Last week, the Canadian Task Force on Preventative Health Care announced that it would be standing firm on its guidance that breast screening in Canada begin at age 50. In a symbolic gesture and a small win for those who vehemently oppose this decision, the Task Force did state that women in their 40s should not be refused access to screening and in consultation with their family physician and make an informed decision based on the potential harms and benefits.
The reaction to this decision was swift and significant, with organizations including Dense Breasts Canada, the Canadian Society for Breast Imaging, The Canadian Cancer Society, and prominent clinical voices including Dr. Toni Zong speaking out to express their disappointment. One of the most prominent of these voices was Canadian Health Minister Mark Holland, who in a press conference held on the day of the Task Force announcement expressed his disappointment and doubt that the Task Force has acted in the best interests of women in Canada. Minister Holland has called for an extended 60-day public consultation period and has asked the Public Health Agency of Canada to step in to conduct a comprehensive review of the Task Force’s decision and supporting scientific evidence. This review will be led by Canada’s Chief Public Health Officer Dr. Teresa Tam.
Canadian women certainly are not in favor of this decision. A poll conducted in September 2023 showed overwhelming support from Canadian women to have the screening age dropped from 50 to 40. Women simply don’t buy the Task Force’s argument that the psychological harms from call backs for additional screening outweigh the benefits. I for one don’t know a single woman who would choose not to submit to additional imaging or even a biopsy if it allowed doctors to find and treat breast cancer earlier.
Folks know where I stand on this matter so this post is written with a clear biased toward screening. I believe that regular screening should begin at age 40 and that women should never be denied access to screening. I know too many women, have heard too many stories of those whose cancer was caught too late to entertain any kind of other opinion.
The trend toward screening at age 40 is a thing. In April the US Preventative Services Task Force announced it would be moving the age of screening down to 40 from 50, responding to new inclusive research findings that show women of Black and Latino heritage are more likely to develop aggressive forms of breast cancer earlier and are diagnosed too often at a later stage. Ten of the 12 Canadian Provinces and Territories are now moving toward screening women starting at age 40, with New Brunswick going live with its program today. One might ask why the Federal Task Force even matters if this is the case. The issue is that the Federal Task Force has the ear of family physicians and the federal guidance holds weight. Family physicians, are as we know, are the first line of defence for women who may have a concern (those women who have a doctor I should add).
There is also evidence as reported by JAMA, the BSJ and our own Canadian study that breast cancer is showing up at a younger age. The WHO predicts that breast cancer incidence will increase by more than 30% globally
Even if we do move the screening age to 40 we will not solve that problem, but it is a step in the right direction.
We’ll all be watching closely as this review period plays out.
