What is BreastCheck?

BreastCheck is a population-based screening program operated by CancerCare Manitoba. The goal is to reduce breast cancer deaths by finding breast cancer at an early stage. Research shows that screening can reduce mortality from breast cancer by up to 25% in women 50 to 69 years of age. The Program provides mammograms every 2 years for all eligible Manitoba women.

Who is eligible? Women 50 years of age and older with no signs or symptoms of breast cancer such as lumps or nipple discharge, no breast implants, no previous diagnosis of breast cancer, and no mammogram in the last 12 months.

What happens at the Program? Women complete a short questionnaire about breast health, risk factors and sign a consent form authorizing sharing of results between health providers. They receive a mammogram, the opportunity to watch a DVD on reducing cancer risk and information on breast awareness including sign and symptoms. The visit takes about 30 minutes. We encourage women to get a regular clinical breast exam from their health care provider.

Where do women go to be screened? BreastCheck has 4 locations as well as a mobile service:

• Winnipeg: 5-25 Sherbrook St. - 788-8000
• Brandon: 620 Frederick St. - 578-2040
• Thompson: Thompson General Hospital 1-800-903-9290
• Winkler/Morden: Boundary Trails Health Centre, Junction of Hwy. 3 & 14, 1-800-903-9290
• Mobile - 90 locations. Call 1-800-903-9290 or look them up at www.cancercare.mb.ca/mbsp WRHA Breast Health Centre: Phone: 235-3906 Toll Free 1-888-501-5219 An assessment centre for women and men of all ages who have signs and symptoms of breast cancer.

 

Patient age	BreastCheck Mammography recommendations and letters
Women age 50 to 74	BreastCheck Screening mammograms are generally recommended every 2 years. The Program: sends letters of invitation to women when they turn 50 years of age. sends result letters to women and their primary care providers within 2 weeks. sends recall letters to program participants every 2 years up to age 74. Women can also self refer. Some women are recalled yearly based on: significant family related risk that considers number of diagnoses, age of diagnosis, male breast cancer. pathological diagnosis of Lobular Carcinoma In-situ (LCIS) or Atypical Ductal Hyperplasia (ADH). radiologist recommendation.
Women over age 74	Women over age 74 should discuss risks and benefits with their primary care provider. Women will not be recalled by letter but can self refer. Women and their primary care provider will receive a result letter. Stopping screening should be considered when there are: Co-morbidities and an expected lifespan of less than 5-10 years. Physical limitation for mammography that prevents proper positioning.

What are the limitations of screening?

Possible limitations of screening include anxiety about further testing, pain, radiation exposure, over diagnosis and missed cancers.

Women can find mammograms painful. BreastCheck asks women to rate the discomfort of a mammogram on a scale of 0 to 10 with 10 being the worst and 0 being no pain. About two thirds of women rate the discomfort a 5 or less.

Mammography involves exposure to radiation. The amount of radiation received from a screening mammogram is almost the same as that received over 3 months from usual surroundings. Studies show that the hypothetical risk of a new cancer starting due to radiation to the breast from breast screening mammography is extremely low. The benefits of early diagnosis and treatment of breast cancer outweigh the small radiation risk for women over the age of 50.

Screening can result in over diagnoses and over treatment of cancers which may not otherwise have become apparent during a woman's life time. Additionally, not all breast cancers found through screening can be cured.

Up to 20% of breast cancers in women age 50 to 69 years of age may be missed by mammography This is why regular screening and awareness of breast cancer signs and symptoms are important. A recent negative mammogram should not be used to reassure a woman if symptoms subsequently appear.

The role of primary care providers:

Primary care providers have an important role to play in the early detection of breast cancer. They can provide information to women about the benefits and limitations of screening mammography so an informed choice can be made. Your recommendation can make a difference in encouraging women to attend. Provide a regular clinical breast examination and encourage breast awareness.

What are the Mammography recommendations for individuals not seen at the BreastCheck?

Women age 40 or under	Screening mammograms not routinely recommended.
Women 40 to 49 years of age	Screening mammograms not routinely recommended but risks and benefits of screening should be discussed and referral made to a diagnostic centre* if appropriate. Women with significant family history can be referred to a diagnostic centre* and are also accepted at a BreastCheck rural and northern mobile site with referral. BreastCheck does not send letters and does not accept women under age 50 at fixed screening sites or Winnipeg mobile sites.
Symptomatic - any age	Refer to a diagnostic centre* for mammogram, ultrasound and/or surgical consultation. If a mammogram is negative in the presence of a palpable abnormality send for further assessment.
Women with implants	Age 49 and younger: discuss risk and benefits of screening younger women, their need for mammograms and refer to a diagnostic centre* if appropriate. Age 50 and over: refer to a diagnostic centre* for a mammogram.
Confirmed BRCA gene mutation	Consult with the WRHA Breast Health Centre or breast specialist as monitoring will vary depending on age, gender and personal history of breast cancer
Women who have had a breast cancer diagnosis	Refer to a diagnostic centre* for mammogram or other follow up as recommended.

   * There are 7 diagnostic centres in Manitoba that provide diagnostic mammograms. Physician referral is required.

Additional resources

The WRHA Breast Health Centre: Phone: 235-3906 Toll Free 1-888-501-5219 An assessment centre for women and men of all ages who have signs and symptoms of breast cancer.

CancerCare Manitoba - Health Care Professionals: Phone: 787-2197 Information on cancer treatment and primary care provider resources.

The CCMB Breast Cancer Centre of Hope: Phone: 788-8080 Toll Free 1-888-660-4866 An information and support centre for women and men with or concerned about breast cancer and the people who care for them.

Canadian Cancer Society's Cancer Information Service: Toll Free 1-888-939-3333 9am - 6pm, Monday - Friday Anyone can call for information about cancer.

Public Health Agency of Canada: Information on Mammography for Women Aged 40 and older: A Decision Aid for Breast Screening in Canada is available at www.publichealth.gc.ca/decisonaids that is available in English or French