Breast Cancer Screening June 2014 Education Module Breast Cancer Screening Slide Objective: Title slide

June 2014 Each province in Canada offers Cancer Screening programs. Three cancer screening programs are available in Ontario: Ontario Breast Screening Program for screening cancer of the breasts Ontario Cervical Screening Program for screening cancer of the cervix ColonCancerCheck Program for screening cancer of the rectum and colon

Overview Breast Cancer Facts Risk Factors Be Breast Aware June 2014 Overview Breast Cancer Facts Risk Factors Be Breast Aware Breast Screening Cervical Screening Colorectal Screening How to Reduce Your Risk This presentation reviews: Facts and stats Br ca risk factors and ways to minimize your risk Br screening – what it is, what to do at what age and how to access the OBSP

One in nine women will develop breast cancer in her lifetime . . . June 2014 True or False? One in nine women will develop breast cancer in her lifetime . . . True 1 in 9 women has a chance of developing br ca in her lifetime. And 1 in 28 will die of it. If nine women live to the age of 85, one will develop breast cancer sometime during her lifetime.

June 2014 True or False? Only women with a family history of breast cancer will develop breast cancer . . . False A strong family history means you have a higher risk of getting breast cancer. A strong family hx refers to having a mother, sister, or daughter who is found to have br ca before menopause. It also includes a mother, sister or daughter who has cancer of the ovaries at any age. To keep family hx in perspective, remember that only 11% of women who get br ca have a mother, sister or daughter with the disease. Women with a strong family hx should talk to their doctor about screening that is right for them. Only 11 per cent of all women diagnosed with breast cancer have a family history of the disease. All women as they age are at risk for breast cancer.

June 2014 True or False? If you notice a change in your breast, you should watch it closely for a few months to see if it goes away . . . False If you notice a change in or around your breasts, you should tell your doctor about it as soon as possible. Remember the breast area includes your chest wall, extends up to the collar bone and under the arm pit.

June 2014 True or False? Breast Self Examination (BSE) is just as effective as having a screening mammogram . . . False BSE is simply checking your own breasts to learn what is normal for you & to help you recognize any unusual changes. For women age 50 and older, having regular mammograms is the best way to find breast cancer early, when it is small and less likely to have spread to the lymph nodes.

Breast Cancer in Ontario 2013 June 2014 Breast Cancer in Ontario 2013 Estimated new cases: 9300 Estimated deaths: 1950 The estimated deaths for breast cancer in 2013 is 1950. The estimated new cases for breast cancer in 2013 is 9300. The overall participation of women is 61% in 2010–2011 in the province (http://www.csqi.on.ca/cms/One.aspx?portalId=258922&pageId=273161#.U3tzytJdXTo) Over the past 20 years, more women are getting breast cancer but less are dying from it. Less women are dying of breast cancer today because they are being screened and their cancers are being found early. When breast cancer is found early before as woman can see or feel it, it can be easier and more successful to treat. Statistics are going to be updated each year at the end of May on http://www.cancer.ca/en/cancer-information/cancer-101/canadian-cancer-statistics-publication/?region=on Regular mammograms can find breast cancer early when it is easier to treat

More Breast Cancer Facts June 2014 More Breast Cancer Facts 80% (8 out of 10) of breast cancers are found in women age 50+ 50% (5 out of 10) are found in women age 50 – 69 years Less than 1% of breast cancers are diagnosed in men

June 2014 More Facts Breast cancer symptoms present the same in men as they do in women Research shows that increased participation in breast screening will reduce breast cancer mortality rates The more women we screen, the more likely we’ll find cancers early and less deaths will result.

Be Breast Aware Women of all ages: Know what is normal for you June 2014 Be Breast Aware Women of all ages: Know what is normal for you Know what changes to look for Look and feel for changes often Report any unusual changes to a doctor or nurse practitioner immediately Peer Health educator explains thingamaboob emphasizing the importance of mammogram to detect very small changes compared to clinical exam done by nurse or physician or self exam. For all women at any age, it is important that women should be aware about their breasts and what is normal for them. A woman can find out what is normal for her by feeling and looking at her breasts and chest area often. Standing in front of a mirror while she does this is helpful. Be aware of the shape and texture of your breasts so you can learn what is normal for you. Be aware of how breasts change during menstruation. If a woman notices a change that does not go away after your menstrual cycle, see a doctor or nurse practitioner as soon as possible. While it is important to be aware of breast health at all ages, women age 50 and older should go for regular mammograms, which is the test for breast cancer screening. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-detection

Report any unusual changes to a doctor or Nurse Practitioner immediately:

All Women Need to Be Breast Aware . . . Have a physical breast exam done by a doctor or nurse practitioner Women age 40 – 49: speak to a doctor or nurse practitioner about breast screening Women age 50 and older: go for regular breast screening at least every two years

Regular Breast Screening June 2014 Regular Breast Screening Screening is the best way to detect breast cancer early when it is more treatable Includes a two view breast x- ray (mammogram) Breast screening includes: A test called a mammogram. This is a safe x-ray of your breasts. Sometimes it is called mammography. It is the best screening tool available today. AND A physical exam of the breasts by a trained healthcare provider. (Phys examinations – evidence-based practice – it doesn’t show its as effective.) Only women with NO breast problems or symptoms can be screened. A screening mammo is a low dose x-ray of the breast done to find or DETECT abnormal changes in the breast. A diagnostic mammo is used to check (EVALUATE) abnormal changes in the breast.

June 2014 Risk/Benefit A mammogram is not a perfect test, some cancers may be missed Cancers can/may develop in the interval between screens Many studies show that having regular mammograms can reduce the risk of dying from breast cancer Mammograms are the best way to find breast cancer early. But, they are not perfect. They may miss some cancers. Also, some cancers develop in the interval between screens. However, many studies have shown that regular mammograms reduce the risk of dying from breast cancer. Some cancers that appear on a mammogram may never progress to the point where a woman has symptoms during her lifetime. Therefore, some women may have surgery or treatment for a breast cancer that would never have been life threatening. Not all cancers found at screening can be cured.

June 2014 Risk/Benefit Some cancers that appear on a mammogram may never progress to the point where a woman has symptoms during her lifetime Not all cancers found through screening can be cured Mammograms are the best way to find breast cancer early. But, they are not perfect. They may miss some cancers. Also, some cancers develop in the interval between screens. However, many studies have shown that regular mammograms reduce the risk of dying from breast cancer. Some cancers that appear on a mammogram may never progress to the point where a woman has symptoms during her lifetime. Therefore, some women may have surgery or treatment for a breast cancer that would never have been life threatening. Not all cancers found at screening can be cured.

50 Candles or more on your cake 50 Candles or more on your cake? …you’re eligible to start screening through the Ontario Breast Screening Program

June 2014 Who is Eligible to Participate in the Ontario Breast Screening Program? Women aged 50 – 74 years No changes in breast health No personal history of breast cancer No current breast implants Ontario resident for more than 6 months Breast cancer screening using a mammogram is done on women who are: Age 50 or older Who are healthy without any signs or symptoms of breast cancer Who have not had breast cancer in the past No current breast implants Ontario residents for more than 6 months (Refugees/immigrants who do not have health card show immigration documents)

What Happens During Screening? June 2014 What Happens During Screening? Change into a gown Two-view mammogram (x-ray) of each breast

Result letter within two weeks Reminder letter for next appointment June 2014 What Happens After? Result letter within two weeks Reminder letter for next appointment

High Risk Screening Through OBSP June 2014 High Risk Screening Through OBSP High risk screening: Women aged 30 to 69 years Asymptomatic May have personal history of breast cancer Confirmed to be at high risk for breast cancer (see next slide) Slide Objective: Provide OBSP eligibility criteria for women at high risk Background Information: The OBSP screens two groups of women. Women eligible for high risk screening through the OBSP are Ontario residents aged 30 to 69 years who are at high risk for breast cancer, have a referral from their physician, have no acute breast symptoms and fall into one of the following risk categories: Identified as a carrier of a deleterious gene mutation that increases their risk for breast cancer (e.g., BRCA1, BRCA2) First-degree relative of a mutation carrier and has declined genetic testing Family history consistent with a hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25% using the IBIS Genetic Breast Cancer Predisposition Tool or the BOADICEA Model of Genetic Susceptibility to Breast Cancer Received chest radiation for treatment of another condition (e.g., Hodgkin’s disease) before the age of 30 and at least eight years previously For further information go to: www.cancercare.on.ca/pcs/screening/breastscreening/OBSP/highrisk Reference: Warner E, Messersmith H, Causer P, Eisen A, Shumak R and Plewes D. Magenetic Resonance Imaging Screening of Women at High Risk for Breast Cancer: A Clinical Practice Guideline. Program in Evidence-Based Care. April 12, 2007. 21

High Risk Categories High risk categories: June 2014 High Risk Categories High risk categories: Confirmed carrier of gene mutation First-degree relative of mutation carrier and refused genetic testing ≥ 25% personal lifetime risk (IBIS, BOADICEA tools) Radiation therapy to chest more than 8 years ago and before age 30 Slide Objective: Provide OBSP eligibility criteria for women at high risk Background Information: Women will be referred to the OBSP for genetic assessment of their eligibility if they have significant family history, such as: First-degree relative of a mutation carrier (e.g., BRCA1, BRCA2), has not had a genetic assessment or genetic testing A personal or family history of at least one of the following: Multiple cases of breast cancer (particularly where diagnosis occurred at ≤ 50 years) and/or ovarian cancer (any age) in the family, especially in closely related relatives, on the same side of the family Primary cancer occurring in both breasts, especially if one or both cancers were diagnosed at ≤ 50 years Both breast and ovarian cancer in the same woman Breast cancer at ≤ 35 years Invasive serous ovarian cancer Breast and/or ovarian cancer in Ashkenazi Jewish families An identified BRCA1 or BRCA2 mutation in any blood relative Male breast cancer For further information go to: www.cancercare.on.ca/pcs/screening/breastscreening/OBSP/highrisk/ Reference: Warner E, Messersmith H, Causer P, Eisen A, Shumak R and Plewes D. Magenetic Resonance Imaging Screening of Women at High Risk for Breast Cancer: A Clinical Practice Guideline. Program in Evidence-Based Care. April 12, 2007. 22

Ontario Breast Screening Program Benefits June 2014 Ontario Breast Screening Program Benefits A referral is not needed from a doctor You can call and book your own appointment Publicly funded Result letter is mailed to your home Reminder letter to return every two years The Ontario Breast Screening Program uses a mammogram (breast X-Ray) to screen women age 50 to 74 every two years or yearly if recommended by the doctor. A referral is not needed from a doctor You can call and book your own appointment No cost – publicly funded through tax payer dollars Result letter is mailed to the woman and she is reminded when to return for her next appointment.

Want to Book an Appointment? June 2014 Want to Book an Appointment? Call this number to book your appointment: Ontario Breast Screening Program Provincial Toll-Free Number 1-800-668-9304 Call this number to book your appointment Ontario Breast Screening Program Provincial Toll-Free Number 1-800-668-9304

June 2014 Questions?

June 2014 Thank you