Sask. women 45+ can now self-refer for breast screening mammograms, but awareness, capacity issues continue
Experts, advocates, survivors call for provincial awareness campaigns
Saskatchewan women age 45 and older can now self-refer for screening mammograms without a doctor's requisition as part of a phased strategy to gradually lower the age for screening to 40 by June 2026. The latest age drop went into effect on June 30.
Experts, advocates and survivors have been waiting for this change, but they are worried the province is not doing enough to let women in their mid-forties know they now qualify.
Mandy Kasper, a cancer survivor and provincial manager of Saskatchewan for the Canadian Association of Medical Radiation Technologists, tells CBC the provincial government needs to ramp up communication about the age drop.
"It seems like right now, unless they self-refer based on the guidance of their physician, unless they're watching the news or really up on the latest through social media or whatnot, they're not really getting the information," said Kasper, who is a radiation therapist by trade.
Jennie Dale, founder and executive director of Dense Breasts Canada, said the organization is happy Saskatchewan has met the age 45 milestone. But she is also concerned about a lack of communication.
"It's one thing to announce that screening is going to begin at 45, and then it's another thing to get women to know and to come," Dale said.
She said that since Ontario dropped the age for mammogram screening to women in their forties in October 2024, the average uptake across the province has been approximately 14 per cent. Dense Breasts Canada would really like to see those numbers a lot higher in Saskatchewan.
"That would take some awareness campaigns. So we would like to see the government take those steps to make sure that as many women as possible able to take advantage of this," said Dale.
The breast cancer survivor said mailing reminder and invitation letters to women who now qualify would be the most effective method.
Kasper, who also serves on the patient voice advisory board with the Canadian Medical Association, agrees with Dale.
It's one thing to announce that screening is going to begin at 45, and then it's another thing to get women to know and to come.- Jennie Dale, Dense Breasts Canada
"Women get letters reminding them of their Pap test for screening for cervical cancer all the time," Kasper said.
"People get a letter in the mail, they know that they need to book an appointment. They go and do so ... So I don't see why it wouldn't work for mammography."
Dale and Kasper also recommend the Saskatchewan Health Authority (SHA) educate physicians about the age drop and why it's a necessary step forward, and provide signage and information pamphlets to doctors offices. Dale said the province should also initiate widespread communication about self-referrals for mammogram screening across all social media platforms.
Self-referral eligibility
To be eligible for self-referral, women must have no breast cancer symptoms such as lumps, discharge, or skin changes. They also cannot have breast implants or be in an active follow-up for breast cancer, and must be cancer free for five years.
Mammogram screening is meant to find signs of cancer, and is not used for diagnostics.
At this time, women between the ages of 40 and 44 can still apply for screening mammograms if they have a doctor's requisition.
The Saskatchewan Cancer Agency (SCA), which provides mammogram screening, tells CBC it is promoting breast screening with regular posts on social media, including the community visit schedule for the mammography bus.
"If the bus is coming to a community and appointments are available, additional promotion with that community occurs, such as sharing information with town offices or posting on local buy/sell sites," the agency said in a statement to CBC.
It said it also works with the SHA to distribute printed information to doctors' offices.
"We have developed a lot of capacity in our system for screening mammograms. So we can offer it both in Regina and Saskatoon, where we have added an extra screening mammogram machine, as well as in our satellite sites," Leah Palmer, an early detection manager at SCA, said in an interview.
Satellite centres are in Moose Jaw, Swift Current, Yorkton, North Battleford, Prince Albert and Lloydminster.
Palmer said the agency wants self-referring for screening mammograms to be like going to your dentist appointment or going for an eye check up.
"It should be an easy accessible process," she said. "As we know, breast cancer is easier to treat the sooner that you catch it, and early detection can provide that."
Breast cancer risks for women in their 40s
Dale said getting breast cancer during one's forties adds extra danger to the mix.
She said Dense Breasts Canada would like to see the entire country reach 40 sooner than later, because every day that passes means someone may be missing out on a diagnosis.
"We do know that cancer in the 40s is extremely aggressive and 17 per cent of cancers do happen in the 40s. And the rate of mortality for women from 40 to 49 is high."
She adds that there are also many racial disparities, because many ethnicities get cancer earlier than white women.
"So it is inequitable not to be screening at 40 everywhere. But we are happy to see that Saskatchewan will be getting there."
Dale said that at this time there are seven provinces and territories that screen at 40 years old.
Concerns over system overload
One Weyburn women says she's concerned that having more women signing up for mammogram screening will flood an already overloaded system.
CBC first spoke with breast cancer survivor and advocate Lisa Vick in February 2024, when she had been waiting five months after her diagnosis to get a surgeon consultation. She was unable to make a treatment plan until after that consultation.
Today, Vick keeps track of all wait times related to breast cancer. She said wait times for mammogram screening for women with signs of breast cancer are still not being met.
"I'm happy for those women that, you know now can self-refer, but what about those still waiting on yearly mammograms?" Vick said.
A two-month wait and you have visible, palpable lumps in your breast and you have to wait? It's not acceptable.- Lisa Vick, breast cancer survivor and advocate
She said women with signs of breast cancer are constantly reaching out to her. For example, Vick said last week a woman said she had been told she would have to wait two months for a screening mammogram, even though she had found two lumps in her breast.
"A two-month wait and you have visible, palpable lumps in your breast and you have to wait? It's not acceptable. And the lack of communication in between the SHA and patients and doctors needs to be cleared up. This ... needs to be dealt with," said Vick.
The SCA said current screening mammogram wait times are "at most" six months, but it said many locations offer appointments within days or weeks of booking.
Meanwhile, Kasper said the provincial health-care system does not have enough medical radiation technologists who perform breast diagnostic exams to meet the growing demand the age drop will bring.
"If we are screening more, we're going to find more [cancer]," Kasper said.
"But will we have enough staff and will the system get overloaded on Phase 2? So if you find something on screening, are these women going to have access to diagnostic scans?"
SHA says recruitment 'challenging'
In a statement to CBC, the SHA said recruitment of medical radiation technologists who perform breast screening exams has been "challenging."
The authority said it continues to recruit through a number of initiatives in order to fill vacancies, including posting positions locally and nationally.
"Efforts to support recruitment may include financial incentives, depending on the position and location. Saskatchewan's compensation rates for medical radiation technologists are competitive and comparable to other provinces."
The Ministry of Health first announced the expansion of breast cancer screening in September 2024. In January it dropped the age from 50 to 47.
The next age drop comes in January 2026 for women aged 43 to 45 years old.
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