||As of this Report
| Percentage of Ontario screen-eligible women, ages 50 to 74, with an abnormal OBSP screening mammogram result who were diagnosed (benign or cancer) within the recommended time interval:
- within 5 weeks of the abnormal screen date, if without a tissue (core or surgical) biopsy; or
- within 7 weeks of the abnormal screen date, if with a tissue (core or surgical) biopsy.
| See Methodology and Approach to find out how the ratings are calculated.
In 2014, approximately 39,000 Ontario women ages 50 to 74 who had an abnormal Ontario Breast Screening Program (OBSP) mammogram and did not require tissue biopsy for a definitive diagnosis were diagnosed within the recommended 5 weeks of the abnormal result1. Ninety-three percent (93%) of women who did not require a tissue biopsy were diagnosed within 5 weeks of their abnormal mammogram result in 2014, an increase of 7 percentage points from 2011 (86%).
Also in 2014, approximately 5,700 Ontario women ages 50 to 74 who had an abnormal OBSP mammogram and required tissue biopsy for a definitive diagnosis were diagnosed within the recommended 7 weeks of the abnormal result1. Seventy-seven percent (77%) of women who required a tissue biopsy were diagnosed within 7 weeks in 2014, an increase of 13 percentage points from 2011 (64%).
What is breast cancer screening (mammogram)?
- A screening test identifies people in a healthy, asymptomatic population who may be at risk for disease. It is not a diagnostic test. The purpose of breast screening is to find cancer at an early stage, when it is easier to treat. Ontario operates screening programs for 3 types of cancer: breast, cervical and colorectal.
- A mammogram uses low-dose X-rays to produce images of the breast2. A breast magnetic resonance imaging (MRI) scan uses magnetic waves and an intravenous contrast agent to create cross-sectional images of the breast3. Both tests can show changes in the breasts that may indicate early signs of breast cancer, even when the changes are too small for a woman or her doctor to feel or see.
In my words
I believe screening is very important: my cancer was discovered during a routine screening test and this this early detection allowed me to get the required treatment quickly and effectively.
- Breast cancer screening with mammography is recommended every 2 years for average-risk women ages 50 to 742.
- Breast cancer screening with mammography and breast MRI is recommended every year for women ages 30 to 69 who are identified as being at high risk for breast cancer4.
- Most women with an abnormal mammogram result will not have breast cancer5. More tests are required after an abnormal mammogram result to determine whether a cancer is present.
- Diagnostic assessment includes additional radiological or surgical procedures, such as diagnostic mammography, ultrasonography, and core and/or open surgical biopsy.
- In Ontario, breast cancer screening occurs through both the OBSP (an organized, province-wide screening program) and through non-OBSP centres. For a map of locations, visit the section on Breast cancer screening participation.
What do the results show?
Follow-up performance within the recommended intervals (i.e. the time between an abnormal screen and diagnosis) is improving1, but it remains better for women who do not need a tissue biopsy (Figures 1 and 3).
- In 2014, the majority of women who had an abnormal mammogram did not need a tissue biopsy.
- In 2014, 93% of women who did not need a tissue biopsy were diagnosed within 5 weeks of their abnormal mammogram result. Five-week (without tissue biopsy) follow-up has improved annually since 2011 (when it was 86%); it surpassed the national target of 90% in 2012.
- In the same year (2014), 77% of women who required a tissue biopsy were diagnosed within 7 weeks of their abnormal mammogram result. Seven-week (with tissue biopsy) follow-up has improved annually since 2011 (when it was 64%), but it still falls below the national target of 90%.
- The Local Health Integration Networks (LHINs) with the highest 5-week (without tissue biopsy) follow-up for 2014 were Waterloo Wellington and Central East (96%). The North West LHIN had the lowest 5-week follow-up in 2014 (82%).
- The LHIN with highest 7-week (with tissue biopsy) follow-up for 2014 was North Simcoe Muskoka (85%). The LHIN with the lowest 7-week follow-up in 2014 was the North West LHIN (49%).
- Most LHINs improved their follow-up from 2011 to 2014. In particular, 5-week (without tissue biopsy) follow-up improved substantially in the South West LHIN (27 percentage points) over this time period, and considerable improvements in 7-week (with tissue biopsy) follow-up were seen in South West (33 percentage points), Central West (24 percentage points) and Mississauga Halton (21 percentage points).
Follow-up varies by socio-demographic factorⱡ.
- In 2014, 5-week (without tissue biopsy) follow-up (Figure 2) did not vary by age group.
- Seven-week (with tissue biopsy) follow-up varied by age group in 2014 (Figure 4). Among women who required a tissue biopsy, the percentage diagnosed within 7 weeks was higher in the older age groups (78% of women ages 65 to 69 and 80% of women ages 70 to 74), compared to the youngest age group (75% for women ages 50 to 54).
- Five-week (without tissue biopsy) follow-up was higher for women in urban areas (93%) than for women in rural-remote (91%) and rural-very remote areas (90%). Seven-week (with tissue biopsy) follow-up was higher for women in urban areas (77%) than for women in rural-very remote areas (68%).
- Five-week (without tissue biopsy) and 7-week (with tissue biopsy) follow-up improved as urban neighbourhood income quintiles rose. In 2014, 92% of women in the lowest income urban areas were diagnosed within 5 weeks and 75% were diagnosed within 7 weeks of an abnormal mammogram result, compared to 94% within 5 weeks and 77% within 7 weeks in the highest income urban areas.
- In 2014, five-week (without tissue biopsy) follow-up was lowest among women living in neighbourhoods with the lowest concentration of self-reported immigrant residents (92%). Five-week (without tissue biopsy) follow-up was highest among women living in neighbourhoods with the highest concentration of self-reported immigrant residents (95%).
- When looking at 7-week (with tissue biopsy) follow-up, the trend was reversed. Seventy-eight percent (78%) of women living in neighbourhoods with the fewest self-reported immigrant residents were diagnosed within 7 weeks of their abnormal mammogram result, compared to 74% of women in neighbourhoods with the most self-reported immigrant residents.
ⱡ Percentages by socio-demographic factor are available in the data tables (select the desired file type and click “Download”) and presented in the figures by age group.
Why is this important to Ontarians?
Delay between an abnormal screening mammogram and diagnosis can be very stressful for women and may lead to poor outcomes.
- Psychological distress intensifies as the waiting time for diagnosis gets longer6.
- The OBSP offers multidisciplinary breast assessment (i.e. diagnostic) services through 70 breast assessment centres (Figure 5).
- Coordinated diagnostic procedures ensure that a diagnosis is made as quickly as possible. This helps alleviate anxiety for women and allows treatment to begin more quickly, potentially improving outcomes (e.g. reducing deaths and morbidity).
- Diagnostic intervals are affected by factors such as human and other resource shortages, including access to imaging and surgical services. Cancer Care Ontario continues to work with relevant partners to find solutions for improving follow-up times.
Organized screening offers important advantages for women and physicians.
- The OBSP provides high-quality screening for women at average risk of developing breast cancer through the use of mammography, and for women at high risk through mammography and MRI or ultrasound.
- Communication to women and healthcare providers includes the following:
- women eligible for screening through the OBSP average risk program are sent invitations to be screened through the program, along with information about breast cancer screening and how to find an OBSP site.
- normal result letters are sent to women after their screening visits.
- women screened in the OBSP are sent recall and reminder letters when they are due for their next round of screening.
- OBSP centres follow up on abnormal screening results and communicate both normal and abnormal results to a woman’s healthcare provider.
- Coordination and navigation includes the following:
- arranging genetic assessment (if appropriate) for women who have been referred to the OBSP High Risk Screening Program;
- booking mammography and breast MRI (or, if appropriate, screening ultrasound) appointments via OBSP centres;
- suggesting an appropriate screening recall interval based on a woman’s screening result and risk factors; and
- having OBSP assessment centres coordinate follow-up tests, track test results and provide navigation from abnormal screen to final diagnosis for women with abnormal screening results.
How does Ontario compare with other jurisdictions?
- Ensuring there are comparable data and measures from multiple jurisdictions is a challenge. It is recommended to use caution when comparing indicators from different jurisdictions due to the different data definitions, methodologies and years that are used in indicators measured outside of and across Canada. Cross-jurisdictional comparison is still useful, however, for providing a rough indication of how Ontario is doing compared to other jurisdictions.
- Ontario’s wait times for resolution of abnormal breast screens compare favourably with those of other Canadian provinces on both the 5-week (without tissue biopsy) and 7-week (with tissue biopsy) follow-up targets.
- Data from the 2015 Cancer System Performance Report* show that in 2012, Ontario had the second-lowest median wait time for resolution of an abnormal breast screen without tissue biopsy (1.9 weeks)7. The lowest median wait time for resolution without tissue biopsy was Alberta (0.7 weeks)7.
- For women requiring a tissue biopsy, Ontario had a median wait time of 5 weeks in 2012, the fourth-lowest in the 10 provinces and 1 territory included in this measurement. The province with the lowest median wait time was Alberta (2.9 weeks)7.
*Note: The 2015 Cancer System Performance Report includes women ages 50 to 69 only.
- Cancer Care Ontario has developed an online Primary Care Screening Activity Report (PC SAR) for all 3 screening programs (cervical, breast and colorectal cancer). This tool (accessed online) allows physicians in a Patient Enrolment Model (PEM) practice to see the complete screening status of each patient, including those who are due for screening and follow-up. Next steps including working with the regional primary care leads to identify barriers to adoption of the tool and to promote and encourage use of the PC SAR.
- Canadian Partnership Against Cancer. Report from the evaluation indicators working group: guidelines for monitoring breast cancer screening program performance. 3rd Edition. Toronto: Canadian Partnership Against Cancer; 2013.
- Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Mammograms; 2015 Jan 16 [cited 2015 Dec 17]. Available from: https://cancercare.on.ca/pcs/screening/breastscreening/mammograms.
- The Canadian Cancer Society [Internet]. Toronto: Canadian Cancer Society; c2016. Magnetic Resonance Imaging (MRI); [cited 2016 Jan 29]. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/magnetic-resonance-imaging-mri/?region=on.
- Chiarelli AM, Prummel MV, Muradali D, Majpruz V, Horgan M, Carroll JC, et al. Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screening from Ontario high risk breast screening. J Clin Oncol. 2014 Jul 20; 32(21):2224–30.
- Cancer Care Ontario. Ontario Breast Screening Program 2011 report. Toronto: Cancer Care Ontario; 2013.
- Risberg T, Sorbye SW, Norum J, Wist EA. Diagnostic delay causes more psychological distress in female than in male cancer patients. Anticancer Res. 1996 Mar–Apr; 16(2):995–99.
- Canadian Partnership Against Cancer. The 2015 cancer system performance report. Toronto: Canadian Partnership Against Cancer; 2015.