Every province does its own thing.
Our screening program in British Columbia was the first in Canada in 1988. When we started, all women got a letter of invitation on their 40th birthday, and women were allowed to attend annually starting at 40 and going all the way through. It has gradually deteriorated over the years. We're striving for mediocrity instead of being the leaders now in B.C.
Now there is no letter, so if a woman happens to have seen something in a women's magazine and asks her doctor, it will depend greatly on what her doctor says. Now a woman in B.C. does not need a requisition. She can self-refer as long as she has the name of a physician to give. Sadly, only 25% of eligible women in their forties are having screening in British Columbia.
We know of examples, and because I volunteer with Dense Breasts Canada, which deals not just with dense breasts but works to get equitable access to screening across the country, we know of so many cases, as you heard from Dr. Appavoo, when a woman asked and even begged for a requisition, and her family doctor said, “No. That's not what we do here. You don't need one until you're 50.”
I give credit to the task force. As you heard from Dr. Nadler, it has changed it a bit this year. It still says it doesn't recommend it, but it's made it much clearer, from what I've read so far, that if the patient wants it, she should have it and the doctor should give her a requisition. That was not as clear when the 2018 guidelines came out. It was in the fine print, further down in the article. We even know of patients in British Columbia, where they don't need a requisition, if a woman asks her family doctor, she might be told not to bother until she's 50.