Victoria General Hospital will extend hours for mammograms to 11 p.m. starting this month to reduce wait times, says B.C. Health Minister Adrian Dix.
The current wait to book a regular breast-screening exam through B.C. Cancer is about four months. Screening exams are typically done every two years.
Victoria General Hospital is now booking screening exams into February and West Coast Medical Imaging at 1990 Fort St., for instance, is booking into March.
Beginning Nov. 14, hours for routine breast screening will be extended to 11 p.m. from the current 8 p.m. on weekdays. Saturday hours of 8 a.m. to 4 p.m. will be unchanged, said Island Health.
A new evening breast-ultrasound shift will be added to support dense-breast screening from 3 to 11 p.m., said Dix.
Normal dense breast tissue appears white on a scan, as do tumours, which makes them harder to detect in dense tissue. If a person has other risk factors, an ultrasound might be recommended.
Diagnostic breast-screening exams, based on referrals from a primary care provider outside of the routine screening program, will now run 7 a.m. to 11 p.m. They previously concluded at 4 p.m. The current wait for non-urgent diagnostic imaging is 20 weeks.
“Improving diagnostic capacity has been a big part of what I’ve been focused on,” said Dix. “This is a way of using our equipment and getting people to the results they need sooner.”
An estimated 28,600 women will be diagnosed with breast cancer every year in Canada, and 5,500 women will die from it. It’s the most common form of cancer in those born female in Canada and the second leading cause of cancer deaths, according to the Canadian Medical Association Journal last year.
When it’s found early, many people survive breast cancer, with an almost 100 per cent five-year relative survival rate for those diagnosed at stage 1.
The survival rate drops to about 23 cent for those diagnosed at stage 4.
The push to get mammograms booked faster in B.C. comes on the heels of an announcement from the Ontario government this week that that province is lowering the eligibility age of self-referral for publicly funded mammograms to 40 from 50, beginning next fall.
Dix said B.C. already offers screening mammography for those as young as 40 without a health-care provider’s referral. “Effectively what they’re doing is doing what we’ve been doing in B.C. for some time,” he said.
The number of women age 40 to 49 getting self-referred screening mammograms is low, however, said radiologist Dr. Paula Gordon, a clinical professor in the department of radiology at the University of British Columbia.
“Our program in British Columbia was the first one in Canada, started in 1988, and from the get-go, women have been allowed to self refer starting at 40, and the shame is that only 25 per cent of eligible women do,” Gordon said in an interview.
The biggest problem, said Gordon, is that the Canadian Task Force on Preventive Health Care, in its latest 2018 guidelines, recommended against regular screening for average-risk women in their 40s.
The task-force panel is made up mostly of doctors who are not breast-cancer experts, Gordon said, yet care providers are deferring to the guidelines and even dissuading women in their 40s who request a routine-screening mammogram.
“Family doctors don’t realize that these aren’t experts and their guidelines are killing women,” she said.
She cites the case of a B.C. woman who listened to her doctor’s advice not to screen until age 50 and ended up being diagnosed with stage 4 metastatic breast cancer at the age of 47, after an emergency room visit.
Not screening women for breast cancer in their 40s would lead to an additional 400 avoidable deaths every year in Canada, said Gordon, who argues women in their 40s — when breast cancer is more aggressive — should be screened annually.
Currently in B.C., those age 40 to 74 can get screening mammography every year only if they have a first-degree relative with breast cancer. Otherwise, it’s every two years.
While women with a family history are at higher risk, 85 per cent of women who get breast cancer have no family history, Gordon said.
For women who are Asian, Hispanic and Black, breast cancers often occur young, with a peak incidence in the mid 40s, she said, adding radiation risk from mammograms is only relevant in women under age 20 and is negligible in women age 40 and older.
Gordon suggests the province should send screening-mammography invites to women on their 40th birthdays.
After the U.S. Preventive Services Task Force dropped its recommended age for breast screening to age 40 earlier this year, the federal government gave the task force $500,000 to speed up its update, expected this fall.
The national guidelines suggest that for women without risk factors, the benefits of routine screening and early detection are outweighed by the harm of false positives. Gordon rejects that argument, saying that while seven to 12 per cent are called back after screening for more pictures, women are well-equipped to cope with a bit of worry caused by these “false alarms.”
“The task force says: ‘Oh my God, we can’t let women get anxious,’ I mean, for heaven’s sakes, women can tolerate some transient anxiety and 95 per cent of the women who get called back have no cancer and they find out about it quickly and the cancers that we are finding, for the most part, they are early cancers,” said Gordon.
B.C. has been a leader in breast-cancer screening and has some of the lowest breast-cancer mortality rates in the country.
But there are things the province could do better, said Gordon, including scrapping the requirement for women to list a physician, nurse practitioner, or walk-in clinic on the self-referral form, given that about one million British Columbians don’t have a family doctor.
“British Columbia is the only province or territory that demands that a woman give the name of her health practitioner before she can have screening and that’s a huge impediment,” said Gordon.
Visit the B.C. Cancer Screening website or call 1-800-663-9203 to learn more about how to book a mammogram.
Note to readers: This story has been corrected. A previous version misstated the number of women who receive a breast cancer diagnosis each year in Canada.
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