Dr. Melinda Wu, a family physician and general practitioner in oncology at the Peter Gilgan Centre for Women's Cancers at Women’s College Hospital, discusses when to start getting screened for breast cancer.

Breast screening is meant to look for early signs of breast cancer, before there are any clinical symptoms. If breast cancer is found and treated early, the chances of successful treatment are better.

If you do have symptoms, such as a lump in your armpit or changes to the size/shape of your breast or changes to your nipples, see your family doctor for an evaluation - this is considered diagnostic breast imaging versus screening.

Mammography, a low-dose x-ray of the breast, is the most reliable way to find breast cancer early in women. Women should be aware of the benefits and limitations of screening mammography based on their age and risk factors to help decide if it is right for them. Your doctor can help you make this decision.

At age 40, it’s a good time to review your breast cancer risk factors, family history and weigh the risks and benefits of breast screening. The guidelines suggest that for women of average risk, breast screening is to commence at 50. According to the Canadian Cancer Society, if you are 50 to 74 years old, have a mammogram every two years. Early screening is an option depending on personal risk factors and/or perspectives on early screening.

Breast density has been identified as an independent risk factor for breast cancer for those patients with extremely dense tissue. Because of this, it's important that mammogram reports include a patient's breast density rating. Typically, this is reported as category A, B, C, or D, with A being fatty breast tissue, and D being extremely dense tissue. You can only tell a patient's breast density on breast imaging - it's not something that can be felt on examination. Patients with extremely dense tissue may benefit from annual screening. Overall, it's encouraged that you discuss your breast density with your provider to determine how best to screen you going forward.

How has the COVID-19 pandemic affected breast cancer screening?

During the pandemic, we have seen an increase in reactive lymph nodes following COVID vaccination. These are not harmful but sometimes require an additional ultrasound follow up. This doesn’t mean you should delay getting vaccinated in order to have a mammogram, nor should you delay mammogram screening in order to wait for vaccination – both are important tools for keeping you healthy. If the mammogram detects an enlarged lymph node, your doctor will monitor it accordingly.

Due to a myriad of factors, we are catching up on breast cancer screening missed during the pandemic. According to the Ontario Medical Association, for example, about 400,000 fewer mammograms to screen for breast cancer were performed in the province during the pandemic than forecasted. Despite the backlog, it’s important to seek care if a concern arises and, if appropriate, to resume/start breast screening at this time.

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