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The Role of Quality Breast Imaging in Screening and Assessment

By Dr. Jean Seely, Regional Breast Imaging Lead, Champlain Regional Cancer Program

The Ontario Breast Screening Program (OBSP) is an organized provincial screening program funded by the Ministry of Health and Long Term Care (MOHLTC) and administered by Cancer Care Ontario (CCO) and the Regional Cancer Program. The mission of the OBSP is to reduce mortality from breast cancer by delivering high-quality breast screening to Ontario women 50 years and older.

The OBSP:

  • provides high-quality mammograms in sites accredited by the Canadian Association of Radiologists (CAR)
  • sends results of the screening mammogram within 2 weeks to patients and to their family physician or other primary care provider
  • provides assistance to arrange referrals or additional tests if needed
  • sends a reminder letter to patients when it is time to return for their next screening mammogram.

There are 13 OBSP screening sites and 7 OBSP assessment centres in the Champlain LHIN. Both the Arnprior and Queensway Carleton Hospitals are in the process of becoming OBSP assessment centres. This will further expedite care of patients with screen- detected abnormalities.

High-quality mammography

There is a commitment to high-quality mammography in the OBSP. A rigorous process is in place by which all OBSP sites must maintain quality assurance. The results of all screening studies are carefully monitored to ensure the highest quality and compliance with National Practice Guidelines.

All OBSP screening and assessment centres require accreditation by the Canadian Association of Radiology Mammography Accreditation Program (CAR MAP). A list of CAR MAP accredited sites in Champlain region can be found on the CAR website. http://www.car.ca/en/accreditation/accredited-centres.aspx

CAR MAP is a 20-year-old program that ensures that the quality of mammography images meet the highest guidelines. It is a voluntary program that offers radiologists the opportunity for peer review and evaluation of a facility’s staff qualifications, equipment performance, quality control and quality assurance programs, image quality, breast radiation dose, and processor quality control where applicable. Facilities successfully completing the CAR requirements are granted accreditation for a three-year period, with annual updates.

The OBSP requires that sufficient volumes of screening mammography must be done at each site (1500 mammograms annually). However, the OBSP may approve sites with lower volumes to provide increased access and outreach to more remote communities. In these cases, a specific agreement, including quality indicators, is required.

The MOHLTC has directed CCO and the College of Physicians and Surgeons of Ontario to form the Ontario Quality Management Partnership in order to develop and implement comprehensive quality management programs. Mammography, colonoscopy, and pathology in Ontario will be included in this program.

Results: OBSP High Risk Screening Program (as of November 2013):

  • 594 high risk patients have been screened with MRI
  • 7 cancers detected
  • 1 interval cancer found
  • 79.3%  BIRADS 1 & 2 (benign)
  • 3.9%  BIRADS 3 (probably benign)
  • 12.3  % BIRADS 4 & 5 (recommended for biopsy)

Digital mammography

All OBSP sites in the Champlain LHIN use digital mammography units. Digital mammography offers several advantages over film-screen mammography:

  • highest cancer detection rates in younger women and in women with dense breasts
  • overall lower radiation doses
  • easier transfer of images by CD or digital imaging repository (DIR)
  • faster access to diagnostic imaging tests.

A recent CCO study on computed radiography (CR) showed that CR has lower cancer detection rates and should not be recommended for screening.

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