It’s time!

Every October, as the leaves turn red, orange, and yellow, another colour also makes its appearance—pink. Each Breast Cancer Awareness Month, Canadians don pink ribbons and raise money for research, but tragically the needless suffering and deaths continue. This October, dare we hope for better?

In June, the Health Ministry announced $500,000 for an expedited review of Canadian breast screening guidelines, with a deadline of this Fall. This came shortly after the US decision to lower the breast screening age from 50 to 40, following current and inclusive science.

In Canada, organizations dedicated to breast cancer screening and patient advocacy, including the Canadian Society of Breast Imaging and Dense Breasts Canada, have been publicly calling for similar revisions to the Canadian guidelines for years. Overwhelming evidence proves we are not doing enough to support early diagnosis of breast cancer, which drastically improves outcomes and saves lives. The Canadian Task Force on Preventive Health Care, which creates the guidelines for 54,000 health care practitioners, has overlooked evidence in the past and instead pushes anti-screening rhetoric. Can we trust them to make an objective decision this time?

Canada’s current breast cancer screening guidelines have not changed since 2011, recommending screening starting at age 50 despite 17% of cases and more aggressive cancers occurring in women in their 40s. The Task Force ignored a study of 2.8 million Canadian women showing screening decreases breast cancer mortality by 44% in women 40-49. The guidelines also recommend against additional screening for women with dense breasts, even though they are at higher risk of developing breast cancer, and dense breasts make cancers harder to find on mammograms.

Some provinces ignore the guidelines, beginning screening at 40, and some provide supplemental screening to women with dense breasts. While this is wonderful, different screening protocols between provinces cause confusion for practitioners and patients and ultimately create a postal code lottery for women when it comes to catching breast cancer early.

Working with Statistics Canada, researchers in Ottawa compared provinces and territories with organized screening programs for women aged 40-49 to ones without. They found in jurisdictions that screened in the 40s there were fewer cases of advanced breast cancer from age 40-59 and lower breast cancer mortality rates. They also found that since 2011, the rate of metastatic breast cancer in women 50-59 has increased by 10%. Moreover, the Task Force’s guidelines disproportionally impact Black, Asian, and Hispanic women who experience a younger age of onset (mid-forties) compared to white women (early-sixties). Black women are more likely to get aggressive breast cancer, more likely to have dense breasts, and are 40% more likely to die.

Earlier detection is also beneficial to our beleaguered health care system owing to exponential increases in cost to treat advanced breast cancer. Treatment for a single Stage 4 patient can cost over half a million dollars, 11 times as much as treating a Stage 1 patient.

Last year, we lost 5500 Canadians to breast cancer. In light of current evidence, and with so many lives at stake, one hopes the Task Force will do the right thing and change the guidelines. There is, however reason to be concerned:

The guideline-making process is far from unbiased. Before the evidence review even began, the Task Force co-chair told the Toronto Star “she does not see any reason to change the guidelines.” Although the Task Force has taken the unusual step of asking the public to provide evidence, it is uncertain if the evidence will be reviewed with impartiality. The Task Force panel has no breast cancer specialists, and as a result, it understates the benefits of screening and overstates harms, like the anxiety faced by women recalled for more tests after screening. Breast cancer survivors will tell you that the anxiety of a recall requiring further investigation is dwarfed by that of a later-stage diagnosis.

The Public Health Agency of Canada has repeatedly stated the Task Force is an arms-length body, leaving us to ask where is the accountability?

The health and wellbeing of so many Canadians lies in the hands of this Task Force panel. Will this Breast Cancer Awareness Month be the one when justice is done? It’s time.