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When should I get a mammogram?

The aim of breast cancer screeningScreening:
The search for diseases such as breast cancer in people without symptoms. Mammography is an important tool for breast cancer screening and earlier detection.
is to reduce mortality ratesMortality (rate):
The number of people that die from a disease in a population over a period of time.
by detecting breast cancer earlier. When breast cancer is detected at an earlier stageStage:
A way of classifying breast cancer that describes how far a cancer has spread. It identifies whether breast cancer is at an early, locally advanced or metastatic stage. The stage of breast cancer can sometimes be represented as a number (e.g. between 0 and 4).
, most patients have more treatment options, less invasive treatment and a better chance of surviving the disease.

Breast cancer screening looks for earlier signs of breast cancer, usually by mammographyMammogram (also called mammography):
a low-dose X-ray of the breast. It is used to take images of the breasts and is an important screening tool for the earlier detection of breast cancer.
. Population-based breast cancer screening is the regular testing of women every one to two years to detect breast cancer earlier – before a woman notices signs and symptoms of the disease, including tumoursTumour:
An abnormal mass of tissue that occurs when cells divide more than they should or do not die when they should. Tumours may be benign (not cancer) or malignant (cancer). A tumour is also called a neoplasm.
that are too small to feel.

When you start screening and how you are screened will be informed by your age and risk factors.

Screening for women at average risk

The majority of Canadian women (approximately 80%) are at average risk of developing breast cancer.

Women in Canada are encouraged to be screened through their provincial or territorial organized breast screening program, which offers the highest quality screening. All organized breast screening programs screen women at average risk of breast cancer with no breast symptoms.  Half of Canada’s organized breast cancer screening programs invite women to screen from the age of 40, with some programs requiring a health care provider’s referral for the first appointment. The remaining programs invite women to screen from the age of 50. Most programs also recommend an upper age limit for screening. Speak to your health care provider or your organized breast screening program about the eligibility guidelines in your province or territory.

Earlier detection and diagnosis of breast cancer through participation in an organized screening program can reduce breast cancer deaths in women 40-49 by 25%. Despite difference in screening policies and practices across Canada, research shows that women aged 40-49 at average risk for breast cancer can benefit from having an annual screening mammogram, and the benefits increase with age.

Wherever it is available, Canadian Breast Cancer Foundation encourages women to be screened with digital mammographyDigital mammography:
A low-dose X-ray similar to screen-film mammography, equipped with a digital receptor and a computer instead of film.
. This newer technology has largely replaced screen-film mammography in Canada. This is because it is better at detecting breast cancer in women in their 40s, women 50+ who have not gone through menopauseMenopause:
A natural part of a woman's aging process, when the ovaries start to make less estrogen and progesterone and the menstrual periods stop. This change typically occurs between the late 40s and mid-to-late 50s.
, and women with dense breastsDense breasts (breast density):
Dense breasts have less fat and more glandular and connective tissue. A woman’s breast density depends on her age and genetic factors. Breast density is a risk factor for breast cancer. Having “dense breasts” is a clinical diagnosis that can only be assessed by mammography.
.

Screening for women at high risk

A small number of Canadian women, approximately 1-2%, are at high risk of developing breast cancer. 

Some provinces and territories include screening for women at high risk of breast cancer in their screening programs. Others have developed guidelines for health care providers to follow in referring their high risk patients for breast cancer screening.

Women who are at high risk of developing breast cancer are advised to consider breast cancer screening at an earlier age than women at average risk. The age at which high risk women are recommended to start screening varies by province and territory, but may begin as early as age 25.  Screening for women at high risk of developing breast cancer includes digital mammography and MRIMagnetic Resonance Imaging (MRI):
An imaging technique that uses powerful magnetic fields and radio waves to create detailed, 3-dimensional images of the organs and tissues in the body, such as the breast.
, if available.

For more information about breast cancer screening and high risk women see our section on being high risk.

Exploring the options for women at intermediate risk

Organized breast cancer screening programs are designed for women at average risk of breast cancer. Some women are at intermediate risk for developing breast cancer in their lifetime. Research suggests that women at intermediate risk of breast cancer will also benefit from having enhanced screening options for the earlier detection of breast cancer. Currently, few guidelines exist for how often and by what method women at intermediate risk should be screened for breast cancer. If you think you may be at intermediate risk, speak to a health care provider about your screening options.  You can learn more about breast cancer risk categories on our page on understanding risk.

Make an informed decision about what is right for you

For all women, Canadian Breast Cancer Foundation encourages you to learn about your breast health, breast cancer risk, ways to reduce your risk, and about the benefits and limitations of breast cancer screening. If you are in your 40’s, nearing them, or a woman 50+ and not currently being screened for breast cancer, we encourage you to consider speaking to a health care provider to help you make an informed decision about what is right for you and to learn about the breast cancer screening options available in your province or territory.

If you think you may be at intermediate or high risk of developing breast cancer, a health care provider can do an initial assessment of your risk based on your family and medical history, and consider referring you for genetic counselling for further assessment – or to a high risk screening program or clinic. 

Getting access to breast cancer screening

For the highest quality screening, Canadian Breast Cancer Foundation encourages all women who choose to be screened to join their provincial or territorial organized breast screening program, if eligible. If you do not live near an organized screening program clinic, you can still ensure you get the highest quality mammogram by going to a facility that has been accredited by the Canadian Association of Radiologists’ (CAR) Mammography Accreditation Program. A list of CAR–accredited mammography clinics across Canada is available on the CAR website. 

What can I do if I am not eligible and wish to have a mammogram?

If you are aged 40-49 you may wish to have a mammogram or be may be advised to do so by a health care provider. If you are not eligible to join your organized breast screening program you may be able to have a mammogram with a referral from a health care provider.

If you are ever worried about changes to the look or feel of your breasts, whatever your age, Canadian Breast Cancer Foundation encourages you to see a health care provider as soon as possible to discuss your concerns.

 

Sources:

Canadian Breast Cancer Foundation. (2010). Earlier Detection and Diagnosis of Breast Cancer: A Report from It’s About Time! A Consensus Conference. Toronto, ON: Canadian Breast Cancer Foundation. 

Canadian Breast Cancer Foundation. (2010).  Earlier Detection and Diagnosis of Breast Cancer. Recommendations and Scientific Review from It’s About Time! A Consensus Conference. Toronto, ON: Canadian Breast Cancer Foundation.

Pisano, E. et al. (2005) Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening.  New England Journal of Medicine, 353 (17), 1773-1783.

Warner, E. (2011). Breast Cancer Screening.  New England Journal of Medicine, 365 (11), 1025-1032.