Manitoba’s health minister is open to the possibility of expanding cancer screening to women with dense breast tissue.

Uzoma Asagwara said in an interview that while the province relies on the expertise of CancerCare Manitoba, it is prepared to consider emerging research to guide decision-making. The comments follow a Free press report that raised the question of whether some women with dense breast tissue were falling through the screening cracks.

“(CancerCare has) experts and researchers who inform and guide how they implement policies and provide care to Manitobans,” Asagwara said. “Our department also looks at research nationally and beyond to help inform the decisions I make as minister.

“We want to make sure we stay on the cutting edge of science and the best information we have. »

A cancerous tumor and dense breast tissue are both present as white on a mammogram, creating a masking effect for women in categories C and D, the two densest breast categories.

In density category D, mammograms miss about 40 percent of breast cancers; in category C, about 25 percent are missed.

Some advocates and experts are concerned about a policy gap affecting Manitoba women who are told in their mammogram results letters that they have dense breasts, but are not advised to seek screening additional.

Jennifer Borgfjord, 54, had mammograms at ages 50 and 52. She discovered a lump on her breast a month after her second mammogram, which turned out to be cancerous. Mammograms failed to detect the lump.

“Both of my results letters contained information about the density of my breast tissue and my second letter identified me as having dense category C breasts, which it said can increase the risk of cancer.”

However, a leaflet accompanying the letter stated that dense breast tissue is common and does not mean a woman will develop breast cancer.

“Literature contradicts itself,” says Borgfjord. “I have dense category C breasts, which appear white on mammography. The cancer also appears white on mammogram imaging. I needed additional screening – ultrasound and MRI – to find the 2.3 centimeter tumor. But there is no call to action in the letter. They do not offer additional screening.

Borgfjord and others are calling for screening ultrasounds to be offered to women over 40 with C or D breast density, as well as lowering the screening age so that women 40 and older can refer themselves to mammograms.

The provincial government recently announced plans to increase breast cancer screening and lower the self-referral age to 45 by the end of 2025 and to 40 by the end of 2026. However , he did not provide any details regarding additional screening, such as ultrasounds and MRIs. being offered to women with dense breasts.

Heather Brister had a similar experience to Bjorgfjord. She was 44 years old when she first felt a small lump the size of a pea on her right breast. After a diagnostic mammogram revealed no problems, Brister was sent home without being offered additional testing or information about breast density.

When the lump grew to 10 centimeters, Brister was sent for an ultrasound, with the resulting biopsy revealing she had triple-negative advanced invasive ductal carcinoma.

The cancer had spread to his lymph nodes; she had stage 3C breast cancer.

Dr. Lorne Brandes, a Winnipeg oncologist, said Brister should have been referred for an ultrasound when the initial mammogram failed to locate the lump.

“If a radiologist doesn’t refer this woman for an ultrasound at that time, then there is something radically wrong with their judgment, in my opinion,” he said.

“People trust you and you have to do the right thing. The right thing is always to leave no stone unturned.”

Although women under 50 may be able to attend mammograms themselves, a doctor’s request is necessary for an ultrasound.

“It’s up to the family doctor to be aware of the problem and decide whether or not the patient should be seen by a breast specialist or, in most cases, have an ultrasound,” Brandes said.

However, some women in Manitoba do not receive additional screening even after their doctor requests it.

A former Ottawa resident, now living in Manitoba, has Class C breasts and her doctor in Ottawa informed her that she would need follow-up.

Unable to register with a family doctor here, the woman, who asked to remain anonymous, went to a walk-in surgery, where she “convinced a reluctant doctor” to send a request ultrasound at a breast cancer screening clinic.

However, she was turned away because the clinic’s radiologist deemed it unnecessary.

The woman is still unable to access necessary follow-up testing in Winnipeg.

Theresa, 33, is from Germany. She has a history of breast cancer in her family and her gynecologist in Europe advised her to undergo regular breast cancer screenings from a young age.

When her GP couldn’t determine if she had a lump, she was referred for a screening ultrasound. However, she had to have a mammogram instead.

“The radiologists said the ultrasounds didn’t do anything. I eventually filed a complaint against the clinic with the College of Physicians, but my complaint was dismissed because no screening ultrasounds are currently performed in Manitoba,” she said.

Because her mother’s cancer was detected late, Theresa (who did not want her last name used) signed up for an ultrasound at a private clinic in Toronto. She has since been told she needs follow-up.

“Ideally, I would like our health system to offer this service free to all Manitobans. Early detection is crucial when it comes to breast cancer. I would like this to be a service that I can access here on an annual basis,” she said.

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AV kitchen
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AV Kitching is a writer about the arts and life in Free press. She has been a journalist for over two decades and has worked on three continents writing about people, travel, food and fashion. Learn more about AV.

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