Don’t lump all women together: Guidelines for breast cancer screening don’t account for data-driven distinctions between racial groups

Canada’s current guidelines for when women should start being screened for breast cancer do not take diverse populations into account, according to an Ontario physician.The guidelines, which are set by the Canadian Task Force on Preventive Health Care (established by the Public Health Agency of Canada), recommend against mammography for women until age 50. This age threshold “inadvertently discriminates” against Black, Hispanic and Asian women, who have peak incidence of breast cancer in their 40s, said Dr. Neil Isaac, a radiologist at North York General Hospital.“The current guidelines do not account for the diverse population of Ontario,” he said during his presentation, “Breast Cancer Screening Updates for Black Women,” at the Black Physicians’ Association of Ontario’s annual symposium, in late February. Breast cancer, particularly triple-negative breast cancer, is the most common type of cancer among Black women, according to Dr. Isaac’s presentation that cited data from the U.S.—in Canada, race-based data is not widely tracked.Data from the U.S. also show that while breast cancer incidence rates are lower for Black women than white women, breast cancer mortality rates are higher for Black women; they are more likely to get more aggressive cancers and are 30%-to-40% more likely to die than white women.There are many reasons why the age threshold for screening should be lowered to 40, argued Dr. Isaac, including the fact that breast cancer is the leading cause of death in Canadian women aged 40 to 55. He also noted that the incidence of breast cancer increases significantly at age 40, and that early detection reduces mortality risk and the need for aggressive therapies.Family physicians do have the authority to refer a patient for screening earlier than current guidelines recommend, Dr. Isaac told the Medical Post in an interview. “If they have a strong suspicion, or the patient has a family history, or the patient just simply wants to be screened and it’s not an inappropriate age to do, they can refer the patient for a mammogram,” he said.“There’s no reason why they can’t. It’s just that they meet resistance or they keep getting information from the Canadian Task Force saying to start [screening] at age 50.”Dr. Isaac’s comments come ahead of the Ontario government lowering the age threshold for access to regular, publicly funded breast cancer screenings from 50 to 40. The change, which is set to take effect in the fall, will allow women in Ontario aged 40 and over to be screened without a physician referral.It’s a change that Dr. Isaac welcomes. “I think people are listening to the evidence. I mean, there’s lots of people out there that have been advocating for this for years . . .. I’m glad it’s finally coming to fruition,” he said. “There’s growing evidence that screening starting at age 40 results in better outcomes, earlier diagnosis and less aggressive treatment.” This change to Ontario’s screening guidelines, he added, was in response to recommendations proposed last year by the U.S. Preventive Services Task Force, which suggested that screenings should start at 40 instead of 50 in order to reduce mortality risk.“The U.S. Preventive Task Force was the watershed moment for Ontario,” Dr. Isaac said. Currently, out of Canada’s 13 provinces and territories, only four recommend screenings starting at age 40: Nova Scotia, Prince Edward Island, British Columbia and Yukon.His comments also precede an update on screening guidelines from the Canadian Task Force, which is expected to come in the spring.“My hope is that if and when they release their guidelines in the spring . . . there will be some guidance for women aged 40 and above, which falls in line with what the evidence is pointing us to and what experts from around the world are telling us, which is that women aged 40 should be included in screening,” Dr. Isaac said.

Don’t lump all women together: Guidelines for breast cancer screening don’t account for data-driven distinctions between racial groups

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