Update, December 12, 2018
This article is drawn from Dense Breasts Canada
Just released breast screening guidelines, will cause unnecessary deaths
Vaughan, AL, Canada Dense Breasts Canada DEC 13, 2018
Canada’s new breast screening guidelines will cause unnecessary deaths and harm and should be ignored by women and their family physicians, say two of this country’s leading breast screening experts.
The Canadian Task Force on Preventive Health Care (CTF) today released its latest guidelines for breast cancer screening for women at average risk. The CTF guidelines are used by 43,500 family doctors to guide their discussions about breast cancer screening with up to nine million Canadian women between the ages of 40-74. The 2018 guidelines advise against mammography for women aged 40-49, against women doing breast self-exams, and against doctors doing breast exams. They recommend women aged 50-74 have mammograms every two to three years.
“These recommendations are alarming and should be rejected by family physicians and their patients. Canadian women should be outraged,” says Dr. Paula Gordon, a clinical professor of Radiology at the University of British Columbia. “These recommendations, if followed, will cause unnecessary suffering and deaths.”
Dr. Martin Yaffe, Co-Director, Imaging Research Program, Ontario Institute for Cancer Research, says if the CTF guidelines are followed, Canada will see approximately 400 avoidable breast cancer deaths annually.
“The CTF will spend a lot of our tax dollars on communication tools to try to convince doctors and the public that less screening is a good idea. They’ll suggest that few cancers occur each year and few lives will be saved each year. These numbers will look very small,” says Dr. Yaffe. “But scale them up to the Canadian population and the story looks very different – screening at age 40 would mean about 400 lives per year saved. And for the women in their 40s, each death prevented represents about 20 extra years for a woman to live her life.”
Both Dr. Gordon and Dr. Yaffe say the new guidelines are based on studies that are out of date and use inaccurate numbers and obsolete technology. The CTF has overstated the risk of over diagnosis, exaggerated the “harms” of screening and ignored the importance of women knowing their breast density. The CTF has also ignored the findings that screen-detected breast cancers require less harsh therapies like mastectomy, armpit node surgery (resulting in swelling of the arms) and toxic chemotherapy.
“The most lives are saved when mammograms start at age 40,” says Dr. Gordon. “The task force is ignoring indisputable peer-reviewed evidence by internationally respected organizations that mammography saves lives. Women who have screening mammograms are 40-60 per cent less likely to die of breast cancer than women who do not. The CTF underestimates the percentage to be 15.”
Dr. Gordon says it’s wrong for the CTF to recommend against breast self exams and clinical breast exams when that’s precisely how many interval cancers (the ones found between mammograms) are found. She added that women with dense breasts especially should be encouraged to do breast self-examinations. Women and their physicians should be educated about the risks of dense breasts, and the ability of supplementary screening ultrasound/MRI (dependent on their individual risk) to find the small, invasive node-negative cancers missed on mammograms.
“The CTF is composed of methodological experts with no specific knowledge of breast cancer screening or treatment, ostensibly to avoid bias. It operates at arm’s length from government and its operations are unsupervised,” says Dr. Yaffe. “One would expect that the mission of the CTF would be to recommend how to prevent deaths and suffering from breast cancer. Instead it seems that its goal is simply to reduce access to screening. Their recommendations are misleading, dangerous and a waste of tax dollars.”
Jennie Dale, Co-founder of Dense Breasts Canada, said not only is the CTF undermining confidence in the tools that have helped reduce breast cancer and the need for harsh therapies, but they also missed the opportunity to save lives by not including recommendations for women with dense breasts.
“So much progress has been made against breast cancer in the past 30 years. We should be moving to reinforce and build on that progress,” says Ms. Dale. “Our Canadian screening programs and our doctors assume that the guidance from the CTF is accurate and reliable. Sadly, this is not true. The impact of these misguided recommendations will be devastating to many Canadian families.”