Organized Breast Cancer Screening Programs in Canada

1999 and 2000 Report

Participation in Screening Programs

Participation in organized breast cancer screening programs continues to increase, although at a much lower rate than in previous years. From 1999 to 2000, Canada-wide annual screening volumes increased by only 6.7%, a much lower increase than that observed between 1998 and 1999, and the smallest recorded since the inception of organized screening in Canada (see Table 3). Participation rates in the eligible population also remained stable, with slight increases for all provinces except Alberta (which saw a small decrease) and Saskatchewan (where participation remained virtually unchanged compared with 1997 and 1998). Currently, none of the programs meet the national performance target for participation. Self-report data from 2000-2001, which include screens occurring external to programs in the fee-for-service sector, estimate participation rates at 64.7%. Even with the overestimate inherent in self-reported data, this figure falls short of the 70% participation target for women aged 50 to 69 (Figure 4). 

Table 3
Annual screening volume by program 1988 to 2000, all ages 

^a Although Quebec accepts women aged 40-49 and 70+ with physician referral if done at a program screening centre, data for these women are not captured.

†Data from New Brunswick are provisional.

Notes: Northwest Territories, Yukon and Nunavut programs are still in development. Data include all screens; figures have been updated and may vary slightly from previous reports.

The stability of screening volume growth and participation rates suggests that programs are reaching the limits of their capacity to recruit additional women. Another impediment is the fact that not all programs have the resources to adequately reach all women in the target population. Expansion of organized breast cancer screening programs and shifting resources for the recruitment of target-aged women would reduce some of the barriers currently in place (e.g. such as waiting for appointments or lack of access to organized screening). 

Participation in organized breast cancer screening programs continues to increase, although at a much lower rate than in previous years. Currently, none of the programs meet the national performance target of at least 70% participation.

At the moment, additional capacity appears to exist in the provincial health care systems external to organized breast cancer screening programs. Comparison of Figure 4 and Figure 3 indicates the difference between the proportion of women obtaining screening through organized programs and that of women reporting mammography from any source. While some provinces are delivering the vast majority of their breast screening services through organized programs, Canada- wide data indicate that a considerable proportion of screening is delivered through the fee-for-service sector. This is a concern, because such screening mammography is delivered in an ad hoc fashion without targeting or recall of the women who are most likely to benefit from mammography screening. Organized screening programs can ensure that quality control elements of the screening process are in place and monitor interim indicators to determine whether the program is on track towards achieving a reduction of breast cancer mortality in the population. 

In 1999 and 2000, the percentage of total screens that were delivered to women aged 50 to 69 ranged by province from 50.3% to 100% (Figure 5). Some programs also screen women aged 40 to 49 and 70 years and over. The percentage of total screens in 1999 and 2000 delivered to women aged 40 to 49 was as high as 36.6%, and to women aged 70 and over as high as 20.4%. As a result of the mounting evidence questioning the value of screening women under age 50 and a general lack of capacity to meet recruitment targets for women aged 50 to 69, programs are revisiting their policies concerning active recruitment of women outside the target age range. 

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