• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Breast Cancer Screening Participation

 
Measure Desired Direction As of this Report
Participation: Age-adjusted percentage of Ontario screen-eligible women, aged 50 to 74, who completed at least 1 mammogram within a 30-month period  Black Arrow Up  Yellow Arrow Level
Retention: Percentage of Ontario screen-eligible women, aged 50 to 72, who had a subsequent OBSP screening mammogram within 30 months of a previous program mammogram  Black Arrow Up  Yellow Arrow Level
See Methodology and Approach to find out how the ratings are calculated.

Key findings

In 2013–2014, approximately 1.3 million Ontario women aged 50 to 74 were screened for breast cancer with a mammogram among the approximately 2 million women who were eligible for screening. Participation in breast screening has remained steady at 65% since 2011–2012 and has declined slightly from 66% in 2009–2010.

The percentage of women screened through the Ontario Breast Screening Program (OBSP) continues to increase, with 51% of women screened in the OBSP in 2013–2014 (compared to 42% in 2007–2008). Screening in the OBSP offers important advantages for women and physicians.

The number of women who meet eligibility criteria for OBSP screening also continues to increase, up by nearly 391,000 women since 2007–2008.

Among Ontario women who had a mammogram through the OBSP in 2012, 83% returned within 30 months for another mammogram. The same percentage of women screened in 2011 returned for a subsequent mammogram within 30 months (i.e. retention has levelled off).

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 breast1. A breast magnetic resonance imaging (MRI) scan uses magnetic waves and an intravenous contrast agent to create cross-sectional images of the breast2. Both tests may 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.
  • Breast cancer screening with mammography is recommended every 2 years for average-risk women aged 50 to 741.
  • Breast cancer screening with mammography and breast MRI is recommended every year for women aged 30 to 69 who are identified as being at high risk for breast cancer3.
  • Most women with an abnormal mammogram result will not have breast cancer4. 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 both through the OBSP (an organized, province-wide screening program) and through non-OBSP centres.
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What do the results show?

More Ontario women are being screened through the OBSP, and breast screening participation has levelled off (Figure 1).

  • Provincial breast cancer screening participation has remained steady at 65% since 2011–2012.
  • Approximately 1.3 million Ontario women aged 50 to 74 were screened for breast cancer in 2013–2014. Of these women, over 1 million were screened through the OBSP.
  • The percentage of women being screened in the OBSP increased to 51%, up from 48% in 2011–2012. The percentage of women being screened in the OBSP has increased annually since 2007–2008.

Regional variation in OBSP participation exists across Local Health Integration Networks (LHINs) (Figure 2).

  • In 2013–2014, the LHIN with the highest percentage of women screened through the OBSP was North East (57%). The LHIN with the lowest OBSP participation was Toronto Central (41%).

Breast cancer screening participation varies across the province (Figure 3).

  • In 2013–2014, the LHIN with the greatest participation was North Simcoe Muskoka (69%). The Toronto Central LHIN had the lowest participation (60%).
  • The Central West LHIN showed the greatest improvement in participation from 2007–2008 to 2013–2014 (up 3 percentage points). Participation decreased by 4 percentage points in the North East LHIN during the same time period.

Breast cancer screening participation varies by socio-demographic factorⱡ.

  • Breast cancer screening participation varies by age group (Figure 4). In 2013–2014, participation was highest for women aged 65 to 69 (69%) and lowest for women aged 70 to 74 (58%). A similar pattern can be seen in previous years.
  • Participation increased steadily as urban neighbourhood income quintiles rose. In 2013–2014, 57% of screen-eligible women living in the lowest income urban areas participated in breast screening, compared to 69% of women living in the highest income urban areas (a difference of 12 percentage points).  
  • In 2013–2014, participation was slightly higher in rural areas (66%) than urban areas (65%), but lower in rural-very remote areas (63%).
  • Sixty-six percent (66%) of screen-eligible women living in neighourhoods with the lowest concentration of self-reported immigrant residents participated in breast screening in 2013–2014, compared to 61% of women in neighbourhoods with the highest concentration of 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.

Retention in the Ontario Breast Screening Program has levelled off (Figure 5).

  • The OBSP sends recall letters to women about 24 months after their previous program mammogram, which is consistent with Cancer Care Ontario screening guidelines1. The retention indicator allows for a 6-month grace period to account for potential wait times for screening mammogram appointments at OBSP screening centres.
  • Approximately 413,000 women who had an OBSP mammogram in 2012 returned for a subsequent program mammogram within 30 months (83%, the same as for women screened in 2011).
  • Initial and subsequent re-screens are being reported as a single measure of retention in order to be consistent with Ontario’s cervical and colorectal cancer screening programs.
  • National breast screening guidelines have 2 separate targets for initial and subsequent program re-screens: ≥75% initial re-screens within 30 months and ≥90% subsequent re-screens within 30 months5.
  • The LHIN with the highest retention for women screened in 2012 was Erie St. Clair (88%). Central West had the lowest retention at 78%.

Retention in the OBSP varies by socio-demographic factorⱡ.

  • Breast cancer screening retention varied by age group (Figure 6). For women screened in 2012, retention was highest among women aged 65 to 69 (86%); it was lowest for women aged 50 to 54 (79%). A similar pattern can be seen in previous years.
  • Retention was highest for women living in rural-remote areas (84%) and slightly lower for women in urban and rural-very remote areas (83%).
  • Retention increased steadily as urban neighbourhood income quintiles rose. Among women screened in 2012, 75% of women living in the lowest income urban areas returned for a subsequent program mammogram within 30 months, compared to 85% of women in the highest income urban areas (a difference of 7 percentage points).
  • Retention was highest among women living in neighbourhoods with the lowest concentration of self-reported immigrant residents (84%).  Eighty percent (80%) of women in neighbourhoods with the highest concentration of self-reported immigrant residents returned for a subsequent program mammogram within 30 months.

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?

Breast cancer burden weighs in Ontario.

  • Among Ontario women, breast cancer is the most common cancer diagnosed and it is ranked as the second-most common cause of cancer deaths6.
  • An estimated 9,800 Ontario women were diagnosed with breast cancer in 2015 and approximately 1,900 women died of the disease that year6.
  • Women over 50 are at greatest risk of getting breast cancer, with 82% of breast cancers in Canada diagnosed in women over 50 in 20156.

Regular screening plays an important role in improved outcomes.

  • A recent summary of evidence reported that using mammography to screen for breast cancer resulted in a 21% reduction in breast cancer mortality in average-risk women aged 50 to 697.
  • Finding breast cancer early increases the treatment options available, and it can lead to better treatment outcomes and survival8.
  • In studies that demonstrated the benefit of regular breast cancer screening, participants returned within recommended intervals9–11. The value of screening in reducing mortality relies on women returning for screening tests regularly for as long as they are eligible.

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 centre.
    • 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 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 well Ontario is doing compared with other jurisdictions.
  • When comparing Ontario to other provinces*, participation in the OBSP (51% in 2013–2014) is lower than that of Alberta (57% in 2011–2012)12, British Columbia (53% in 2010–2012)13 and Nova Scotia (59% in 2011)14.
  • For more information on comparisons on breast cancer screening participation between jurisdictions, see the Comparison of Screening section of CSQI.

*Note: all provincial comparisons were based on women aged 50 to 69, and some provinces only monitor participation in screening programs and cannot directly be compared.

Next steps

  • To improve the program’s retention, Cancer Care Ontario implemented centralized recall letters in 2015 to remind women when they are due for their next screening appointment.
  • The OBSP will be expanding as new non-OBSP screening centres are transitioned into the program. Screening within the OBSP offers important benefits to women and physicians, including communicating the results of normal and abnormal test results to a woman’s healthcare provider, coordinating follow-up tests when appropriate and helping women with abnormal screening results navigate from abnormal screen to final diagnosis.
  • 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 include 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.
  • Annual public awareness campaigns will be conducted in each region.
  • Based on recommendations following the first year of the OBSP High Risk Screening Program, the OBSP Requisition for High Risk Screening was launched in the summer of 2015 to improve the appropriateness of referrals to the program.
  • A refreshed handout for providers and a guideline summary for the OBSP Average Risk and High Risk Screening Programs were launched to increase awareness among primary care providers and increase referrals into the OBSP.

View Notes

  1. 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.
  2. 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.
  3. 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.
  4. Cancer Care Ontario. Ontario Breast Screening Program 2011 report. Toronto: Cancer Care Ontario; 2013.
  5. Canadian Partnership Against Cancer. Organized breast cancer screening programs in Canada: report on program performance in 2007 and 2008. Toronto: Canadian Partnership Against Cancer; 2013.
  6. Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Canadian cancer statistics 2015; c2015 [cited 2015 Nov 26]. Available from: http://www.cancer.ca/en/cancer-information/cancer-101/canadian-cancer-statistics-publication/?region=on.
  7. Canadian Task Force on Preventive Health Care, Tonelli M, Gorber CS, Joffres M, Dickinson J, Singh H, et al. Recommendations on screening for breast cancer in average-risk women aged 40–74 years. CMAJ. 2011 Nov 22; 183(17):1991–2001.
  8. Nelson HD, Fu R, Cantor A, Pappas M, Daeges M, Humphrey L. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 U.S. Preventive Services Task Force Recommendations. Ann Intern Med. 2016 Feb 16; 164(4):1–20.
  9. Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskjold B, Rutqvist LE. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. The Lancet. 2002 Mar 16; 359(9310):909–19.
  10. Otto SJ, Fracheboud J, Looman CW, Broeders MJ, Boer R, Hendriks JH, et al. Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review. The Lancet. 2003 Apr 26; 361(9367):1411–7.
  11. United States Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Ann Intern Med. 2002 Sep 3; 137(5 Part 1):344–6.
  12. Alberta Health Services. Q2 performance report, 2012/13. Edmonton: AHS Planning and Performance, Data Integration, Measurement and Reporting (DIMR) and Communications; 2013.
  13. British Columbia Cancer Agency. Screening mammography program 2012 annual report. Victoria: BC Cancer Agency; 2013.
  14. Nova Scotia Breast Screening Program. Nova Scotia breast screening program annual report 2012 (2011 data). Halifax: Nova Scotia Breast Screening Program; 2013.