Breast cancer screening in Canada 2021/2022

Screening individuals at elevated risk

Individuals at elevated risk are those who are considered to have a greater than average risk for developing breast cancer but have a risk level less than the highest risk group.

Nine provincial and territorial breast screening programs manage participants at elevated risk of developing breast cancer. Screening programs define elevated risk differently by jurisdictions and individuals who are found to be at elevated risk are usually screened annually with a mammogram, started at the age of 40 or 50, and stopping at the age of 74.

QC and NB do not classify participants as elevated risk of developing breast cancer, although NB is currently evaluating this.

Definitions of elevated risk for breast cancer

P/T First-degree family history Hormone replace-ment therapy Breast density > or ≥ 75% History of high-risk benign breast disease Radiologist recommend-ations Other
YT ✓*
NT · Above average exposure to estrogen
· Drinking more than one drink of alcohol per day
· Being overweight or obese after menopause
· Smoking, especially if started at a young age and before the birth of first child
NU
BC
AB
SK · Personal history of breast cancer
· Personal history of other cancer
MB · At least one 1st or 2nd degree female relative on either maternal or paternal side of the family with a history of breast or ovarian cancer that does not fall into the high increased risk category
· Ashkenazi decent
ON · Personal or first-degree family history of ovarian cancer
· First-degree male relative with breast cancer at any age
· Two or more first-degree female relatives with breast cancer at any age, or one under age 50
QC · Does not classify participants as high risk
NB · Under evaluation as part of current Increased/High Risk Guideline development
NS
PE
NL · Participants with four second degree relatives on the same side of the family (grandparent, aunt, uncle, niece, nephew, half sibling with breast or ovarian cancer)
· Participants with three second degree relatives with breast or ovarian cancer on the same side of the family with one or more of the following:
1. One person affected < 50 years of age
2. Breast and ovarian cancer in the same individual
3. Male breast cancer
· Participants with a personal history of ovarian cancer diagnosed < 50 years of age
· Participants who have received mediastinal radiation before 30 years of age
· Participants who have been assessed by genetics and confirmed to be at a high risk of breast cancer

YT: * Applies to participants who receive a ‘D’ breast density score (BI-RADs category D- extremely dense >75% glandular)


Management of participants at elevated risk by screening programs

P/T Does the program manage participants who are at elevated risk? Recommended screening modality Recommended start age Recommended interval Recommended stop age
YT Mammography None given Annual None given
NT YKBSP: mammography and ultrasound, MRI in some cases
HRBSP: mammography
40
(40 with referral from PCP, 50 self-referral)
1-2 years, based on radiologist recommendation 74
(75+ have the option to continue screening)
NU
BC Mammography 40 Annual for those with family history or history of benign high-risk breast lesions 74
AB*
SK Mammography 40 (with referral from PCP to diagnostic centre, 50 self-referral) Annual for those with family history and high breast density, history of benign high-risk breast lesions 74
(75+ have the option to continue screening)
MB Mammography 50 Varies depending on level of risk and radiologist recommendation 74
(75+ have the option to continue screening)
ON^ Mammography 50 Ongoing annual screening for those with family history and/or documented pathology of high-risk lesions
Temporary annual screening for those with breast density ≥75% at the time of screening or based on recommendation by the radiologist at the time of screening or assessment
74
QC
NB~
NS Mammography 50
(40-49 can self-refer)
Annual 74
PE ✓** Mammography 50 (40-49 can self-refer) Annual 74
NL Mammography 50‡ Annual 74~

AB: *The ABCSP does not have official recommendations for elevated risk as the program includes all eligible individuals; however, PCPs and radiologists can make screening recommendations based on individual risks.
ON: ^The OBSP does not use the term “elevated risk”, however, there are several reasons a participant in the OBSP will be recalled by the program in one year: documented pathology of high risk lesions; a personal history of ovarian cancer; two or more first-degree female relatives with breast cancer at any age; one first-degree female relative with breast cancer under age 50; one first-degree relative with ovarian cancer at any age; one male relative with breast cancer at any age; breast density ≥75 percent at the time of screening; or recommendation by the radiologist at the time of screening or assessment.
NB: ~Provincial recommendations for those assessed at Increased or High Risk of developing breast cancer are currently under development. NB does not plan to use the term elevated risk.
PE: **Participants with a first degree relative with a history of breast cancer can enter the screening program at an earlier age with documentation.
NL: ‡Start/stop age is variable depending on conditions for elevated risk designation (e.g. breast density ≥75% may be a transitory condition, therefore start/stop age would be adjusted).
– No information was provided at the time the data were collected.