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

2. 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

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. 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 (
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
Regular mammograms can find breast cancer early
when it is easier to treat

9. 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

10. 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.

11. 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.

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

13. 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

14. 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.

15. 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.

16. 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.

17. 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

18. 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)

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

20. 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

21. 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:
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

22. 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:
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

23. 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.

24. 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
Call this number to book your appointment
Ontario Breast Screening Program
Provincial Toll-Free Number

25. June 2014
Questions?

26. June 2014
Thank you