Ontario Breast Screening Program Expansion
The province is expanding the Ontario Breast Screening Program (OBSP) to include specialized screening for women at high risk for breast cancer aged 30 to 69. This expansion is part of a 2011 budget commitment to provide an additional $15 million over three years for 90,000 more screens.
The OBSP, first established in 1990, is a breast cancer screening program targeted to women at average risk of developing breast cancer aged 50 years and older. In addition to screening services, the program includes automated reminders, coordinated follow-up for women who have abnormal screening results, ongoing quality assurance, and performance monitoring and evaluation of patient and program outcomes.
The program expansion to women at high risk for breast cancer (ages 30 to 69) is based on clinical evidence and reviews, and on recommendations from Cancer Care Ontario. In 2010, the Ontario Health Technology Advisory Committee issued guidelines for screening women at high risk for breast cancer with breast MRI and mammography and recommended that they be part of an organized screening program that provides coordination and follow-up.
Expansion of Services
The newly expanded program will begin rolling out in July 2011 at selected sites across the province. These sites will act as High Risk Screening Centres that will provide referrals for genetic assessment and testing, and will also offer breast MRI, mammography and diagnostic services.
Beginning July 1st, services to women at high risk will be offered in a limited number of sites to ensure and maintain high-quality standards for screening services and care. As the program matures, other centres will be added to ensure that timely, accessible and high-quality services are available to women at high risk of breast cancer.
Eligibility Criteria for High Risk Women
Women aged 30 to 69 are considered high risk if they have any of the following risk factors:
- genetic testing confirming that they have a mutation (e.g., BRCA1, BRCA 2 or TP53) that increases their risk for breast cancer;
- a parent, sibling or child with genetic testing confirming a mutation that increases their risk for breast cancer;
- a family history that indicates hereditary breast cancer syndrome and a 25 per cent or greater lifetime risk of breast cancer confirmed through genetic assessment and counselling;
- radiation therapy to the chest before 30 years of age and more than eight years ago as treatment for another cancer or condition.
Women should see a doctor or nurse practitioner to discuss whether testing is required to determine their risk for breast cancer.How Women Can Access The Newly Expanded Services
A woman will go first to her doctor or nurse practitioner to discuss her risk profile for breast cancer and determine the appropriate screening. If a woman has already been identified as being at high risk for breast cancer, she will be referred to the OBSP to be booked for breast MRI and mammography.
If a woman is identified by her doctor or nurse practitioner as having a family history that may indicate a higher risk for breast cancer, she will be referred to the OBSP to be booked for genetic assessment and testing. If the genetic assessment or testing shows that she carries a genetic mutation or has a 25 per cent or greater lifetime risk of breast cancer, she will be booked for breast MRI and mammography.
Impact and Benefits
Approximately 34,000 women in Ontario are at high risk of developing breast cancer. Screening these women with annual breast MRI and mammography will detect approximately 17 cancers per year in every 1,000 women screened. Through screening, more cancers would be detected at earlier stages resulting in increased chance of survival, less invasive treatments and ultimately, improved health outcomes for women.
Regular screening and early detection for high risk women is important because:
- Women at high risk (less than one per cent of females) have a 25 per cent or greater lifetime risk of developing breast cancer;
- The risk of developing breast cancer is two to five times higher for women at high risk for breast cancer than in the general population;
- Women who are BRCA1 or BRCA2 gene mutation carriers have a lifetime risk of up to 85 per cent of developing breast cancer with substantial risk beginning at age 30;
- Women at high risk develop breast cancer at a younger age than the general population; and
- Breast cancer is more aggressive in younger women who are at high risk.