Conversations in Breast Cancer Screening: An Exploration of Age, Density, and Emerging Technologies

Abstract

Breast Cancer remains a significant burden in Canada, reflecting global patterns as one of the most common cancers affecting women. In 2023, it was estimated that 26% of all new cancer cases among Canadian women were attributed to breast cancer, contributing to 13% of all cancer deaths in this group. Recent advancements in both detection and treatment of breast cancer have significantly improved cure rates, particularly when breast cancer is detected early. Early-stage breast cancer detected through screening can have a 5-year survival rate of 99%. Thus, the quest for early detection through effective and economical screening initiatives is a critical component in minimizing the burden of disease and reducing breast cancer-related mortality. However, ongoing dialogue continues within the medical community regarding the optimal timing of screening initiation for women at average risk. Discussion about the appropriate age to discontinue screening is an evolving topic. This conversation is complex and multifaceted, involving careful consideration of the intricate balance between the benefits of early detection, economic implications of population screening, and potential harms such as overdiagnosis and the psychological impact of false positives. Current Canadian guidelines, last updated in 2018, recommended mammography screening every 2–3 years for women aged 50–74 years, reflecting an expert consensus that considers both scientific evidence and population health needs. These guidelines are under revision with an update expected in 2024, while other major organizations have recently published new recommendations, reflecting the value of early detection at a younger age in the effort to minimize cancer deaths. Additionally, the efficacy of mammography alone as a screening modality in women with dense breast tissue, who constitute up to 43% of the screening population, has come into question.7,8 This challenge has catalyzed discussion around recommended supplementary screening modalities to improve cancer detection rates in women with dense breast tissue.9 This article explores the ongoing discourse on breast cancer screening recommendations for average-risk women, including the age at which to initiate and stop screening, imaging modalities, and emerging technologies.