Health experts criticize decision to keep breast cancer screening age at 50 in Canada

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

Federal Health Minister Mark Holland also joined in this criticism. He expressed his “concern” and “disappointment” with the task force's findings and called for the guidelines to be reviewed by leading experts. He also called for an extension of the public consultation phase.

The Canadian Task Force on Preventive Health Care, which provides guidelines for primary care providers, said it is maintaining its current recommendation to start routine breast cancer screening at age 50 and stop after age 74.

While it did not lower the age for routine screening, the task force suggested that women between the ages of 40 and 49 should have a mammogram every two to three years if they wish, after educating themselves—ideally in a discussion with their doctor—about the risks and benefits of early screening.

The Canadian Cancer Society was also disappointed with the draft guidelines.

“This puts the responsibility on people to advocate for early detection and screening and to access referral, rather than being automatically invited to provincial and territorial (prevention) programs,” the society said in a press release.

Dr. Jean Seely, chief of breast imaging at The Ottawa Hospital, called the task force's recommendation “bad news” that will cause confusion among women in Canada.

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

Seely was one of the experts who reviewed the evidence to create those guidelines. He said the task force did not place enough emphasis on more recent studies showing the benefits of screening starting at age 40 and relied too heavily on randomized controlled trials conducted decades ago.

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

Potential dangers of earlier screening include false positives that can lead to unnecessary, painful biopsies, as well as “overdiagnosis” of cancers that would not have been a problem if they had not been detected, Siu said.

Seely said the failure to lower the age for routine screening puts women from ethnic minorities at higher risk.

“The highest incidence of breast cancer among black, Asian, Hispanic (and) indigenous women is among women in their 40s,” she said.

“Telling them to wait until they're 50 puts them at a huge disadvantage. This is one of the reasons why they are more likely to be diagnosed with advanced breast cancer in Canada.”

The president of the Black Physicians' Association of Ontario also condemned the task force's recommendations and agreed that breast cancer occurs earlier in women from ethnic minorities.

“The data show that this group has lower 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 benefit the most from early screening,” Dr. Mojola Omole, who is also a breast oncologist and general surgeon, said in an email.

The task force said “more research is needed” to decide whether or not earlier screening should be recommended for women on racial grounds.

The task force said it was aware that not all women had access to a primary health care provider and encouraged them to use information published on its website about the benefits and harms of screening.

Holland, meanwhile, expressed concern about the task force's findings, particularly the emphasis on the potential harm of earlier screenings.

“I honestly don't understand the task force's fear that a false positive would cause despair. I know that the women in my life would rather have a false positive than a negative than not be tested,” Holland said.

“I really want to encourage women around the world, regardless of what we know today, to talk to their doctors and make sure they are taking the right steps in terms of their screening.”

Shira Farber, a volunteer with Dense Breasts Canada who was diagnosed with advanced breast cancer shortly after her 48th birthday, said she was grateful for the minister's stance after being “very upset” by the task force announcement.

“We are advocating for better screening policies because we believe we are victims of the current screening policies,” Farber said in an interview.

Farber said she asked her primary care doctor twice in her 40s whether she should have a mammogram.

“I was told not to do anything about it because the guidelines said we didn't have to start until age 50,” said Farber, who is now 51 and has had both breasts and 40 lymph nodes removed. She said she also received aggressive chemotherapy because her cancer was so advanced.

The draft recommendations will be open for public consultation for six weeks before becoming final, but Holland called for that period to be extended to at least 60 days. He also said he wants breast cancer experts to review the task force's recommendations.

Provinces and territories have discretion when to offer free mammograms.

Several provinces and territories, including British Columbia, Nova Scotia, Prince Edward Island and Yukon, already offer breast cancer screening starting at age 40. According to the Canadian Cancer Society, Ontario, New Brunswick, Saskatchewan and Newfoundland and Labrador have also committed to this step.

READ MORE: 40 the new target age for breast cancer screening: Canadian Cancer Society

READ MORE: Doctors say Canadians are dying due to outdated cancer screenings