Breast Imaging Guidelines
Screening Mammography- Self-referral
The Canadian Association of Radiologists (CAR), National Standards and Guidelines for Breast Screening, recommend mammography screening for asymptomatic women at least 40 years of age.
- Minimum age 40
- No new breast symptoms
- No breast implants
- No personal history of breast cancer
- Minimum 1 year since previous mammogram
- Resident of Nova Scotia with a valid Nova Scotia Health card
Frequency:
Women in Nova Scotia, aged 40-49, are recommended to have annual screening mammography
Women in Nova Scotia, aged 50-74, are recommended to have screening mammography at two year intervals. Women 50-74 can also be recommended to return on an annual basis if they:
- have a strong family history of breast cancer (mother, sister, daughter, father, brother, son),
- are currently on HRT or
- the radiologist has recommended returning sooner.
Women over the age of 75 are recommended to continue to have screening mammography if they are in good health.
Women or men who are symptomatic (have new breast problems) should be checked by their family physician and possibly have a Diagnostic Mammogram arranged for them by the physician's office. A requisition must be completed. Physicians are required to fax requisitions for Diagnostic Mammograms to 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 doctor's office to be issued to the woman. These requisitions must indicate specific new signs or symptoms, or other reasons for diagnostic eligibility such as:
- Symptomatic
- Post Surgical Breast Biopsy (if less than 1 year)
- All first post "benign" Core Biopsy follow-up mammograms
- All 6 month follow-up appointments
- Implants
- Pregnant or breast feeding
- Breast cancer survivors
- Women under the age of 40
It is not recommended to use ultrasound as a screening tool. It may be utilized:
- As an additional test if an abnormality is seen on mammography
- As an additional test for a palpable abnormality
- As an initial test on women under the age of 30 if there is a palpable abnormality.
If requested by the radiologist from a previous mammogram, 6 month mammogram or ultrasound procedures should be booked by the family physician. Following these short term follow-up requests, a return to routine screening is usual.
6 months following a benign core biopsy a unilateral diagnostic mammogram is recommended
12 months following the benign core biopsy a bilateral mammogram is recommended - this can be done as a screening mammogram
Treatment following a core biopsy with a histological diagnosis of "atypical ductal hyperplasia" is recommended to be similar to any boarderline lesion. This should involve a surgical consult and probable excisional biopsy. These patients should be followed with annual screening mammography.
The purpose of this guideline is to help radiologists, oncologists, surgeons and General Practitioners understand the role of MRI in breast cancer and to utilize the resource effectively in the appropriate clinical settings by outlining the indications for use in Nova Scotia. This guideline applies to women in Nova Scotia where breast MRI will:
- enhance treatment planning, problem solving or diagnostic evaluation of the breasts or
- serve as an additional screening modality for those women who are at high lifetime risk for breast cancer development (i.e > 25% lifetime risk of breast cancer).
*To view the entire Breast MRI Guidelines document in pdf format please click here