Breast cancer screening in Canada: 2021/2022
Response to COVID-19
The COVID-19 pandemic has had a profound impact on health services across the country, including the reduction or pausing of cancer screening. Jurisdictions have been impacted in different ways, and many have developed innovative tools and processes to respond and adapt to the impact of COVID-19.
A social media campaign outlining safety measures in place at centres is ongoing, and information on centre safety measures is included with recall notices.
The program is making greater use of electronic tools to triage patients and decrease touchpoints and face-to-face time.
Capacity for mammograms has fluctuated throughout the waves of the pandemic. The program now registers clients from their vehicles to reduce touchpoints within screening sites and is using its mobile unit to assist with backlogs.
In spring 2020, the Ontario Ministry of Health issued a directive to pause non-essential screening services as a result of the COVID-19 pandemic. This included a pause in invitation and recall letters, which gradually resumed beginning in December 2020. Since resumption, Ontario Health (Cancer Care Ontario) has monitored screening trends and provided supports to regional cancer programs as needed. Resources and tools developed and provided to radiologists, primary care providers and Ontario Breast Screening Program (OBSP) sites include:
- A regional monitoring and planning tool shared with regional cancer programs on a monthly basis. It allows healthcare providers and administrators to monitor the volume of OBSP screening mammograms and high-risk OBSP breast screening magnetic resonance imaging, as well as the number of abnormal OBSP screens with pending diagnosis at regional and site levels. The tool also estimates the backlog volume and recovery time for OBSP screening mammograms for a given region or site based on regional inputs (e.g., capacity).
- A tip sheet to support decision making for the gradual increase of OBSP breast cancer screening and assessment services at sites.
- A tip sheet to support primary care providers as they resume screening for breast, cervical and colorectal cancer (as part of the OBSP, Ontario Cervical Screening Program and ColonCancerCheck) during the pandemic.
- A guidance document for OBSP sites on axillary adenopathy following COVID-19 vaccination and breast screening.
- A guidance document for medical imaging sites on vaccine-related lymphadenopathy following COVID-19 vaccination.
- A guidance document for primary care providers on managing vaccine-related lymphadenopathy in their patients.
To accommodate participants who were not able to access a screening appointment when they were 74 and have now turned 75, Cancer Care Ontario temporarily suspended the need for mammogram referrals from primary care providers for OBSP participants if they turned 75 in calendar years 2020 or 2021. The program also developed a media kit with materials (e.g., key messages, robo-call scripts, program fact sheet) to support regional public awareness campaigns.
The program conducts periodic surveys to assess access to screening and investigation exams. These surveys measure volumes, wait lists and delays for most exams (mammographs, ultrasounds and biopsies) for each of the program’s centres.
Screen volumes significantly decreased during the height of the pandemic. One new process introduced to the program was to increase the breast screening time slot to allow for proper cleaning of equipment between clients.
Prince Edward Island
The screening program was halted during the initial COVID-19 pandemic outbreak. The shut-down lasted from March to the end of May 2020 and resulted in screening delays and backlogs. Upon re-opening, the program worked in collaboration with Islanders to mitigate any delayed appointments through extended hours of operation, including evenings and weekends. Appointment numbers increased gradually, allowing for social distancing and cleaning protocols. While some individuals were apprehensive about attending hospital appointments, comfort levels seem to have improved.
Newfoundland and Labrador
During the pandemic, the program deployed a new IT system that had real-time integration into the provincial client registry and the provincial Electronic Health Record. Participants are given a date and time for their next appointment as they receive results from their current appointment. The program also recognizes that people have changed their screening behaviors during the pandemic, and they are planning to proactively provide appointment dates and times to people who have missed screening.