Expanded eligibility may lead to longer wait times

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This article was published 25/09/2024 (657 days ago), so information in it may no longer be current.

It’s a good-news announcement, but it creates expectations that our health-care system will find difficult to meet.

Yesterday morning, the Manitoba government announced that it plans to expand eligibility for breast cancer screening by gradually lowering the minimum age for self-referrals from 50 to 40. The first step toward that objective is a commitment to reduce the minimum age to 45 by the end of next year.

It’s a long-awaited promise that will undoubtedly save lives, but the government’s refusal to reduce the eligibility to age 40, as is occurring in other jurisdictions, means that many Manitobans will continue to die from a disease that has a high survival rate if detected and treated at its early stage.

Indeed, draft recommendations published by the Canadian Task Force on Preventive Health Care state that “women aged 40 to 74 should be provided information about the benefits and harms of screening to make a screening decision that aligns with their values and preferences. If someone in this age range is aware of this information and wants to be screened, they should be offered mammography screening every two to three years.”

The importance of that recommendation rests on the reality that breast cancer is the most common cancer, and the second leading cause of cancer-related death, among Canadian women. The Canadian Cancer Society estimates that one out of every eight Canadian women will develop the disease during their lifetime, and one in 36 will die from it.

The society projects that approximately 30,500 Canadian women will be diagnosed with breast cancer this year, representing 25 per cent of all new cancer cases among that group. An estimated 5,500 women will die from the disease nationwide, representing 13 per cent of all cancer deaths among women.

On top of that, the society also anticipates that 290 Canadian men will be diagnosed with breast cancer and 60 will die from breast cancer.

The numbers are terrifying, but the mortality rate for breast cancer has been cut in half over the past 25 years, thanks in large part to early detection and improved treatments.

With that in mind, and so many lives at stake, it is fair to ask why the government did not reduce the minimum eligibility age to 40 in one fell swoop, and why it refused to provide a clear timeline for when it will do so. The answer in this case appears to be the same reason why Manitobans endure some of the longest health-care wait times in the nation: we have too few staff, spread too thin across the province.

In yesterday’s media release, Health Minister Uzoma Asagwara said: “As we lower the screening age in Manitoba, it’s critical that the system has what it needs to meet a higher demand.” The minister added that “additional breast screening clinics will be added as targets and staffing requirements are met.”

The same release also pointed out that CancerCare Manitoba has been working with partners within the health-care system to hire more mammography technologists and increase screening appointments for individuals aged 50 to 74.

That may sound impressive, but the government is saying that our health-care system barely has the capacity — the doctors, nurses, technologists, health-care aides and infrastructure — to carry out the all the mammograms required under the existing (50 to 74) age criteria, let alone the many additional mammograms that would be required because of the lowered age criteria.

Even worse, it may not have the capacity to treat the additional cancer cases that will inevitably be detected because of the expanded testing.

The result is a situation in which it could be argued that the age criteria for mammograms is based upon our health-care system’s current capacity, and not on how many additional lives could be saved. It’s a calculated risk, caused in large part by a continent-wide shortage of health-care professionals.

The government deserves credit for recognizing the need to lower the age criteria for mammograms, and for its frankness about our health-care system’s capacity challenges. Until those challenges are solved, however, nobody should be surprised if the lowered age eligibility results in even longer wait times.