Introduction
Breast Cancer is one of the most common malignant diseases among women, with a serious impact on the health and well-being of individuals and the community. If left undetected or untreated, high rates of morbidity are expected. Contrarily, successful treatment with early detection can be expected. As a result, routine screening remains one of the most important parts of women’s health across the world.
In this post, we briefly review the standard of care regarding Breast Cancer Screening in Ontario and provide some practical details on engaging with the program.
The Program
The Ontario Breast Screening Program (OBSP) is a province-wide program aimed at the early detection of Breast Cancer. The program consists of routine breast mammogram studies every 2 years for healthy adults between the ages of 40 to 74 years old, but may be extended to younger or older populations, based on individual risk factors. These tests are covered by OHIP, and generally, no payment is required of individuals to enroll in this screening.
Breast Mammograms are low-dose X-ray studies with specific techniques, which may include compression of the breasts to provide detailed views of tissues in search of any abnormal structures, indicating further investigations.
There are different ways you can participate in this program, either through your primary care provider or directly through the Cancer Care Ontario website. The instructions on how to contact the Appointment Booking Line or access the mammogram appointment information centre can be found on the website, accessible at cancercareontario[.]ca
The Benefits
While some might worry about the risk of adverse effects, mostly due to radiation exposure, with going through routine mammogram investigations without an underlying disease, the potential risks have been weighed against the benefit of early detection of breast cancer, and the results are in favour of routine screening.
To elaborate further, the risk of developing breast cancer in an individual is affected by a variety of both genetic and environmental factors. These are not predictable based only on one’s medical and familial history.
Furthermore, Breast Cancer is not always detectable through routine physical examination or self-breast examination. Especially early on, when surgical or medical options are more beneficial, Breast Cancer might not be easily distinguishable from benign breast lesions.
Conclusively, our most reliable tool guiding further investigations in early detection of breast cancer remains the routine mammogram, when odds of successful treatments are much better compared to detection in late stages, which may have devastating health outcomes in uncurable stages.
Screening in Pregnancy and Breastfeeding
While some guidelines mention that mammogram studies might be safe in pregnancy due to the distance between the focus of the low-dose X-ray and the abdomen where the fetus is growing, it is generally recommended to postpone the studies until a few weeks after the pregnancy to minimize any risk of harm.
Furthermore, a mammogram poses little to no risk to breastmilk content and is generally considered safe during breastfeeding.
That said, the most reliable source of information regarding an individual’s risk factors based on their medical and family history is their primary care provider. Thus, it is recommended to seek your healthcare professional’s opinion on planning your routine screening tests before, during, and after your pregnancy.
The Results
Mammogram results are reported based on a few findings. Firstly, the breast tissue is categorized based on the balance between fatty tissues and the fibroglandular tissues (the milk-producing glands and ducts). The breast is divided into categories A, B, C, and D. These classifications are important, as abnormal lesions, such as cysts or nodules, might be harder to detect among fibroglandular tissues and easier among fatty tissues. As a result, a closer follow-up, usually a routine annual mammogram instead of once every 2 years, may be recommended for categories C & D with a higher density of fibroglandular tissues.
Additionally, abnormal findings may be reported, such as cysts, nodules, with details regarding their location, size, and characteristics. These details help with follow-up comparisons, as any changes in size or characteristics of lesions may indicate more invasive investigations.
These findings are reported into BI-RADS categories I through VI, depending on how benign (generally categories I, II) or suspicious / malignant-looking (with higher scores) findings may be.
Based on these results, further investigations may be indicated, such as earlier mammogram studies (3-6 months), Ultrasound studies, fine-needle aspiration, and biopsies for pathological investigations.
All these rigorous investigations are made possible thanks to routine mammogram studies for all healthy individuals, even those without any suspicious findings on their familial or medical history and physical examination. They help us with early and timely detection of breast cancer and provide for higher rates of treatment success when the disease might still be curable before reaching aggressive stages with poorer outcomes.
Conclusion
In conclusion, Routine mammogram studies, accessible through the Ontario Breast Screening Program (OBSP), are effective tools in the early detection of breast cancer for improved rates of successful treatment.
It is recommended to seek advice from your healthcare provider and plan your enrollment.
Feel free to write to us about your valuable experience with the OBSP. How is the ease of access? What are the challenges, and how could this service be improved based on your experience? Are these programs available promptly? Do the waiting times exceed your expectations? What does your healthcare provider think of these routine tests?
Feel free to share your ideas in the comments section or via email.
