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Scientific evidence supports breast cancer screening for women in their 40s
TORONTO, Nov. 21, 2011
- Strong scientific evidence and public demand exists for screening
Canadian women aged 40-49 for breast cancer, the Canadian Breast Cancer
Foundation (CBCF) said today in response to new screening guidelines
released by the Canadian Task Force on Preventive Health Care.
"The fact is scientific evidence demonstrates that earlier detection and
diagnosis can save lives among women 40-49 by at least 25%," said
Sandra Palmaro, CEO, Canadian Breast Cancer Foundation - Ontario Region.
Palmaro added that screening can help find cancers that are smaller and
haven't spread, which can allow for better treatment options and
reduced disability and death from breast cancer. Breast cancer
continues to be the most frequently diagnosed cancer among Canadian
One of CBCF's most significant concerns about the Task
Force report is that it relied heavily on old data from "randomized
controlled trials" (RCT's) related to breast cancer screening and
mammography, some of which are 25 - 40 years old and were based on
equipment that is now outdated. There has been an enormous change in
breast imaging since that time, including significant improvements to
analog technology, and the continued adoption of digital mammography
across Canada. Digital mammography has been shown to increase accuracy
in younger women pre and perimenopausal women, and women with dense
breasts, the group the Task Force recommends be excluded.
"This undermines the scientific basis for the Task Force's conclusions,"
said Dr. Martin Yaffe of Sunnybrook Research Institute. "Screening
technology is significantly more sophisticated and accurate at detecting
breast cancer today than it was when those studies were done."
Dr. Yaffe chaired a Scientific Advisory Committee during the CBCF It's
About Time conference that included in its review more recent
observational studies from Europe and Canada. The conference's It's
About Time report issued in October, 2010, concluded that there are
benefits of screening women in their 40's that include savings lives
through earlier diagnosis.
"All RCTs have limitations due to
non-compliance (when women invited to be screened decline) and
contamination (when women in the control group have mammography outside
the trial) and therefore RCTs also underestimate the benefits of
screening," says Dr. Paula Gordon of BC Women's Hospital.
"It's critically important to consider these issues in the context of
today's technology and in terms of the real life experiences of Canadian
women. That evidence strongly supports screening women beginning at
age 40," said Gordon. "Our own data from BC show 25-39% mortality
reduction among screened women aged 40-49. And these data were derived
even before widespread implementation of digital mammography."
CBCF is encouraging the six provinces and territories where women 40-49
are not eligible to participate in their organized screening program -
Ontario, Manitoba, Newfoundland and Labrador, New Brunswick, Quebec
and Saskatchewan - to take a first step in allowing women 40-49 access
to organized screening programs where possible and if recommended by a
health care provider. This is the current practice in Alberta while in
BC, Nova Scotia, PEI, Northwest Territories and Yukon women do not
require a health care provider's recommendation to participate in
organized screening programs.
CBCF's position is also
consistent with the breast cancer screening guidelines from the
National Cancer Institute, the American Cancer Society, and the
American College of Obstetricians and Gynecologists, all of which
recommend that women begin screening at 40 years of age.
1-in-6 women who die from breast cancer are diagnosed in their 40s, we
simply cannot afford to see missed opportunities for earlier
detection" Palmaro said. "Scientific evidence, including data from
British Columbia, shows that screening women in their 40s through
organized programs can help to save lives."
While all screening
tests, including mammography, have both benefits and limitations,
Canadian women appear to be more concerned about being
thoroughly-tested than the possibility of a false alarm. A recent
Canadian survey conducted by Strategic Communications Inc, sought the
views of 1,670 women on the topic of breast cancer screening.
When surveyed, women were provided information about the potential for
"false positives" during screening and what the outcomes of those
results could be, 87.5 per cent of respondents still felt organized
screening for women 40-49 offered either "much more benefit" or "more
benefit" than limitation.
The survey found that if offered the choice between two theoretical screening tests:
A majority (63 per cent) of Canadian women would choose a screening
test that "never misses cancer but 1-in-10 tests are false alarms." Only 20 per cent would choose a test that "misses 1-in-3 cancers but gives no false alarms."
CBCF encourages women to make an informed decision about breast cancer
screening by learning about the benefits and limitations of screening
and to speak with a health care provider about what is right for them.
"While recognizing governments' need to make prudent budget decisions
and the need for women over age 50 to continue to have full access to
organized screening, CBCF believes we should work toward all Canadian
women aged 40-49 participating in provincial and territorial organized
breast cancer screening programs with a healthcare provider's
recommendation," Palmaro said.
CBCF recently announced the
Canadian Breast Cancer Foundation National Grant Competition on the
Earlier Detection of Breast Cancer, a $5 million initiative,
underscoring the Canadian Breast Cancer Foundation's commitment to
earlier detection as a nation-wide priority to reduce the impact of
About the Canadian Breast Cancer Foundation
2011 marks the Canadian Breast Cancer Foundation's 25th anniversary.
Founded in 1986, a small but determined group of women and men
established the first volunteer-led grassroots organization in Canada
devoted exclusively to breast cancer research, health promotion and
advocacy. Our mission is to create a future without breast cancer
through reducing the number of people diagnosed, reducing mortality from
breast cancer, and improving quality of life for those affected. In
addition to our education and advocacy initiatives, we are the largest
non-governmental funder of breast cancer research in Canada, directing
donor dollars to world-class researchers and clinicians who are making
groundbreaking progress in breast cancer prevention, earlier detection,
diagnosis, treatment and care. Visit www.cbcf.org to find out more
about how you can get involved.
For more information or to arrange interviews contact:
Canadian Breast Cancer Foundation