breast cancer screening programs and strategies in canada environmental scan
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Breast Cancer Screening Programs and Strategies in Canada environmental scan. March 2013. Background. Quarterly, the Canadian Partnership Against Cancer collects information from the provinces/territories on the status of population-based breast cancer screening programs and/or strategies. - PowerPoint PPT PresentationTRANSCRIPT
BREAST CANCER SCREENING PROGRAMS AND STRATEGIES IN CANADA
ENVIRONMENTAL SCAN
March 2013
Background
Quarterly, the Canadian Partnership Against Cancer collects information from the provinces/territories on the status of population-based breast cancer screening programs and/or strategies.
The information is collected through provincial and territorial leads represented on the National Committee of Canadian Breast Cancer Screening Initiative supported by the Canadian Partnership Against Cancer.
March 2013
Presentation Outline
Canadian Task Force on Preventive Health Care Guidelines
Provincial and Territorial Guidelines Breast Cancer Screening Program Distribution and
Administration Recruitment and Recall Quality Assurance Breast Cancer Data Reported Breast MRI (High Risk Screening Guidelines)
March 2013
Canadian Task Force on Preventive Health Care Guidelines
The Canadian Task Force on Preventive Health Care (2011) recommends the following for breast cancer screening:
Mammography For women aged 40-49, routine screening not recommended (Weak
recommendation; moderate quality evidence) For women aged 50-69, routine screening every 2 to 3 years (Weak
recommendation; moderate quality evidence) For women aged 70-74, routine screening every 2 to 3 years (Weak
recommendation; low quality evidence)
Magnetic Resonance Imaging Routine screening not recommended (Weak recommendation; no
evidence)
March 2013
Canadian Task Force on Preventive Health Care Guidelines (Cont’d)
Clinical Breast Exam Routine screening for breast cancer is not recommended when
performing clinical breast exam alone or in conjunction with mammography (Weak recommendation; low quality evidence)
Breast Self Exam Routine practice of breast self exam is not advised by the Task Force
(Weak recommendation; moderate quality evidence)
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Breast Cancer Screening Programs: Provincial and Territorial Guidelines
Start Age Interval Stop Age
Nunavut
Northwest Territories Begin at age 50 (age 40 – 49 accepted by physician referral and self –referral
but not actively recruited)
For women aged 40-49 - annual recall
For women aged 50-69 - biennial recall
For women aged 70+ - biennial recall
79
Yukon Begin at age 40 For women aged 50-69 - biennial recall
For women aged 70+ - biennial recall
70+
British Columbia Begin at age 40 (<40 accepted with physician referral)
For women aged 40-49 - annual recall
For women aged 50-69 - biennial recall
For women aged 70-79 - biennial recall
79 (age 80+ only with physician referral)
Alberta Begin at age 50 (age 40-49 accepted with physician referral for the first
screen)
For women aged 40-49 - annual recall
For women aged 50-69 - biennial recall
70+
Saskatchewan Begin at age 50 (age 49 accepted on the mobile if turning 50 in same calendar
year)
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall (only if previously enrolled in the program)
75+
Manitoba Begin at 50 (ages 40-49 accepted to mobile unit only with physician referral)
For women aged 40-49 - biennial recall
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall
75+
Ontario Begin at age 50 (ages 30-49 accepted if high risk and referred by physician)
For high risk women aged 30-49 - annual recall
For high risk women aged 50-69 – annual recall
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall
75+
Breast Cancer Screening Programs: Provincial and Territorial Guidelines (Cont’d)
Start Age Interval Stop Age
QuébecBegin at age 50 (accept ages 35-49 only
with physician referral if done at a program screening centre)
For women aged 50-69 - biennial recall69 (age 70+ only with a
physician referral at a program screening centre)
New Brunswick Begin at age 50 (age 40-49 accepted only with physician referral)
For women aged 50-69 - biennial recall 69 (age 70+ only with a physician referral)
Capacity to increase to age 74
Nova Scotia Begin at age 40 For women aged 40-49 - annual recall
For women aged 50-69 - biennial recall
70+
Prince Edward Island Begin at age 40 (ages 30-39 accepted if high risk and referred by physician)
For women aged 30-39 - annual recall
For women aged 40-49 - annual recall
For women aged 50-69 - biennial recall
For women aged 70-74 - biennial recall
74
Newfoundland & Labrador
Begin at age 50 (age 40-49 accepted only with physician referral)
For women aged 50-69 - biennial recall 69 (age 70+ only if previously enrolled in the program)
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Ontario
QuebecManitobaSaskatchewan
Alberta
British Columbia
Yukon Territory
NorthwestTerritories Nunavut
New BrunswickNew Brunswick Nova ScotiaNova Scotia
Prince Edward IslandPrince Edward Island
Newfoundland Newfoundland & Labrador& Labrador
(1990)
(1998)(1995)(1990)
(1990)
(1988)
(2003)
(1990)
(1995)(1995) (1991)(1991)
(1998)(1998)
(1996)(1996)
Province/TerritoryProvince/Territory(Program Disribution)(Program Disribution)
Mammography aloneMammography alone
Clinical Breast ExaminationClinical Breast Examination & Mammography& Mammography
No Organized No Organized ProgramProgram
Distribution of mammography and CBE among breast screening programs
Breast Cancer Screening Program Administration
Program Start Date Program Name Agency Responsible for Program Administration
Nunavut
Northwest Territories 2003
2008
Breast Screening Program, Stanton Territorial Health Authority
Breast Screening Program, Hay River Health and Social Services Authority
Stanton Territorial Health Authority
Hay River Health and Social Services Authority
Yukon 1990 Yukon Mammography Program Government of Yukon
British Columbia 1988 Screening Mammography Program of British Columbia
BC Cancer Agency
Alberta 1990 Alberta Breast Cancer Screening Program Alberta Health Services
Saskatchewan 1990 Screening Program for Breast Cancer Saskatchewan Cancer Agency
Manitoba 1995 BreastCheck Cancer Care Manitoba
Ontario 1990 Ontario Breast Screening Program Cancer Care Ontario
Québec 1998 Québec Breast Screening Program Ministère de la Santé et des Services sociaux
New Brunswick 1995 New Brunswick Breast Cancer Screening Services
New Brunswick Cancer Network (NB Ministry of Health)
Nova Scotia 1991 Nova Scotia Breast Screening Program Government of Nova Scotia
Prince Edward Island 1998 PEI Breast Screening Program Government of Prince Edward Island
Newfoundland and Labrador
1996 Breast Screening Program for Newfoundland and Labrador
Eastern Health, Cancer Care Program
Participant Recruitment
Doctor referral Self-referral Initial letter of invitation
Age group to which letter is sent
Nunavut
Northwest Territories
Yukon
British Columbia 50-69
Alberta 50-69
Saskatchewan 50-70+
Manitoba 50-69
Ontario
Québec 50-69
New Brunswick (not all regions) 50-69
Nova Scotia*
Prince Edward Island
Newfoundland and Labrador
* NS initially started sending out letters of invitation; however, they have since stopped due to capacity issues.
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Recall Following a Normal Mammogram
Send out recall letters
Coordination of recall for women following a normal screening episode performed by
Any additional follow-up to first recall letter after no reply
Age group for recall
Nunavut
Northwest Territories Centralized management (Program or Agency) 40-79
Yukon Screening centre 40-79
British Columbia Centralized management (Program or Agency) 40-79
Alberta (AHS Screen Test only)
Centralized management (Program or Agency) 40-69
Saskatchewan Centralized management (Program or Agency) 50-70+
Manitoba Centralized management (Program or Agency) 50-74
Ontario Regional coordination centres/ Screening centre 50-74
Québec Regional coordination centres 50-69
New Brunswick (not all regions)
Screening centre 50-69
Nova Scotia (postcard) Centralized management (Program or Agency) 40-69
Prince Edward Island Screening centre 40-74
Newfoundland and Labrador
Screening centre 50-74
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High Breast Density Recall and Recommendations
Five provinces and territories recall women based on high breast density
Recommendations following a high breast density reading varies across P/Ts
Automatic annual recall based on breast density
Value considered high breast density
Recommendation for high breast density levels
Northwest Territories > 75% Annual recall
Alberta >75% Annual recall
Ontario >75% Annual recall
Nova Scotia >75% Annual recall
Newfoundland and Labrador >75% Annual recall
March 2013
Association of Screening Program/Centre with Diagnostic Follow-Up
Assessment of abnormal results (radiological or histopathological) occurs within the screening program
Screening centre books diagnostic assessments
Medical prescription needed for each diagnostic assessment
Radiological/ pathological assessment teams have access to screening reports
Nunavut
Northwest Territories
Yukon
British Columbia Facilitates diagnostic referral
Alberta (Varies by site) (Varies by site) (On request)
Saskatchewan
Manitoba
Ontario (Varies by site)
Québec (Varies by site)
New Brunswick (Varies by site)
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Quality Assurance: General
Conduct a review of screening films/digital images of interval cancers*
Conduct a review of missed at assessment cancers
Require a ‘double read’ of a portion of all screens
Have a questionnaire to evaluate client satisfaction
Conduct analyses to estimate the effect of organized breast screening on mortality
Nunavut
Northwest Territories
Yukon
British Columbia
Alberta**
Saskatchewan
Manitoba
Ontario (Done at individual centres)
Québec
New Brunswick (Provincial Cancer Report)
Nova Scotia *** (periodically)
Prince Edward Island
Newfoundland and Labrador
(in the process)
*Classify cancer as either true interval or missed at screening**Alberta Health Services Screen Test sites only***NS review of all interval cases 1991 to 2004 and CD of various cases are sent to all screening radiologists. Now with full field digital this will be competed electronically.
Quality Assurance:Client Satisfaction Surveys
NWT, BC, AB, MB, NS and NL evaluate client satisfaction on an ongoing basis
Mammography exam
Particular Screening Centre
Organized Screening Program
Northwest Territories
British Columbia
Alberta
Manitoba
Nova Scotia
Newfoundland and Labrador
Table: Specific information collected when evaluating client satisfaction per province/territory
March 2013
Quality Assurance:Evaluation of Radiologist Performance
Most P/Ts evaluate radiologists on their level of performance on an annual basis with the exceptions of YK and PEI. NB collects this data but does not report on it
Positive Predictive Value (PPV)
Abnormal call rate
Cancer detection rate
Interval cancers
General performance reviews
Other (specified)
Northwest Territories
British Columbia Sensitivity/ Specificity
Alberta Sensitivity/ Specificity
Saskatchewan
Manitoba
Ontario Sensitivity/ Specificity and
One year recall rate
Québec
Nova Scotia
Newfoundland and Labrador
Sensitivity/ Specificity
Table: Specific information collected when evaluating radiologist performance per province/territory
Table: Specific volume requirement for radiologists per province/territory
NL NS NB QC ON MB SK AB BC NT
1,500 / year 2,500 / year 1200/ year** 500/ year 1,000 / year 1,000 / year* 3,000 / year 480 / year** 2,500 / year 480 / year
*All radiologists greatly exceed this number**Includes diagnostic and screening mammograms
Quality Assurance:Vital and Cancer Registry-Linkages with Provincial Registries
Collection of ‘Vital Status’ variable
Collection of ‘Date of Death’ variable
Collection of cancer stage (TNM or Collaborative stage) or other cancer variables
Nunavut
Northwest Territories
Yukon ** **
British Columbia
Alberta * *
Saskatchewan
Manitoba
Ontario
Québec
New Brunswick ***
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
*Through provincial client registry**Decreased lists are provided to WGH monthly***linkage for post-screen cancer information only
March 2013
Mammography Screening Program:Vital and Cancer Registries – TNM or Collaborative Stage
For the provinces and territories that do not currently link with provincial cancer registries to collect cancer stage (TNM or Collaborative Stage) or other cancer variables, it may still be possible:
For the collection of post-screen cancer information (BC, QC, NS*) For the collection of cancer and stage information (BC, NS*)
*Note: Both linkages are possible in NS; however, an agreement has not yet been established
For YK it is unknown if this is possible
March 2013
Breast MRI: High Risk Guidelines
Self-reported family history (>=2) of breast cancer (first degree relative)
Self-reported family history of BRCA 1/2
Genetic testing BRCA 1 or 2
Risk of breast cancer >20% (scored by validated assessment tools)
Chest irradiation between the ages of 10 and 30 years
Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome
British Columbia ****
Alberta
Ontario * ** ***
Nova Scotia **
Newfoundland and Labrador
>=3
Prince Edward Island
Currently there are five provinces (BC, AB, ON, NS, NL) that have developed standard guidelines for MRI referral
Table: The criteria or evidence that MRI referral is based upon per province
* First degree relative
** >25% using validated assessment tool
*** Chest irradiation before age 30 and at least 8 years ago
**** BC includes the following syndromes: Li Fraumeni Syndrome, Cowden’s Syndrome, HDGC (CDH-1), Peutz-Jegher’s Syndrome
March 2013
Future Implementation of MRI
Ontario has implemented an MRI screening component to its organized screening program for women considered at high risk for breast cancer.
BC, NS and AB have established guidelines for the use of MRI among women considered to be at elevated risk (i.e. in BC the women considered are confirmed cases of BRCA1 and BRCA2 mutation only). For more information on MRI guidelines for NS please visit www.breastscreening.ns.ca
NL is exploring the appropriateness of using MRI among women considered to be at elevated risk
March 2013
Reference Slide
Please use the following reference when citing information from this presentation:
Breast Cancer Screening in Canada: Programs and Strategies. Cancer View Canada. Available at: [Enter Link], Accessed: [Enter Date Accessed].
March 2013