Breast screening in Canada, 2023-24

Screening strategies for participants with elevated risk

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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. Characteristics that make someone at elevated risk are defined differently across screening programs.

Ten provincial and territorial breast screening programs have unique criteria for the management of participants at elevated risk of developing breast cancer. In most cases, individuals who are found to be at elevated risk are screened annually with a mammogram, starting at the age of 40 or 50, and stopping at the age of 74.

Definitions of elevated risk of 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
  • Consuming more than one alcoholic drink 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 first or second-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 descent
ON ✓ ✓ ✓ ✓
  • Personal or first-degree family history of ovarian cancer
  • First-degree relative assigned male at birth with breast cancer at any age
  • Two or more first-degree relatives assigned female at birth with breast cancer at any age, or one under age 50
  • BI-RADS breast (chest) density D classification ~
QC
  • Does not classify participants as high risk
NB ✓ ✓

BI-RADS C or D

 ✓** ✓
NS ✓ ‡ ✓ ✓ ✓
PE ✓ ✓ ✓ ✓
NL ✓ ✓ ✓
  • 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).
^SK: Screening radiologist recommendations.
~ON: As of July 24, 2023, participants who have a breast (chest) density classification of BI-RADS D are recalled in 1 year. Prior to this date, the 1 year recall due to breast (chest) density was based on percent mammographic density (PMD) ≥75%.
**NB: Personal history of pathologically confirmed lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), or atypical ductal hyperplasia (ADH).
‡NS: Participants on hormone replacement therapy are no longer considered to be at elevated risk, and will no longer be receiving annual screening.

Management of participants at elevated risk by screening programs

P/T Does the program manage participants who are at high risk? Recommended screening modality Recommended start age Recommended interval Recommended stop age
YT ✓ Mammography None given Annual None given
NT ✓ Yellowknife Breast Screening Program (YKBSP): mammography and ultrasound; MRI in some cases

Hay River Breast Screening Program (HRBSP): mammography

 40, with referral from PCP (50 can self-refer) Every one to two years, based on radiologist’s 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 (75+ have the option to continue screening)
AB ✓ Mammography* 40+ with referral from PCP; 45–74 can self-refer Annual 74 (75+ have the option to continue screening)
SK ✓^ Mammography 50 (can self-refer; if recommended earlier, PCP will refer to diagnostic centre) Annual for those with family history and high breast density, history of benign high-risk breast lesions, and radiologist recommendation 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.
Recall at 1-year for those with breast density BI-RADS D at the time of screening or based on recommendation by radiologist at the time of screening or assessment.**		 74‡
QC – – – – –
NB No*** Mammography Varies, depending on assessed risk conditions Based on radiologist recommendation.

Generally, annual mammography except  for BI-RADS Cor D (two- to three-year mammography) with option for additional individualized supplemental screening (tomosynthesis, CESM, U/S or MRI) as per radiologist recommendation

 Varies, depending on assessed risk conditions
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 revised CPG has elevated risk recommendations depending on the risk factors. The modality and start age may vary.
^SK: PCPs
~ON: The Ontario Breast Screening Program (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 relatives assigned female at birth with breast cancer at any age, one first-degree relative assigned female at birth with breast cancer under age 50, one first-degree relative with ovarian cancer at any age, one relative assigned male at birth with breast cancer at any age, breast density BI-RADS D at the time of screening, or recommendation by the radiologist at the time of screening or assessment.
**ON: As of July 24, 2023, participants who have a breast (chest) density classification of BI-RADS D are recalled in 1 year. Prior to this date, the 1 year recall due to breast (chest) density was based on percent mammographic density (PMD) ≥75%.
‡ON: People over age 74 can be screened within the OBSP; however, they are encouraged to make a personal decision about breast cancer screening in consultation with their healthcare provider. The OBSP will not recall people over age 74 to participate in the program.
***NB: Provincial recommendations for those assessed at increased or high risk were implemented in February 2022.
^^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).
-NU, QC: No information was provided at the time data were collected.

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