EDITOR’S NOTE: This article originally appeared on The Trillium, a Village Media website devoted to covering provincial politics at Queen’s Park.
Ontario is joining several other provinces with early breast cancer screening by lowering the age for publicly funded mammograms.
Starting next fall, Ontarians will be able to self refer for a mammogram once they turn 40, a decade earlier than the current age of 50. This comes in advance of updated guidelines on breast cancer screening that are expected to be released this fall from a national task force.
“This change of course will allow for up to an additional one million Ontarians to self refer for a mammogram if they decide screening is right for them,” Health Minister Sylvia Jones said on Monday morning at Women’s College Hospital just down the street from Queen’s Park.
“Nearly 12,000 Ontarians are diagnosed with breast cancer each and every year. We know early detection through regular screening mammograms can save lives, detecting breast cancer before it has the chance to spread,” she added.
Finance Minister Peter Bethlenfalvy called the move “game-changing.”
All of us have a mother … and this is such an important day for all the mothers and the daughters, sisters in this world,” he said. “Make no mistake, this is a measure that will save lives and make the health-care system stronger.”
Currently, the Ontario Breast Screening Program recommends that most women, two-spirit, trans and non-binary people aged 50–74, considered average risk, be screened for breast cancer through a mammogram every two years. There are exceptions where individuals with a history of ovarian cancer, for example, could get a mammogram done after just a year.
Under the program, it’s recommended that those aged 30 to 69 who are considered at high risk for breast cancer — if you or an immediate relative have a gene mutation known to increase risk, a family history of breast or ovarian cancer or had radiation to the chest before 30 and eight or more years ago — get both a mammogram and a breast MRI, or an ultrasound if an MRI can’t be performed, each year.
It’s estimated that 18 out of every 200 people screened in the program will be sent for additional tests, and one will have breast cancer. Cancer Care Ontario, which was folded into Ontario Health and oversees the province’s screening program, recommends regular mammograms “because it can find cancer early when it is less likely to have spread to other parts of the body.” Treatment can also work better when a cancer is found early.
Most people whose breast cancer is discovered early will survive for at least five years, according to statistics on Cancer Care Ontario’s website. But found later, only 30 per cent of people are expected to survive for five or more years.
The question of whether or not to lower the age of breast cancer screening for the general population has been a discussion in various jurisdictions across Canada and in the United States, with some pointing to the risk of false positives and subsequent biopsies or other follow-ups to justify starting screen at 50.
The Canadian Task Force on Preventive Health Care, which was established by the Public Health Agency of Canada, said this summer that it would speed up its review of breast cancer screening recommendations and release updated guidelines late this fall. The task force doesn’t recommend mammograms for the general population until the age of 50.
The task force’s announcement came after its American counterpart released a draft recommendation in May “that all women get screened for breast cancer every other year starting at age 40.”
Asked why the Ontario government decided to make the change ahead of the national task force’s recommendation, the health minister’s spokesperson, Hannah Jensen, said “the change comes as a result from consultations with and feedback from healthcare partners and experts.” She also pointed to other provinces that have made a similar move.
Provinces like Nova Scotia, British Columbia, Alberta and P.E.I. have lowered the age for self-referrals for screening mammograms, while others like New Brunswick are making the change next year.
Liberals in Ontario criticized the Progressive Conservative government on Monday for not specifying any funding alongside its plan to lower the age for breast cancer screening.
“While this announcement may feel like a welcome surprise, the devil is in the details,” said Bonnie Crombie, who is one of four candidates in the Liberal leadership contest, in a statement. “The announcement comes with no additional funding.”
The Ontario government said in a press release on Monday that an additional 130,000 mammograms will be able to be completed each year. It said the locations participating in the province’s program will increase capacity over the next several months and work with the government “to develop a public reporting tool that allows people to view appointment wait times across the province.”
Jones’ spokesperson, Jensen, said the cost of this policy change will depend on the required increase in capacity and how many staff need to be hired.
But Liberal MPP Adil Shamji, who worked as an emergency room doctor, said without details on staffing and costs, “this is just another announcement that isn’t backed up by any sort of implementation plan.”
Shamji and Crombie also said many Ontarians are waiting for breast and cervical cancer screenings, with Crombie noting “and the waitlist keeps getting longer.”
The Ontario Medical Association said last October that more than 400,000 fewer mammograms had occurred during the pandemic, and that while “screenings have returned to forecasted levels,” there were concerns about undiagnosed cancers and longer wait times for surgeries once breast cancer is diagnosed.
Shamji said he hasn’t seen updated wait list statistics, but there’s been “no indication whatsoever that there has been a meaningful improvement in that number.”
He said while the government’s announcement was a step in the right direction, he has additional concerns.
“Most guidelines in North America, when they do suggest that women between 40 and 50 should get mammograms, usually say that the decision should be made together with the physician, and the announcement today says simply that women can self-refer,” Shamji said, adding that this highlights the lack of access to family doctors across the province. “They should have the opportunity to speak with a physician and be able to make an educated decision.”
Meanwhile, Sherry Wilcox, who was diagnosed with breast cancer last year at the age of 44, applauded the government’s move.
Wilcox, a mother of three who joined provincial officials for the announcement, said she had asked her doctor about a mammogram when she turned 40, but “parked the topic” when she was told she wasn’t eligible, until she found a lump in her breast.
She recalled a meeting in Jones’ office earlier this year with the Ontario Association of Radiologists, thanking the minister “for listening and for prioritizing women’s health” with the upcoming change.
“To all the women who are breast cancer survivors and patients and to the families of those who have passed, this announcement is a recognition of what you have endured,” Wilcox said. “While it may be too late for us, this is an incredible opportunity for others going forward that hopefully will not have to bear the negative consequences of a later diagnosis.
“If you are a woman in your 40s, go please and get a mammogram. And for everyone else, tell your daughters, sisters, mothers co-workers to get screened,” she added. “Early detection saves lives.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
