It varies from province to province.
For example, in Dr. Gordon's province of B.C., women in their forties don't need a requisition to screen. They can go and screen, but they're not necessarily encouraged to screen, whereas there's probably.... If it's similar to Alberta, you have about 60% of women in the target age group—so 50 and up—who will screen.
In the 40 to 49 age group, about 20% of those women will screen. They're allowed to self-refer, but their doctors don't push them to do it. When I say push, I mean encourage them, have the discussion or just say, “You should do this, if you want.”
In other provinces where.... I think in Ontario you have to have a requisition to screen. In Alberta, you do at 40, as well, if you want to screen. It requires that the family doctor be motivated to want to screen that patient. The family doctors very often—not all of them—take strong leadership from the task force. If the task force is saying not to screen, the doctor is going to say not to screen.
Time after time.... I work with a patient engagement group for the Canadian Society of Breast Imaging. Several, if not most, of the patients on the panel had asked for a screening mammogram at 40 and were told that, no, they didn't need it, that the task force said they didn't need it, and then within a few years, they showed up with a late-stage cancer.