mammogram Archives - Your Health Matters

Undetected breast cancers are a serious side effect of the COVID-19 pandemic

Sunnybrook — Sat, 06 Feb 2021 13:00:15 +0000

When the COVID-19 pandemic was declared in March 2020, cancer screening programs were paused in Ontario. No one knew what COVID-19 would bring and that looming health-care crisis was understandably prioritized.

But now, nearly a year later, there’s another crisis brewing beneath the surface: undetected breast cancers.

In a regular year, about 73,000 women participate in the Ontario Breast Screening Program (OBSP), which invites women aged 50-74 for a screening mammogram every two years. Each year, about 430 of those women go on to receive a diagnosis of breast cancer.

Last year, just 28,000 Ontario women underwent screening mammography. Those tests detected 148 cancers, most at their early stages. The missing mammograms mean about 200 more women in Ontario have undetected breast cancers.

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Screening mammography is a test done on people who are at risk of getting cancer, but have no symptoms of the disease. The goal of a screening test is to detect breast cancer in its earliest stage, when it’s more curable and requires less aggressive treatment. Research shows that early detection helps reduce breast cancer deaths.

The decline in screening tests means instead of catching a cancer when it is small and undetectable by a physical exam, a woman seeks medical care when she notices a lump or change in her breast. By then, it’s more likely the cancer will be advanced. And while we can’t turn back time to know if an advanced cancer might have been seen on a screening test, we do know that a screening test is one step we can take to try to catch breast cancer early.

At Sunnybrook, our OBSP screening site reopened last summer when we were permitted to do so, and since, the team has been holding some “Saturday Blitzes” to get through the backlog of breast screening tests. Our backlog is cleared, and if you are due for a mammogram, we want to see you.

If you missed a mammogram in 2020 or are due for one in 2021, please call your health-care provider or screening site and book it today.

We have heard from women that they were frightened to come to the hospital. We have also heard that some didn’t think their screening would take place because it isn’t important. It is important and we want to reassure you, it is safe. We have COVID-19 safety rules in place to protect you and our staff.

And, if something highly suspicious is spotted on your test, your health-care professional can refer you to the Marion Solway Breast Rapid Diagnostic Unit, where investigation with a diagnostic mammogram, ultrasound and biopsy are performed and a rapid diagnosis provided within 24-48 hours of those tests.

It’s particularly important for high-risk women to undergo routine screening. If you have a family history of breast and/or ovarian cancer, you can be referred to the High-Risk Breast Clinic at Sunnybrook’s Louise Temerty Breast Cancer Centre where our team of physicians, radiologists who specialize in breast imaging and genetic counsellors can assess if you are at high-risk of developing breast cancer and if so, provide you with recommendations for screening and risk-reducing strategies.

As always, if you notice a lump or change in your breast, please contact your health-care provider right away.

As 2021 gets underway with COVID-19 still a part of it, we all must balance the risks of COVID-19 against the harms related to interruptions in cancer screening, including the development of more cases of advanced cancer requiring more aggressive treatments, utilization of health care resources and cancer-related deaths. Please ask your health-care provider about cervical, lung and colorectal cancer screening as well. If you do not have a family doctor or nurse practitioner, contact Health Care Connect by calling 1-800-445-1822 or visit ontario.ca/healthcareconnect to be connected to a primary care provider.

What are you doing next Saturday? We hope you’ll consider booking your mammogram screening test. It could save your life.

If you have breast tissue, it is recommended that you be screened according to provincial guidelines, regardless of your gender identity or sexual identity. Ontario Health (Cancer Care Ontario) is working to implement a policy for the inclusion of trans and gender diverse people in its organized screening programs. More info can be found here.

Blog authors:

[mks_col][mks_one_half]Dr. Eileen Rakovitch
Medical Director
Louise Temerty Breast Centre
Sunnybrook Health Sciences Centre[/mks_one_half][mks_one_half]Dr. Andrea Eisen
Medical Oncologist and Lead, High-Risk Program
Louise Temerty Breast Centre
Sunnybrook Health Sciences Centre
Co-chair, CCO Breast Site Group
[/mks_one_half][/mks_col]

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Behind the research: 2D or 3D mammography for breast cancer screening?

Alexis Dobranowski — Wed, 23 May 2018 12:00:45 +0000

When new technology is invented, it’s often instantly thought to be “better” at everything.

But when it comes to breast cancer screening, is 3D mammography actually better than traditional 2D mammography at spotting cancers that are aggressive?

That’s what Dr. Martin Yaffe, a senior scientist at Sunnybrook and co-lead on the TMIST trial, is hoping to find out. That, and more.

The randomized trial, which is open now at Sunnybrook and Ottawa Hospital as well as in hospitals across the US, will compare the two types of digital mammography to help researchers learn how to most effectively screen women for breast cancer and help women in the future make informed decisions about screening tests.

3D mammography (called tomosynthesis) is currently used as a diagnostics tool if a woman has a suspicious mass. But, in Canada, it isn’t currently used in breast screening programs because its value for screening has not yet been fully tested.

Since 2014, Dr. Yaffe and his team at Sunnybrook have been conducting a lead-in study to TMIST with over 3,000 women at four sites in Canada.

The TMIST trial (coordinated in Canada by the Canadian Cancer Trials Group and available at more screening locations across the nation over the next few months) is now enrolling 165,000 healthy women ages 45 to 74 who are already planning to get routine mammograms. They will be randomized to receive 2D or 3D mammograms for 5 years.

Dr. Yaffe says the study will answer questions like:

Does the 3D technology actually reduce false alarms from screening?
Can it find more cancers?
Does the 3D technology reduce a woman’s chance of getting advanced and aggressive cancer compared with 2D technology?

Clinical trials like this are important, Dr. Yaffe says, because they can help researchers, clinicians and ultimately patients make better-informed decisions about screening.

“We know breast cancer screening is important,” he says. “How best can we screen in order to catch aggressive cancers so that we can treat them early?”

More Resources:

Learn more about the lead-in study, which was led by Sunnybrook

Canadian Cancer Trials Group

ECOG-ACRIN Cancer Research Group

ClinicalTrials.gov

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A patient asks: Does my ancestry put me at higher risk of breast cancer?

Lisa Priest — Mon, 27 May 2013 12:00:00 +0000

The Question: I had my mammogram done last year. I also registered for a breast-screening program at a hospital. My aunt, who is my mama’s sister, died from breast cancer. Considering that I am of Ashkenazi Jewish ancestry, I think I am at some risk. I was told at the reception area of the mammogram department that I will be having my mammogram every two years. I think it should be every year. What do you think?

The Answer: No professional organization in Canada or the United States recommends testing for the BRCA1 or BRCA2 genetic mutations based solely on ancestry. However, Jewish women are believed to be more likely to test positive for one of those two genetic mutations, compared to women tested at random. Consequently, testing is often recommended for Jewish women with family histories of cancer.

This is true only for Jewish women who identify themselves as being Ashkenazi – a group with mainly Central and Eastern European ancestry. BRCA mutation is not considered more common in those with Sephardic Jewish ancestry (those of Middle Eastern and North African descent), according to Ellen Warner, a medical oncologist at Sunnybrook Health Sciences Centre.The issue of genetic testing – and of taking proactive measures when the results are known – came to the forefront recently when actress and director Angelina Jolie wrote an op-ed piece called “My Medical Choice” in The New York Times. http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?_r=0

After learning she carried the BRCA1 mutation, she opted to get a prophylactic double mastectomy. (Her mother died at age 56, after being diagnosed with cancer almost a decade earlier.)

“I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made,” Ms. Jolie wrote in the New York Times. “My chances of developing breast cancer have dropped from 87 per cent to under 5 per cent. I can tell my children that they don’t need to fear they will lose me to breast cancer.”

In your case, since you have not had a formal risk assessment, there is no medical rationale to warrant ordering more medical surveillance. The best way to start is to have a formal risk assessment in a familial cancer/high-risk clinic. You may have other personal risk factors that are important.

It would also be helpful to determine whether you have other relatives (on either side of your family) who had cancer. If anyone else on your mother’s side of the family had breast or ovarian cancer then genetic testing would start with that person. Otherwise, your mother and any other siblings and children of your aunt should be tested.

If your mother has a BRCA gene and you don’t, that is considered a “true negative” and your risk from your aunt’s cancer disappears, according to Dr. Warner. Alternatively, if your mother (and any other of her relatives who are tested) tests negative, your father has no family history of breast cancer and you have no other significant risk factors, then your risk in only slightly increased by your aunt’s cancer and breast screening every 2 years is perfectly appropriate, Dr. Warner said.

If you carry the genetic mutation, each of your children has a 50 per cent chance of carrying it. Having tested positive for such a mutation may also have other unintended consequences, such as the ability and cost to take out life insurance.

“If she has the mutation, we know how to deal with that,” said Dr. Warner, noting that women who carry either of the breast cancer genetic mutations, will undergo a special type of screening that includes mammography but also magnetic resonance imaging, which is far more sensitive at finding tumors.

You could also be offered a drug such as tamoxifen to lower your risk of breast cancer. You may opt instead for prophylactic mastectomy. It would also be recommended that you remove your ovaries and fallopian tubes because of the high risk of tubal or ovarian cancer with these mutations.

If you have a BRCA1 or BRCA1 genetic mutation, you will be at a high lifetime cancer risk. Specifically, you will have about a 70 per cent risk of having breast cancer and up to a 40 per cent chance of ovarian cancer in your lifetime unless you do something to reduce your risk, like Ms. Jolie did to reduce her risk of breast cancer.

“Knowledge is power,” said Dr. Warner, noting that women, now more than ever, have the ability to control their health.

If you are concerned, I would encourage you to have a discussion with your family physician about obtaining a referral for a full assessment. If you would like to visit the Louise Temerty Breast Cancer Centre at Sunnybrook, ask your physician’s office to call 416-480-4205 or fax 416-480-6179.

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