Breast Cancer Screening Guidelines for Women in British Columbia, Canada
Women in British Columbia should follow a breast cancer screening protocol that includes mammography every 2 years for women aged 50-74, with individualized screening decisions for women aged 40-49 based on personal risk factors and preferences. 1
Screening Recommendations by Age Group
Women Aged 40-49
- Screening is not routinely recommended for average-risk women
- Decision to start screening should be based on individual risk assessment and personal preferences
- Women should discuss benefits and risks with their healthcare provider 2
- Women with family history of breast cancer should consider earlier screening (typically 10 years before the youngest age at diagnosis in the family, but not before age 30) 1
Women Aged 50-74
- Biennial (every 2 years) mammography is recommended
- This age group shows the clearest evidence of mortality benefit from screening 1
- The Screening Mammography Program of British Columbia (SMPBC) has demonstrated effectiveness in this age group 3
Women Aged 75+
- No specific upper age limit as long as woman has good health and life expectancy of at least 10 years
- Consider stopping screening if life expectancy is less than 10 years 4
- Benefits of screening decrease while harms may increase with advanced age
Screening Modalities
Mammography
- Primary screening tool in BC's program
- Digital breast tomosynthesis (DBT) is preferred over standard digital mammography when available due to decreased recall rates 1
Supplemental Screening
- Women with dense breasts should consider supplemental screening with MRI (preferred) or alternatives like ultrasound 1
- Women at high risk (BRCA mutation carriers or ≥20-25% lifetime risk) should receive annual mammography plus annual MRI 1
Risk Assessment Considerations
- All women should have risk assessment by age 25
- Black women and women of Ashkenazi Jewish heritage require special attention for risk assessment 1
- Risk factors that may warrant earlier or more intensive screening:
- Family history of breast cancer in first-degree relative
- Known genetic mutations (BRCA1/2)
- Previous breast biopsy showing atypical hyperplasia
- First childbirth after age 30 1
Effectiveness of BC's Screening Program
The Screening Mammography Program of British Columbia has demonstrated positive outcomes:
- 40% reduction in breast cancer mortality among screened women 5
- Similar mortality reduction benefit observed in women aged 40-49 (39% reduction) as in women over 50 5
- Screened women were more likely to have earlier-stage disease, smaller tumors, and less aggressive histology 6
- Women in the screening program were more likely to receive breast-conserving surgery rather than mastectomy 6
Clinical Breast Examination and Breast Self-Examination
- Clinical breast examination is not recommended as a standalone screening method 1
- Breast self-examination is not recommended due to risk of false positives and lack of evidence of benefit 1
- Women should be counseled about breast self-awareness (understanding the normal appearance and feel of their breasts) 1
Common Pitfalls to Avoid
- Failing to conduct risk assessment by age 25 for high-risk women
- Continuing screening in women with life expectancy less than 10 years
- Relying solely on mammography for high-risk women or those with dense breasts
- Having false sense of security from false-negative results
- Delaying diagnostic follow-up for suspicious findings 1
The BC screening guidelines align most closely with the Canadian Task Force recommendations, which differ somewhat from American guidelines that often recommend more aggressive screening approaches, particularly for women in their 40s.