Many Nova Scotians qualify to self-refer for a screening mammogram—that means you don’t need a doctor’s referral. Diagnostic imaging procedures, however, do require a requisition from a health care provider because they’re used to assess new breast symptoms.
Screening mammograms - self-referral
Current guidelines recommend mammography every 2 years for individuals aged 50-74 who have no increased risk factors such as:
- family history (mother, sister, daughter, father, brother, son)
- evidence of high risk, such as genetic predisposition or radiation therapy to chest wall
If you have any of the risk factors noted above talk to a health care provider about how often you should be screened for breast cancer.
Please talk to a health care provider if you are between the ages of 40-49 and 75+ to see if screening is right for you. If you choose to be screened, you can contact the Nova Scotia Breast Screening Program directly to book an appointment.
Individuals aged 40-49 who choose to have a screening mammogram can be booked for a yearly mammogram. Individuals over the age of 75 who choose to have a screening mammogram can be booked for a mammogram every two to three years.
To be eligible for self-referral screening mammography you must have:
- No new breast symptoms
- No breast implants
- No personal history of breast cancer
- Minimum one year since previous mammogram
- Resident of Canada with a valid provincial health card
Diagnostic mammograms
A diagnostic mammogram is done to assess a breast problem, such as a lump, other breast changes, or following an abnormal screening mammogram. It takes longer than a screening mammogram because more pictures of different views of the breast are taken to look more closely at an area in the breast. You cannot self-refer for a diagnostic mammogram, only a primary care provider can arrange one.
Primary care providers are required to fax requisitions for diagnostic mammograms to 902-473-3959 or toll free at 1-866-470-3959 and a booking time and date will be assigned. The requisition will be faxed back to the primary care provider’s office who will notify the patient of the appointment. These requisitions must indicate specific new signs or symptoms, or other reasons for diagnostic eligibility such as:
- Symptomatic
- Short-term following-up imaging
- Implants
- Pregnant or breast feeding
- Breast cancer survivor
Breast ultrasound
An ultrasound uses sound waves to create an image and is used as an additional diagnostic test if an abnormality is seen on mammography or to evaluate a symptom. An ultrasound can show whether a lump is fluid-filled, such as a cyst, or solid. It’s not recommended to use ultrasound as a screening tool. Only a primary care provider can refer you for a breast ultrasound and it will be performed only if the radiologist feels it’s necessary and approves it.
Breast MRI
Magnetic Resonance Imaging (MRI) uses magnetic fields to create a three-dimensional image of the breast. MRI is used in addition to mammography and is only recommended for very specific clinical situations. Only a primary care provider can refer you for a breast MRI.
High-risk breast screening
Some individuals, due primarily to genetics, are considered at high risk of developing breast cancer—in which case both a mammogram and a breast MRI are recommended. You cannot self-refer for high-risk screening—a referral from a primary care provider is needed.
You are considered to be at high risk for breast cancer if they fall into any one of the following four risk groups.
- Known genetic mutation where mutation is associated with a high lifetime risk of breast cancer (e.g. BRCA1, BRCA2, Cowden’s Syndrome). The recommendation of a genetics service will also be accepted in the event that a single mutation has not, or cannot, be identified, but the person is considered by the genetics service to be at high risk.
- Someone who has declined genetic testing and who’s the first degree relative of a known mutation carrier (e.g. BRCA 1, BRCA2).
- High lifetime risk (>25%) of breast cancer as established and documented by a standard breast cancer risk assessment model (e.g. IBIS, BOADICEA).
- History of having received radiation as cancer treatment to the chest area (therapeutic thoracic radiotherapy) before age 30. Screening is not indicated until eight years after the end of radiotherapy or age 30, whichever date is later.
Women who fall into one of the above categories, have no personal history of breast cancer, have not undergone prophylactic bilateral mastectomy, and are 30 to 74, should get a screening mammogram and screening breast MRI every year.
Primary care providers: to refer a patient to high-risk breast screening, complete a breast MRI requisition with clear documentation of patient eligibility, and fax the completed form to NSBSP.