Bukun Adegbembo
Director of Operations, Canadian Breast Cancer Network
Personalizing breast cancer prevention matches advancements seen in breast cancer treatment.
Historically, cancer treatment decisions were largely based on where the cancer started, its type, and its stage. Today, advances in precision medicine are transforming cancer care by tailoring treatment to the individual, using patient characteristics and the unique biology of their tumour to guide decisions. With precision medicine, also called personalized medicine, treatments may be developed to treat multiple types of cancers that all share similar tumor characteristics. Another example of personalized medicine is a treatment developed for all individuals who have a certain genetic mutation, irrespective of the type of cancer they have.
As cancer treatment continues to evolve toward personalization, cancer prevention must advance in parallel to ensure people receive care that reflects their individual risk. Risk-stratified breast cancer screening supports a personalized approach to prevention by aligning screening methods, starting ages, and screening intervals with an individual’s level of risk, rather than applying a one-size-fits-all model.
Canada’s Current Approach to Breast Cancer Screening
Canada’s current national guidelines for breast cancer screening are for people at average risk of developing the disease. While most people fall into this category, guidelines focused only on average risk leave those at elevated or high risk without clear direction on their most appropriate screening options. This includes uncertainty around which screening method(s) is ideal (for example, mammography, ultrasound, MRI, or combinations of these); how often screening should occur (for example once a year or once every two years); what age screening should start; and if other tests should be done (for example genetic testing for those at risk of hereditary breast cancer).
Research from the Canadian Partnership Against Cancer shows that screening access and guidelines for people at elevated risk (such as those with dense breasts) and high risk (such as those with hereditary risk) vary significantly across the country. Some provinces and territories offer risk-based screening pathways, while others do not. Even when risk-based screening guidelines exist, definitions of risk categories, the recommended screening methods, screening intervals, and the ages to start screening differ considerably between provinces and territories.
The Path Forward
Developing national screening guidelines based on individual risk is essential to achieving equity in prevention and early detection. Canadians need screening approaches that help them make informed healthcare decisions based on their personal risk profile. Adopting a risk-stratified approach to breast cancer screening would ensure that prevention and early detection are personalized, helping to match advances already being achieved in personalized cancer treatment.
Relatedly, people across Canada need access to tools and resources that support them in understanding and assessing their individual risk of developing breast cancer. Once they are armed with this knowledge, then they can take charge of addressing their risk and following the appropriate risk pathway. Canadian Breast Cancer Network’s Beyond the Stereotypes: Aware of Risks. Aware of Myths. campaign does just that. We invite you to learn more about your breast cancer risk, explore ways to take charge of your breast health, and advocate for national risk-stratified pathways that personalizes Canada’s approach to breast cancer prevention and screening by visiting our website.
