Breast cancer screening in British Columbia: A guide to discussion with patients

Breast cancer continues to affect the women of British Columbia and impose a significant health care burden. Population-based screening mammography remains the most accessible and scientifically validated test for detecting breast cancer and reducing breast cancer mortality. Screening is provided across the province by the Screening Mammography Program of BC. Downsides of screening include exposure to ionizing radiation, false-positive results, and overdiagnosis. Current screening policy in BC is based on age and other determinants of risk, including family history and genetic factors. For example, routine screening every 2 years is recommended for asymptomatic women age 50 to 74 of average risk, while routine screening every year is recommended for women age 40 to 74 with a first-degree relative with breast cancer. The Screening Mammography Program compiles data for calculating numerous outcomes, including participation and return rates, time to diagnosis measures, and sensitivity and specificity indicators. Breast density is an issue a woman and her primary care provider may need to consider, since normal dense breast tissue may impede detection of cancer. Imaging technologies undergoing investigation to address this and other challenges include digital breast tomosynthesis, ultrasound, and magnetic resonance imaging (MRI). By discussing imaging options and screening benefits, limitations, and downsides with women, primary care providers can facilitate informed decision making.