Breast cancer screening

Early detection of breast cancer is associated with more effective and less aggressive treatment, and a better chance of recovery than for more advanced cases. Breast cancer screening involves detecting the disease even before signs and symptoms appear. Most of the time, screening mammograms make it possible to discover the cancer early, at the very earliest stages of the disease’s progression, sometimes even at the pre-cancerous stage. 

Mammography is the only screening test recognized as effective for breast cancer in Quebec, as it’s the only test that helps to reduce the number of deaths attributable to breast cancer. For more information on mammography, read 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.

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

In the past, regular clinical breast examination by a physician was recommended; however, since clinical breast examination has not been proven to reduce breast cancer mortality, it is no longer recommended as a screening method by the PQDCS, but can be used as a supplement to mammography.

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

The PQDCS is a free, organized screening program, available in all regions of 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 creation of the PQDCS are in line with this objective, which supports the continuation of the program’s activities. For every 1,000 women who undergo mammography screening every two years for 20 years, seven deaths are prevented.

The PQDCS encourages all Quebec women aged 50 to 74 to have a breast cancer screening mammogram every two years. Women in that age group who are insured under the Quebec public health insurance plan receive an invitation letter in the mail when they turn 50 and every two years after that. This letter is a prescription in itself, and provides all the information needed to make an appointment at a designated screening centre. 

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

Visit the Procedure page of the PQDCS website to learn more about the process to follow, from receiving the invitation letter to getting results of the screening mammogram.

People with breast implants can undergo 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 to their doctor to receive personalized medical care adapted to their situation.

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

If you haven’t already done so, speak to your doctor about your risk factors. After assessing your level of risk, he or she may make personalized prevention and screening recommendations.

To learn more about breast cancer risk assessment, we invite you to watch our educational video (in French) titled Identifier les personnes à haut risque (identifying high-risk individuals).

If you are over 74 years old, 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. That’s why it’s best to exercise caution by continuing to observe your breasts and reporting any persistent changes to a doctor without waiting for your next medical appointment or mammogram.

Researchers are looking to improve breast cancer screening by investigating new, reliable, non-invasive methods as well as ways to improve the sensitivity of existing ones, and studying individual risk factors for more personalized screening recommendations. Further studies are needed before these methods can be approved for breast cancer screening. These studies include:

• Detecting circulating cancer cells: Studies are looking at the possibility of detecting various cancers using blood samples. This technique would allow for simple and quick screening. In cancer patients, cancer cells can be found in the blood. Several research groups are working on techniques to detect them effectively. In addition to discovering cancer at an early stage, this method would be useful for monitoring cancer progression and adapting treatments. 
• Measuring metabolites derived from cancer cells: Cancer cells secrete metabolites, organic molecules that are unique to them. Researchers have shown that metabolites in the blood can predict the onset of all kinds of cancers 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 the tissue.
• Screening according to individual risk: Major studies are being conducted to better characterize which mutations, or combinations of mutations, could increase the risk of developing breast cancer. Ultimately, it could be possible to determine the level of risk based not only on the genetic profile, but also on other risk factors, which would allow for individual assessment and personalized screening strategies based on this level of risk and no longer just on age. See the PERSPECTIVE study (in French), funded by the Quebec Breast Cancer Foundation.

Are you experiencing anxiety while waiting for or after obtaining the results of a medical examination? You’re not alone. Call us confidentially and free of charge from anywhere in Quebec 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)