For the most part, unfortunately, I'd like to say that it was women in the 40- to 49-year-old age group who were not recommended to have it because it was simply something they could “consider”, and it “could” be made available to them should they want to pursue that after a discussion with their primary care provider.
Unfortunately, in British Columbia and across the country, when it comes to accessing and discussing this with a primary care provider, that age group also includes any woman who should be considering a screening mammogram. There is the lack of understanding what a screening mammogram does and what it's for. There is the fear—and I'm speaking from the indigenous perspective of my indigenous patients and of my family members—of pursuing care in the health care system. There is the lack of cultural safety and the lack of access to a health care provider to talk to about this. All of that becomes something that then creeps into the 50-plus age group, where it is strongly recommended in the guidelines to start screening mammography.
However, most of my patients don't search the website to find out what BC Cancer is recommending or what is being recommended. They don't have the access to a primary care provider who says, “Hey, you're turning 50. I strongly recommend that you have a screening mammogram.”