Breast cancer: Doctors, patients call on Canadian panel to lower screening age to 40

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South of the Canadian border, a health panel is calling for the recommended age for women to begin getting mammograms to be lowered by 10 years.

In a May 9 draft statement, the United States Preventive Services Task Force (USPSTF) recommended that women begin getting screened for breast cancer every two years at the age of 40. The task force operates independently from the government.

"This new recommendation will help save lives and prevent more women from dying of breast cancer,” read an USPSTF infographic.

The current standard is to start at age 50 — same as in Canada, where some health officials have already been calling to reduce that age limit.

In an interview with CTV, head of breast imaging at Ottawa General Hospital Dr. Jean Seely said the current guidelines are "harming patients and some people are dying."

Seely said it’s common to see women under the age of 50 be rejected for screening even though they have concerns.

"I see in my practice, women in their 40s who say, 'I’ve been asking to be screened' and they say their family doctors say 'No, I'm not allowed to.'"

The Canadian Task Force on Preventive Care's guidelines are reviewed every five years and are set to be evaluated again this year, the CTV also reported.

This comes just a month after an Ontario woman called for earlier screenings, in an interview with Yahoo Canada.

'Baffling and disturbing'

Dawn Barker-Pierre first sought out a mammogram at age 40.

It was a time in the Ontario resident's life where she began considering taking better care of her health. However, the Barbados-born, Toronto-raised mom-of-three was told by her physician at the time that she was too young for the test. She asked again two years later at age 42, only to be denied and told that it's "best" to start screenings at age 50.

"I left that alone. I said, 'OK, my doctor knows best' and I proceeded with my life," Barker-Pierre, who's coincidentally now 50-years-old, told Yahoo Canada in an interview. "Two years later, I was diagnosed with triple-negative breast cancer.

"After my diagnosis, I was actually told that they have no way of knowing when changes occurred because there were no previous scans in my record to compare it to. That part of the whole story is baffling and disturbing, to be honest."

Now, Barker-Pierre is advocating for lowering the baseline breast screening age in Canada. Last month, she created a petition calling on the Canadian Task Force on Preventative Health Care to drop that age from 50 to 40 across the country.

Varying recommendations nationwide

In Canada, only patients in British Columbia, Nova Scotia, Prince Edward Island and Yukon are able to self-refer for screenings at age 40. In Alberta, self-referrals start at age 45.

In Alberta and the Northwest Territories, a first screening in a person's 40s requires a health care provider's requisition, but subsequent screenings can be self-referrals.

In the other provinces and territories, patients can still get screenings in their 40s but they must have a health care provider's referral. Otherwise, screening programs will only invite women aged 50 or older to start getting tests.

Specific details vary by province or territory, but access to screenings are typically easier and more frequent for women who are considered high-risk. For example, Ontario's program recommends high-risk patients — including people with gene mutations that increase the risk of breast cancer — start annual screenings at age 30.

But for women who don't fall under high-risk categories, like Barker-Pierre at the time, they're often shut out from Canadian screening programs.

Racial disparities

Barker-Pierre said she "desperately" started her petition with the main goal of spreading "awareness." With it, she said she hopes shortfalls of health care for women in Canada — especially those from marginalized groups — are addressed and "taken seriously."

"I really need to make sure that all women have the same access to care," she added. "That they are treating every patient as an individual and allowing them the autonomy to make informed decisions about what is right for them. Allow them the opportunity to express their thoughts and their feelings and their concerns. I think sometimes, they're going too much by the book instead of looking at it as a case-by-case.

"Black women need a different approach to the guidelines that are out there. ... It's just not conducive to everyone," she noted.

Unlike other countries, Canada does not routinely collect race-based data, which University of Toronto research from 2019 indicated is endangering. Canadian data is difficult to find, and Black women in the country are likely both under-screened for diseases like breast cancer, as well as "predisposed to worse outcomes."

It's a point that Barker-Pierre reiterated: Canada needs race-based data as it relies too heavily on American sources.

According to the American Cancer Society, Black women are 40 per cent more likely to die from breast cancer than white women. Breast cancer is also the leading cause of cancer death for Black and Hispanic women.

Black women are also more likely to develop more aggressive types of breast cancer. For instance, triple-negative breast cancer is more common among Black women, which is challenging to treat since it reduces available treatment options.

Changing the narrative

One issue Barker-Pierre noted is that there's a "critical need" for clinical trials that represent people of all races.

Moreover, she'd like to see breast screenings — whether that's mammograms, ultrasounds or MRIs — incorporated into standard care for women.

While the Canadian Task Force on Preventative Health Care currently does not recommend mammograms for women younger than age 50, it's set to update its recommendations in early 2023, following an upcoming federal evaluation.

Barker-Pierre's petition has now reached more than 7,100 signatures, but she said she ultimately wants to continue her advocacy work and reach the people who are in charge.

"What I have is a goal in mind," she said. "A goal to reach the powers that be and the decision makers to look at this as a serious and critical situation, ... life or death, really.

"I'm just trying to open up some dialogue and ruffle some feathers, and hopefully create a change that will benefit all Canadians in the long run."

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