Taking action to improve abnormal call rates

Key takeaways

• Abnormal call rates (ACRs) for breast cancer screening have increased steadily over the past 10 years, exceeding national and international targets.
• While ACRs have increased, the cancer detection rate (CDR) has remained stable. A high ACR without an increase in CDR means more people are having follow-up tests without any added benefit.
• ACRs vary across the provinces and territories, suggesting variations in screening programs and quality assurance practices.
• As breast screening technology advances, Canada’s ACR targets may need to be refined in order to maintain the benefits of screening.
• As Canada resumes screening services post COVID-19, careful planning will be needed to ensure service capacity is not overwhelmed.

Applying the framework

Most people who receive mammograms will not have breast cancer. Accurate screening results help ensure those patients don’t suffer unnecessary stress or harm from tests they don’t need.

A lot of work has been done to improve the quality of mammography screening in Canada. Reducing abnormal call rates (ACRs) will help sustain those improvements — and ensure people continue to receive high-quality screening services. The Pan-Canadian framework for action to address abnormal call rates in breast cancer screening can help breast screening programs adopt evidence-informed approaches for optimizing ACRs. These approaches will help maximize the benefits of screening while minimizing patient harms and costs to the healthcare system.

Screening programs can implement the framework’s approaches over the immediate, short, medium and long terms based on their own capabilities and resources. It’s important to strive for equity in allocating funding and resources to these approaches. Doing so will help minimize the existing gaps in access to high-quality screening. The values of screening participants should also be considered when determining the acceptable balance between ACRs and CDRs.

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