National task force not lowering age for routine breast cancer screening to 40

Several cancer experts, surgeons and radiologists swiftly condemned a national task force’s draft decision not to lower the recommended routine breast cancer screening age to 40 on Thursday.

The criticisms were echoed by federal Health Minister Mark Holland, who said he had “serious concerns,” was “disappointed” in the task force’s findings and wanted leading experts to review the guidelines. He also called for the public consultation period to be extended.

The Canadian Task Force on Preventive Health Care, which provides guidance for primary health-care providers, said it is maintaining current advice that routine breast cancer screening start at age 50 and end after age 74.

Although they refrained from lowering the age for routine screening, the task force did suggest women age 40 to 49 be eligible for mammograms every two to three years if they want one after learning the harms and benefits of early screening, ideally from a conversation with their health-care provider.

The Canadian Cancer Society recommends that routine mammograms start at age 40 and says it is “disappointed” by the task force decision announced Thursday.

In a release, Dr. Sandra Krueckl said while the society respects the expertise of the task force, it has “an obligation to listen to patients who have been loud and clear that they do not feel represented by the guidelines. They have shared frustrations at having to fight for inclusion in screening, the reliance on health-care providers for access to screening, and the lack of clarity around when they should be screened.”

“Today’s guidelines disregard those voices and continue to place the burden of navigating the system on the shoulders of people who needed more support and guidance,” she said.

It is up to the provinces and territories to decide when to offer mammograms free of charge.

Dr. Jean Seely, head of the breast imaging section at the Ottawa Hospital, called the task force advice “bad news” that will lead to confusion for women in Canada.

“Unfortunately, we know that will lead to loss of lives. We know that by screening women, we save at least three out of every thousand women screened,” she said.

Seely was one of the experts who reviewed evidence to inform the guidance, and said the task force did not put enough emphasis on newer studies that show benefits to screening starting at age 40 and relied too heavily on randomized control trials that were conducted decades ago.

Dr. Henry Siu, a spokesperson for the task force and a family doctor in Hamilton, said the task force looked at 92 observational studies, “some of which were published after 2018,” as well as 82 studies on “patient preferences and values,” as well as the older randomized control trials.

Siu said the potential harms of earlier screening include false positives, which can lead to unnecessary painful biopsies, as well as “overdiagnosis” of cancers that wouldn’t have become a problem if they hadn’t been found.

Seely said failing to lower the age for routine screens puts racialized women at higher risk.

“The peak incidence of breast cancer for Black, Asian, Hispanic (and) Indigenous women are all in their 40s,” she said.

“By saying that they should not start until (age) 50 puts them all at a big disadvantage and is one of the reasons why we see in Canada that they’re more likely to be diagnosed at advanced stage of breast cancer.”

The president of the Black Physicians’ Association of Ontario also condemned the task force recommendations, agreeing that the onset of breast cancer is earlier for racialized women.

“Data shows that this group have a decreased mortality than other groups with early screening. This is attributed to the genetic variation that leads to more aggressive cancers in Black women despite similar treatment. They have the most to benefit from early screening,” Dr. Mojola Omole, who is also a breast surgical oncologist and general surgeon, said in an email.

The task force said “more research is needed” to determine whether or not earlier screening should be recommended for racialized women.

The task force said it recognized that not all women have access to a primary health-care provider and encouraged them to use information on screening benefits and harms it would post on its website.

Meanwhile, Holland said he had “serious concerns” about the task force’s findings.

The draft recommendation will be open to public consultation for six weeks before it becomes final, but Holland called for that to be extended to at least 60 days. He also said he’d like experts to examine the task force’s recommendations.

“I am inviting leading experts on breast cancer to carefully review the draft guidelines and to share their critical analysis during the consultation period,” he said in a statement.

It is up to the provinces and territories to decide when to offer mammograms free of charge.

Several provinces and territories, including British Columbia, Nova Scotia, Prince Edward Island and Yukon already offer breast cancer screening starting at age 40. Ontario, New Brunswick and Saskatchewan have committed to doing the same according to the Canadian Cancer Society.