First of all, I need to explain that it is well known that a percentage of women, perhaps around 10% plus or minus are going to be recalled. It is known that women are much less anxious if they're prepared ahead of time and if they're told that this could happen. It's most likely to happen on their first screening mammogram, because there are no priors to compare to. Women need to be told, just as they need to be informed about the possibility of overdiagnosis, so they're prepared.
For my wish list, I'll start with what Dr. Appavoo said, that all women should be assessed for risk early in life, perhaps at around the age of 30. Then all average-risk women who don't need to be screened younger because of increased risk would be able to start at 40. They should be able to self-refer without a requisition from their physician. They should be able to go annually, at least when they're premenopausal, because that's when hormones cause breast cancers to grow faster, and ideally annually until they don't have 10 years of life expectancy left.
We have loads of data to show that's how you save the most lives, the most years of life, and how you get to offer the least aggressive therapy.
Women should be told after they have their screening mammogram what their breast density is. We've only just now, after seven years of lobbying, finally got pretty much every province and territory on board to tell women their breast density. Up until 2018, no woman in Canada was being told their breast density. Why? We were told that it was because we were going to make them anxious.
When men have high blood pressure, we tell them they have high blood pressure because it's a risk and they need to know information about their own health. Women deserve to know their breast density because of the two associated risks.
From there, any woman with category C or D—those are the women with dense breasts—should have access to supplemental screening because, when a woman has dense breasts, there's a risk that her cancer might not be seen on her mammogram. That supplemental screening with either ultrasound or MRI can find many of those cancers.
Finally, women should be able to continue having screening beyond age 74 until their life expectancy is less than 10 years. For most women, that's age 80. At age 75, according to Stats Canada, a healthy woman has a life expectancy of 13 years, and at age 80, it's 10 years.
That's my wish list for screening.