms than women who did not.
CTF ignores other benefits: Since the only measurable outcome of a RCT is how many women die of breast cancer, the CTF ignores three other significant benefits of early detection of cancer: the ability to avoid mastectomy, lymphedema, and chemotherapy.
Overemphasis on harms: Annual mammographic screening starting at age 40 saves the most lives, but the CTF did not recommend it because they focus on “harms” of screening: the anxiety created for women who are recalled for additional tests after screening, and “overdiagnosis.” About 10% of women need additional tests after screening. When women are recalled for tests, this causes anxiety for many women, but it’s transient, and studies show that it doesn’t harm women long-term.
The CTF gives undue weight to overdiagnosis- the theoretical possibility that a woman will be diagnosed with breast cancer and treated for it but die of something else before she would have died of cancer. The CTF estimates 41 percent of breast cancers are over diagnosed. No credible expert in screening correctly estimates overdiagnosis to be more than 10 per cent.
The CTF says that most women age 40-49 would choose not to be screened. Published research shows that when told that mammograms can prevent breast cancer death and allow them to have a lumpectomy and avoid chemotherapy if cancer is detected early, most women choose to be screened.
Lives at risk: The CTF made serious numerical errors in their assessment of the number of women needed to be screened to save a life because it did not consider input from experts. Dr. Martin Yaffe calculated, using a model based on CISNET, that in Canada approximately 1,000 more woman can be expected to die of breast cancer yearly, if the CTF guidelines are followed.
Dense breasts and supplemental screening: Women with dense breast tissue have a much higher chance of having breast cancer detected late because the cancer may be masked by their dense breast tissue. The CTF says there’s insufficient evidence to recommend supplementary screening for women with dense breasts because of their insistence on RCTs. An RCT of screening ultrasound is underway in Japan but it will take at least 7-10 years before it can prove mortality reduction. There is observational data from multiple studies showing that ultrasound finds an additional 3-4 cancers per thousand women. There is increasing evidence that supplemental MRI screening of dense breast tissue allows for an increased cancer detection rate of 16 per 1000 with new evidence that annual MRI screening is cost effective. Finding these cancers earlier will allow less aggressive treatment and reduce mortality.
All women and their family doctors deserve to have all the facts, and the option of shared decision-making, to decide whether the harms outweigh the real benefits. They cannot do that when they are both being given inaccurate recommendations made by non-experts.