The Evolving Approach to Breast Cancer Screening and Treatment in Canada: Implications for Primary Care Providers

Authors

  • Greydon Arthur, MD Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • Charlotte J. Yong-Hing, MD, FRCPC Division of Diagnostic Imaging, BC Cancer, Vancouver, British Columbia, Canada Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • Nathalie LeVasseur, MD, FRCPC Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada

DOI:

https://doi.org/10.58931/cpct.2024.2333

Abstract

Nearly 30,000 Canadians are diagnosed with breast cancer annually, and while its mortality has decreased by over 55% since the 1970s due to modernized screening technologies and advances in systemic therapy, 5,500 Canadians are estimated to die of the disease every year. Primary care providers are critical through all steps of a patient’s breast cancer journey, from facilitating routine screening, to identifying breast cancer risk factors, ensuring expedient referrals, and recognizing acute or chronic treatment toxicities and their impact on overall physical and psychological health.

Author Biographies

Greydon Arthur, MD, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Dr. Greydon Arthur is a third year internal medicine resident at the University of British Columbia and is pursuing a career in medical oncology. He received his medical degree and an honours degree in Biomedical Sciences from the University of Calgary. There, he explored novel combination treatments to overcome mechanistic shortcomings of targeted cancer therapies in DNA repair-deficient malignancies and has since expanded his research to investigate outcomes in patients with advanced BRCA-deficient cancers. He continues to work with cancer care community partners to empower patients through the development of oncologic care feedback networks.

Charlotte J. Yong-Hing, MD, FRCPC, Division of Diagnostic Imaging, BC Cancer, Vancouver, British Columbia, Canada Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Dr. Yong-Hing is Vice Chair Equity, Diversity and Inclusion and Clinical Associate Professor at the University of British Columbia Department of Radiology. She is immediate Past President of the BC Radiological Society and is Medical Director of the BC Cancer Breast Screening Program. She works at BC Cancer Vancouver where she was Medical Director of Breast Imaging from 2017–2024, BC Women’s Hospital, and two UBC affiliated community imaging clinics. She co-chairs the UBC Radiology Equity, Diversity and Inclusion Committee, chaired the Canadian Association of Radiologists Equity, Diversity and Inclusion Working Group and founded Canadian Radiology Women in 2018.

Nathalie LeVasseur, MD, FRCPC , Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada

Dr. Nathalie LeVasseur is an Assistant Clinical Professor in the Department of Medicine, Division of Medical Oncology at the University of British Columbia in Vancouver. She received her medical and completed her internal medicine residency at the University of Ottawa. She subsequently pursued a residency in medical oncology at the University of British Columbia and served as chief resident before completing a breast cancer clinical and research fellowship at the BC Cancer Agency. Dr. LeVasseur is the current chair of Breast Systemic Therapy in BC, the lead of the Breast Cancer Clinical Trials Unit in Vancouver and serves on the Canadian Cancer Trials Group IND Executive Committee and the BC Personalized Oncogenomics Steering Committee. Her research focus is in the development of personalized oncology, the improvement of patient outcomes and survivorship.

References

Brenner DR, Poirier A, Woods RR, et al. Projected estimates of cancer in Canada in 2022. CMAJ 2022;194:601-7. DOI: https://doi.org/10.1503/cmaj.212097

Caswell-Jin JL, Sun LP, Munoz D, et al. Analysis of Breast Cancer Mortality in the US – 1975 to 2019. JAMA 2024;331:233-41. DOI: https://doi.org/10.1001/jama.2023.25881

Kantarjian HM, Wolff RA, Rieber AG. The MD Anderson Manual of Medical Oncology. Fourth Edition. New York City: McGraw Hill; 2022.

Thériault G, Slavtcheva N, Flemming J, et al. Breast Cancer (2024 Update) – Draft Recommendations. Canadian Task Force on Preventative Health Care; May 30, 2024 [September 22, 2024]. Available from: https://canadiantaskforce.ca/breast-cancer-update-draft-recommendations

Hellquist BN, Duffy SW, Abdsaleh S, et al. Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort. Cancer 2011;117:714-22. DOI: https://doi.org/10.1002/cncr.25650

Coldman A, Phillips N, Wilson C, et al. Pan-Canadian study of mammography screening and mortality from breast cancer. J Natl Cancer Inst 2014;106:dju261. DOI: https://doi.org/10.1093/jnci/dju261

Wilkinson AN, Ellison LF, Billette JM, et al. Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years. J Clin Oncol 2023;41:4669-77. DOI: https://doi.org/10.1200/JCO.23.00348

Nicholson WK, Silverstein M, Wong JB, et al. Breast Cancer: Screening – Final Recommendation Statement. U.S. Preventative Services Task Force; April 30, 2024 [September 22, 2024]. Available from: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening#bootstrap-panel--12

D’Orsi C, Sickles E, Mendelson E, et al. Breast Imaging Reporting and Data System. ACR BI-RADS® Atlas, American College of Radiology; 2013 [September 22, 2024]. Available from: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads

Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002;225:165-75. DOI: https://doi.org/10.1148/radiol.2251011667

Butler RS, Hooley RJ. Screening breast ultrasound: update after 10 years of breast density notification laws. AJR AM J of Roentgenol. 2020;214(6):1424-35. DOI: https://doi.org/10.2214/AJR.19.22275

Ohuchi N, Suzuki A, Sobue T, et al. Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan strategic anti-cancer randomized trial (J-START): A randomised controlled trial. Lancet 2016; 387:341-8. DOI: https://doi.org/10.1016/S0140-6736(15)00774-6

Cheung Y, Lin Y, Wan Y, et al. Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: Interobserver blind-reading analysis. Eur Radiol 2014;24:2394-403. DOI: https://doi.org/10.1007/s00330-014-3271-1

Lee C, Monticciolo D, Moy L. Screening Guidelines Update for Average-Risk and High-Risk Women. AJR AM J of Roentgenol. 2020;214(2):316-323. DOI: https://doi.org/10.2214/AJR.19.22205

Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 2014;384:164-72. DOI: https://doi.org/10.1016/S0140-6736(13)62422-8

Schmid P, Cortes J, Pusztai L, et al. Pembrolizumab for Early Triple-Negative Breast Cancer. N Engl J Med 2020;382:810-21. DOI: https://doi.org/10.1056/NEJMoa1910549

Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol 2012;13:25-32. DOI: https://doi.org/10.1016/S1470-2045(11)70336-9

Cortes J, Rugo HS, Cescon DW, et al. Pembrolizumab plus Chemotherapy in Advanced Triple-Negative Breast Cancer. N Engl J Med 2022;387:317-26. DOI: https://doi.org/10.1056/NEJMoa2202809

Nakai Y, Otsuka T, Inoue T, et al. Two cases of delayed onset of immune-related adverse events after discontinuation of nivolumab in patients with metastatic renal cell cancer. IJU Cas Rep 2021;4:326-9. DOI: https://doi.org/10.1002/iju5.12338

Schneider BJ, Naidoo J, Santomasso BD, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J Clin Oncol 2021;39:4073-126. DOI: https://doi.org/10.1200/JCO.21.01440

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Published

2024-12-19

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1.
Arthur G, Yong-Hing CJ, LeVasseur N. The Evolving Approach to Breast Cancer Screening and Treatment in Canada: Implications for Primary Care Providers. Can Prim Care Today [Internet]. 2024 Dec. 19 [cited 2025 Jan. 22];2(3):5–11. Available from: https://canadianprimarycaretoday.com/article/view/2-3-Arthur_et_al

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Volume 2, Issue 3, Fall 2024

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