Breast cancer screening in Canada: 2021/2022
Follow-up after an abnormal mammogram
All provinces and territories, with the exception of NU, send results letters to both primary care providers and participants after an abnormal (positive) mammography result, and many also follow-up with participants over the phone.
The location for conducting diagnostic mammograms after an abnormal result varies across Canada. Some jurisdictions conduct diagnostic mammograms at the screening centre/program while others conduct mammograms at diagnostic imaging centres or refer participants to Breast Risk Assessment units.
Receiving results and follow-up for abnormal breast screening test results
| P/T | Receive abnormal results | Follow up of abnormal results | Location of diagnostic mammogram after abnormal result | Return to screening? |
|---|---|---|---|---|
| YT | · Mailed to individual · Program may also contact participant by phone depending on the follow up required (imaging) |
· Program calls individual to arrange follow up appointments for imaging · If biopsy required, the person must go back to their PCP for referral to biopsy or any other follow up |
· Screening program | · If follow up results are normal, participants are recalled for screening every 2 years (or as recommended by radiologist) |
| NT | · Participants in the program receive a phone call as well as a letter | · Program calls person to arrange follow up appointments for imaging · If biopsy required, the individual must go back to their PCP for referral to biopsy · Program notifies PCP that a patient requires biopsy |
· Stanton Territorial Hospital or a facility in Edmonton, Alberta | · If follow up results are normal, participants are recalled for screening every 2 years (or as recommended by radiologist) |
| NU | · Varies by site; generally sent to PCP who will contact participant to provide results | · PCP manages referrals for any follow up required | ||
| BC | · Participant receives phone call from diagnostic centre to book follow up · Results also sent to PCP and mailed to participant |
· Diagnostic Centre books follow up and calls participant with appointments | · Affiliated Diagnostic imaging departments | · If follow up results are normal, participants are recalled for screening every 1-2 years per identified risk factor program policy |
| AB | · Most clinics notify PCPs and/or participant in person or by phone · Results also sent to PCP and mailed to the individual |
· Clinic or PCP contacts person to arrange follow up · Some clinics book follow up directly (varies by site) |
· If mammogram was completed at a facility that can do diagnostic mammograms, then usually done at that facility · Private clinics · Hospital facilities |
· If follow up results are normal, participants are recalled for screening every 2 years (or as recommended by radiologist) |
| SK | · Participants receive results by phone, either from program (navigator) or their PCP | · Program navigator arranges follow up if given permission to do so by HCP (otherwise HCP will arrange follow up) · If program conducting follow up, they contact the participant by phone to arrange appointments |
· Diagnostic breast imaging centres (hospitals, private radiology clinics, and/or Breast Health Centres) | · If follow up results are normal, individuals are recalled for screening every 2 years (or as recommended by radiologist) · Individuals who are diagnosed with cancer return to regular screening once they have been cancer-free for five years although currently our software system does not re-invite them. |
| MB | · Participants receive phone call from program to provide results · Results also sent by letter to participants and their healthcare provider |
· Referral to diagnostic centre coordinated by program. Individual is advised of follow up appointment by program (phone) | · Diagnostic imaging centre | · If follow up results are normal, participants are recalled for screening every 2 years (or as recommended by radiologist) · All individuals are informed of their status (i.e., if they will be recalled for screening or are no longer eligible) by letter once diagnostic work up is complete |
| ON | · OBSP sites are expected to ensure that the participant’s PCP is informed of the abnormal breast screen results as soon as possible · Participants’ receipt of abnormal results varies by site: some may call, others send letters, a few may liaise with the PCP who will contact participant to provide results |
· Follow up varies by site: some sites may coordinate appointments; at other sites the PCP may coordinate follow up · If participant does not have a PCP, the screening site will designate a physician who will manage follow up for the participant until diagnosis |
· Program assessment sites (hospitals and independent health facilities) that conduct diagnostic imaging · Assessment sites outside of the program (hospitals and independent health facilities) that conduct diagnostic imaging |
· If follow up results are normal, most participants are recalled for screening every 2 years |
| QC | · Mailed to person · PCP or centre will contact participant to provide results |
· Varies; participants are directed to contact site or PCP in their results letter, some sites contact the person proactively to arrange follow up | · Designated screening centres or reference and diagnostic designated centres | · If follow up results are normal, participants are recalled for screening every 2 years (or as recommended by radiologist) |
| NB | · Most sites contact participant by phone | · Varies across sites, participant is typically referred automatically for diagnostic procedure | · Sites vary across zones | · Participants with an abnormal mammogram but no cancer diagnosis can return to the screening program and be re-invited for screening with a physician or nurse practitioner’s recommendation |
| NS | · Mailed to participant · Result letter e-faxed to PCP 3 days before letter sent to individual, so that PCP can notify them of their abnormal results and of their follow-up appointment information |
· Program schedules follow-up appointments per radiologist recommendation; appointment information mailed to PCP and to participant in results letters · Booking process for needle core biopsy varies by site – some booked as per radiologist recommendation (without requisition), others require requisition from PCP |
· Diagnostic breast imaging departments located in hospitals | · If follow-up results are normal, then individuals are recalled for screening every 2 years (or yearly if recommended by radiologist) |
| PE | · Notification of follow up imaging mailed to participant · Results letter mailed to PCP |
· Notification through abnormal results letter l for follow up appointment · Individual is contacted by phone the day prior to appointment · If biopsy is required, the PCP contacts the individual |
· Screening program and diagnostics performed at same 2 hospital sites · Biopsy at one site only |
· If follow up results are normal, individuals are recalled for screening every 2 years (or as recommended by radiologist) |
| NL | · Mailed to participant · Results mailed to PCP 2 days before individual |
· Program coordinates follow up testing appointments and provides to participants by mail along with abnormal results · Appointment with PCP may be made but is not required |
· Diagnostic breast imaging departments located in hospital | · If follow up results are normal, individuals are recalled for screening every 2 years (or as recommended by radiologist or program protocols) |
In the absence of a primary care provider, seven provinces help participants find a suitable primary care provider to follow up after an abnormal mammography result. Other jurisdictions require participants to have a primary care provider to be eligible for a screening mammogram.
When participants cannot be reached (e.g., mail is returned), most provinces and territories contact the primary care provider or obtain current contact information from the primary care provider.
Process when participants do not have a primary care provider or cannot be reached
| P/T | Process when participants do not have a PCP | Process when participants cannot be reached |
|---|---|---|
| YT | PCP Identified when booking the mammogram | Follow-up with PCP |
| NT | Participant must have a PCP to be screened. PCP identified when booking the mammogram. | YKBSP: Program Booking Coordinator will contact the patient by telephone if further imaging is required. If it is something that cannot be completed in Yellowknife a letter is sent to inform the PCP, who is responsible for the referral. If letter is returned the program will check electronic and hospital systems to confirm address and then call patient to confirm address with them. HRBSP: No specific policy. Program Coordinator will call the patient’s listed phone number if patient is from Hay River or Enterprise, if patient lives in an outlying community a call is placed to the community health centre/PCP. |
| NU | PCP identified based on jurisdiction where scan takes place | |
| BC | Participant must have a PCP to be screened. PCP Identified at time of booking the mammogram. | Follow-up with PCP |
| AB | PCP usually identified when booking the mammogram. Program will assist participant with finding a PCP either before the screen or after an abnormal result. | Screen site will notify PCP |
| SK | Client navigator works with participant to find PCP. Program can also refer women to a healthcare provider who will manage follow up. | Follow-up with HCP for current phone number |
| MB | Program will assist participant to obtain a PCP though the provincial ‘Doctor Finder’ initiative in the result of an abnormal result. If a PCP cannot be obtained, Program Medical Lead will assume care of patient for follow up testing. | A result letter is mailed to the participant and their PCP (includes a notation that we have been unable to reach the participant by phone) |
| ON | If participant does not have a PCP, the screening site will designate a physician who will manage follow up for the participant until diagnosis. | Program site will notify PCP and help schedule a follow up appointment. Program site may also continue to call and/or send a letter to the participant, requesting them to follow up with the site. |
| QC | Voluntary Program PCP is assigned to the participant to manage follow-up | Program coordinators contacts participant or PCP 45 days (or less) after an abnormal screening test if no supplementary exam has been confirmed in the information system. If participant is still unreachable after 90 days, send registered mail. |
| NB | No official process. Approach varies by site. | No official process. Approach varies by site. |
| NS | In the event of an abnormal screening report, the program works with the coordinator of each screening site to get a local PCP in the area to accept the report | Central booking site will call the participant. If not successful, central booking staff will contact the PCP to obtain participant’s current contact info |
| PE | Provincial Coordinator (designate), or surgeon contacts the participant about follow-up | Follow-up with phone call to PCP |
| NL | Program will assist participant with finding a PCP, but will still screen participant. Medical Director and Cancer Screening Pathway Coordinator work with individual to ensure all follow-up is complete | Check alternate source for address, if more recent address found re-send. Otherwise follow-up with PCP |