Breast cancer screening

Early detection of breast cancer means more effective, less aggressive treatments, and better chances of a cure than for more advanced breast cancers. Breast cancer screening involves detecting the disease before the appearance of signs and symptoms. Most of the time, screening mammograms makes it possible to detect cancer early on, in the very early stages of the disease’s development, sometimes even at the precancerous stage.

Mammography is the only test recognized as effective for breast cancer screening in Quebec because it is the only one that reduces the number of deaths from breast cancer. For more information on mammography, see our blog post titled Mammography: Who, Why and How? as well as the page on the Quebec government website titled Advantages, disadvantages and limitations of mammography screening.

Chest or breast self-examination, a special technique for detecting changes, is no longer recommended by the Quebec Breast Cancer Screening Program (PQDCS) because it is no longer considered an effective means of screening. That said, it is recommended that you observe your breasts and report any changes to a doctor, who will perform a clinical breast examination if deemed necessary. 

In the past, regular clinical breast examinations by a doctor were recommended; however, since clinical breast examination has not been proven to reduce breast cancer mortality, it’s no longer recommended by the PQDCS as a screening method but can be to complement mammography.

More than 80% of breast cancer cases occur in women aged 50 and over, and the number of cases is particularly high among women aged 50 to 74. This is why women in this age group are targeted by the PQDCS.

The PQDCS is a free organized screening program available across Quebec. The goal of the program is to reduce the breast cancer mortality rate by 25% among women aged 50 to 74. The results obtained since the PQDCS was introduced are on track with this objective, which supports continuation of the program. Seven deaths are prevented for every 1,000 women who take part in mammography screening every two years for 20 years.

The PQDCS encourages all Quebec women aged 50 to 74 to have a breast cancer screening mammogram every two years. Women aged 50 to 74 who are insured under Quebec’s public health insurance plan receive a letter of invitation by mail when they reach age 50 and every two years thereafter. This letter is a prescription in itself, and provides all the information needed to book an appointment at a designated screening centre (CDD). 

Participation in breast cancer screening through the program is voluntary, which means that each woman is free to participate or not.

Visit the PQDCS website to learn more about the steps to follow, from receiving your invitation letter to obtaining the results of your screening mammogram.

People with breast implants can have screening mammograms and participate in the PQDCS. They should follow the same breast cancer screening recommendations as people without implants. 

It should be noted that women aged 50 to 74 who have been diagnosed with breast cancer in the past are not eligible for the PQDCS. These women should speak with their doctor about personalized medical care tailored to their situation.

If your personal risk of developing breast cancer is higher than average, yourdoctor may recommend that you have a screening mammogram at regular intervals before age 50, or more frequently than recommended by the PQDCS.

If you haven’t already done so, speak to your doctor about your risk factors. After assessing your risk, they may recommend personalized prevention and screening measures.

To learn more about breast cancer risk assessment, watch our educational video on identifying high-risk individuals (in French only).

If you’re over 74, you may be able to have a screening mammogram outside the PQDCS with a prescription. Discuss this with your doctor. 

Breast cancer can start to develop in the two years between mammograms. This is known as interval cancer. This is why it is best to take precautions by continuing to observe your chest or breasts and reporting any persistent changes to a doctor without waiting for your next medical appointment or mammogram.

Research is being done to improve breast cancer screening by studying new reliable and non-invasive methods, ways to improve the sensitivity of existing methods, and individual risk factors for more personalized screening recommendations. Further studies are needed before these methods can be approved for breast cancer screening. They include the following:

• Detecting circulating cancer cells: Studies are under way on the possibility of detecting various cancers using blood tests. This technique would allow for quick and simple screening. Cancer cells can be found in cancer patients’ blood, and several research groups are looking at techniques to detect them effectively. In addition to detecting cancer at an early stage, this method would be useful for monitoring the progress of the cancer and adapting treatments.
• Measuring metabolites derived from cancer cells: Cancer cells secrete metabolites, organic molecules that are unique to them. Researchers have shown that the presence of metabolites in the blood can predict the onset of any type of cancer two to five years in advance.
• Improving the sensitivity of mammography: Three-dimensional mammography could improve the early detection of breast cancer by enabling a more in-depth examination of tissue.
• Screening according to individual risk: Major studies are being conducted to better understand which mutations, or combinations of mutations, could increase the risk of developing breast cancer. Eventually, it could be possible to determine risk based not only on genetic profile, but also on other risk factors, enabling individual assessment and screening strategies based on risk rather than just age. Refer to the PERSPECTIVE study (in French only), funded by the Quebec Breast Cancer Foundation.

Are you experiencing anxiety while waiting for or following the results of medical examinations? You’re not alone. Call our free, confidential helpline from anywhere in Québec, Monday to Friday from 9 a.m. to 5 p.m. at 1 855 561-ROSE (7673) or write to us at info@rubanrose.org.

References

• Société canadienne du cancer  
• Ministère de la santé et des services sociaux du Québec 
• Institut national de santé publique du Québec  
• American College of Radiology 
• Ordre des technologues en imagerie médicale, en radio-oncologie et en électrophysiologie du Québec (OTIMROEPMQ)