Let’s talk about systemic racism in Canada’s breast screening guidelines

Let’s talk about systemic racism in Canada’s breast screening guidelines. (1)

Is there systemic racism in Canada’s breast screening guidelines? With our breast cancer screening guidelines under review right now, it’s beyond time to take action.

What’s the issue? Canada’s breast screening guidelines recommend screening start at age 50 but that discriminates against Black, Asian, and Hispanic women who have a peak incidence of breast cancer in the 40s. White women, on the other hand, have a peak incidence of breast cancer in the late 50s and early 60s. In addition, Black women are at higher risk for triple-negative breast cancer, which is the most aggressive type of breast cancer. When detected later, outcomes are poor.

Why do Canadian breast screening guidelines ignore racial differences? The evidence review used by the Task Force panel that makes our guidelines has used research performed almost exclusively on white women in Canada and Europe from the 1960s to the 1980s. (The largest study was 98% white). These old, racially-biased trials were used instead of decades of modern research studies to make the 2018 guidelines.

Will the racial bias be acknowledged in the 2024 guideline update? We know that in this update taking place right now, the panel has dictated that the old research studies continue to be used. The more recent studies with diverse populations continue to be downgraded in value. As a result, we suspect the guidelines will still discriminate against women of colour.
It’s a different story with the 2023 USA breast screening guideline update. The US Task Force panel recommended starting screening at age 40, not 50. They made a “commitment to help reverse the negative impacts of systemic and structural racism, gender-based discrimination, and bias.”

Canada needs to do the same. However, the Task Force panel co-chair, Dr Guylene Theriault, stated to the Canadian Press in May that she does not see any reason to change the guidelines. We say respectfully to the panel, Canadians need guidelines that are free from racial bias, promote health equity, and protect our health and well-being. Please do the right thing.