Breast screening in Canada, 2023-24

Innovations in breast screening

Alberta

As part of Alberta’s continuous improvement process, the program updated the clinical practice guidelines.

Saskatchewan

In response to COVID-19, Saskatchewan’s Screening Program for Breast Cancer created a way to register and receive a mammogram with less contact time with staff. Current practice is continually being assessed in accordance with provincial recommendations.

Ontario

In spring 2020, Ontario’s Ministry of Health paused all non-essential health services (e.g., cancer screening). This resulted in a pause to some breast screening correspondence letters. Resumption of breast screening correspondence campaigns started in winter 2021. Ontario has now returned to full resumption of breast screening.

Two tools were developed in response to COVID-19:

• Tip sheets to support OBSP sites with the gradual resumption and prioritization of breast screening services.
• A COVID-19 Regional Monitoring and Planning Tool that is shared with Regional Cancer Programs (RCPs) on a monthly basis to help monitor and improve COVID-19 recovery metrics (e.g., monitor volumes of screen-detected breast cancers and OBSP participants overdue for mammogram rescreening).

A media kit with materials (e.g., key messages, robo call scripts, etc.) was also developed to support regional public awareness campaigns.

New Brunswick

Regular meetings established with regional health authorities to discuss screening and diagnostic mammography wait times. Some facilities offering individual screening slots at nearby facilities (e.g., evenings and weekends when wait times are long and if individuals want to participate).

Prince Edward Island

No major changes occurred in PEI; however, they began using a program called Skip the Waiting Room to provide reminder calls for patients and prescreen for any COVID-19-related symptoms prior to arrival. The technologists were also given access to a positioning software called Densitas.

Priority work in breast screening

Yukon

Mammography screening exams in the Yukon include tomosynthesis for all eligible people (average, higher than average, and high-risk).

British Columbia

BC Cancer’s BSP launched a higher risk surveillance program for individuals who are at higher risk of breast cancer in May 2022. Further information can be found on the BC Cancer website. This program has expanded services to facilitate breast cancer surveillance for individuals at increased risk. (bccancer.bc.ca)

Alberta

Speed of communication about health services results has changed due to COVID-19. As such, Alberta is working on advancing patient communication, including exploring the use of text and real-time release of patient-facing result letters with radiology reports, etc. The updated CPG provides guidelines on risk-based screening.

Saskatchewan

Work continues with the initiatives set out by the Breast Cancer Screening Pathway, including evaluation of screening eligibility, enhancing the program for the underserved, developing a provincial strategy for mammography computer aided diagnostics, and enhancing the established quality assurance program. New software for all screening programs is in development and result notification to clients and providers is now timelier.

Ontario

Priority work in the Ontario Breast Screening Program (OBSP) completed in 2023 includes:

• Implementation of policy recommendations on screening trans and nonbinary people in the OBSP
• Including people who have breast implants in the OBSP
• Providing OBSP participants with their Breast Imaging Reporting and Data System (BI-RADS) breast (chest) density information in normal results letters
  • In addition, the OBSP has started to define breast (chest) density using the Breast Imaging Reporting and Data System (BI-RADS) classification system instead of percent mammographic density (PMD). Participants with the highest category of density (BI-RADS category D) will be recalled for screening at one year (vs. PMD ≥75% categorization formerly required for 1-year recall).

Priority work ongoing in the OBSP

• Expansion of the OBSP to people ages 40 to 49
• Providing information to OBSP sites on supplemental screening for people with Breast Imaging Reporting and Data System (BI-RADS) category D breast (chest) density
• Developing guidance for breast cancer screening for people who are pregnant or lactating

New Brunswick

Breast Cancer Screening Program Improvement Initiative is planning the replacement and enhancement of an out-of-support system with a breast cancer application developed in-house, which will include near real-time breast cancer screening data, more automated processes, and the management of program correspondence.

The regional health authorities have been upgrading outdated mammography units throughout the province and ensuring every health zone has mammogram disability chairs to assist those with mobility issues to receive mammogram services. CPAC Onco-Simulation Modelling requested for mammography screening of NB women aged 40–49 years (annual and biennial screening, starting at age 40 and 45).

Densitas AI software (Density Module) implemented across the province.

New Brunswick’s Breast Cancer Screening Guidelines, implemented February 2022, recommend healthcare providers use a risk-based assessment approach.

Nova Scotia

Densitas Mammo Quality software was approved for use in Nova Scotia in March 2022, and was implemented in Central Zone by August 2022. It provides standardized clinical image quality evaluations on every screening mammogram done at the Central Zone breast screening site. Image quality results and positioning errors are available immediately at point-of-care and at point-of-reporting. This will reduce mammogram callbacks. The plan is to deploy the software to all breast imaging sites across the province.

Prince Edward Island

Three new tomography-capable machines were installed at the two sites in PEI. PEI will be doing some training in June 2023 to implement tomography for use when performing biopsies.