Breast cancer is the most common cancer in women, second only to some types of skin cancer (non-melanoma). Approximately one in seven women in Alberta will be diagnosed with it during their lifetime, and nearly one in 35 will die from it. With these statistics, it makes sense to consider doing whatever we can to reduce the odds for ourselves.
The goal of screening for breast cancer is to detect it at an early stage, before a lump is found, when it is more easily treated and more likely to be cured. Thankfully, the death rate from breast cancer has dropped over the past 20 years, mainly due to improvements in treatment, but also partly due to increased rates of screening. This article discusses breast cancer screening for people at an average risk, who make up 85% of the population.
The Alberta guideline for breast cancer screening was updated in late 2022, with one of the changes being that average-risk individuals should consider starting regular screening at age 45 instead of the previously recommended age of 50. It is important to note that the population that breast cancer screening pertains to is not just cisgender women (assigned female at birth, and who still identify as women). It also includes transgender, gender diverse, and non-binary people who were assigned female at birth and have not undergone mastectomy (“top” surgery), as well as people assigned male at birth who have been on feminizing hormone therapy for five or more years.
Average-risk persons between the ages of 40 and 45, or those aged 75 and older, may also consider having screening mammograms; however, the guideline recommends that the decision be made only after an informed discussion with a health care provider, weighing the pros and cons based on personal circumstances and preferences. This is because in these age ranges, the relative benefits of screening are lower than in the 45 to 74 age group.
Regular screening mammograms are, by far, the most effective screening tool for breast cancer detection and can reduce the death rate from breast cancer by 30 to 40 percent. No other screening method (e.g., self-breast exam or even clinical breast exam by a healthcare provider) comes anywhere close to the benefit of mammograms. The main risks of mammograms are anxiety regarding the actual procedure, or while waiting for results and false positives (having something show up which proves, with further testing, to not be cancer).
The density of your breast tissue influences the sensitivity or accuracy of your mammogram: the higher the density, the more difficult it is to see early, small breast cancers. In general, younger women tend to have denser breasts than older women because, as we age, the dense glandular tissue is gradually replaced by less dense fatty tissue.
When the mammogram is complete, a radiologist assesses the degree of density and advises whether additional testing, such as an ultrasound, is recommended. Try not to be alarmed if you are recalled for further testing, as in Alberta, about 94 percent of these additional tests do not result in a diagnosis of breast cancer.
Some women worry about the radiation that mammograms expose us to. They are indeed x-rays – however, the amount of radiation you receive each time is only the equivalent of what you are exposed to normally over about 26 days of background radiation from daily living. It is far more likely that a person’s life will be saved by regular screening mammograms than their risk of developing breast cancer because of the radiation.
If you are aged 45 to 74 and wish to book your screening mammogram, you can contact a radiology clinic (e.g., EFW, Mayfair, Pureform, Canada Diagnostics, Beam, etc.) or the Alberta Health Services “Screen Test” mammogram clinic. Be prepared to answer questions such as whether you have breast implants (as there is a special technique used for them), and whether you or a family member have had breast cancer. You do not need a referral or a requisition to book your appointment; however, you will be asked if you have a doctor who you want the report sent to. If you do not, the booking clerk will let you know how they will ensure that any concerning findings will be followed up on.
When you arrive for your mammogram, you will be asked to undress from the waist up and put on a gown. Once in the examination room, you will remove the gown and each breast will be x-rayed individually, being compressed between two panels for each view. There is no question that this process can be uncomfortable, but thankfully, it only takes a few seconds and you can be reassured that you have taken an important step in caring for yourself.
For further information please go screeningforlife.ca.
Cathryn has been a family physician for over four decades and is loving being grandma to five. She currently works part-time in family practice.
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