Nfld. & Labrador

'Not a very good feeling': Breast cancer screening changes worry Corner Brook woman

The health authority says it's not about saving money, but about bringing cancer screening programs in line with national guidelines.

National experts say clinical breast exams produce many false positives

Eastern Health says national guidelines for breast cancer screening do not include manual breast exams in a clinical setting, if a patient is of average risk.

A woman in Corner Brook is upset by a change in breast screening procedures across Newfoundland and Labrador.

Donna Davis went for her annual checkup last week at the Breast Screening Centre in Corner Brook, and was told clinical breast exams aren't offered there anymore.

"With that gone," said Davis, "I tell you, it's not a very good feeling."

Davis said she's been getting a mammogram and clinical breast exam for the past six years, since she turned 50.

Last week, she still received her mammogram, but was told the nursing staff that used to be based at the Centre are no longer employed there.

Davis is not happy to lose out on a service she valued so much.

"That was my main reason actually for going to the breast clinic because, for people out there that had a breast exam there, they did a really, really good job. And I felt more comfortable having the breast exam than I did the mammogram."

Davis said early detection is emphasized as the key to successfully finding and treating cancers of all types, so she's surprised by this change. She found it reassuring to have that extra measure of screening.

"From people that I've talked to that have had the breast exams, they've found a lot of cancers that probably they would not have found."

Cancer screening clinics across the province stopped offering clinical breast exams in May, to women who are not considered high risk. (Lindsay Bird/CBC)

Not about money

Eastern Health, which runs Corner Brook's Breast Screening Centre as part of the Provincial Breast Screening Program, said the change was made in May at all its screening facilities, in St. John's, Gander and Corner Brook.

The equivalent of five full-time nursing positions were cut as a result, and that's expected to save about $465,000 per year.

But the health authority said the change is not a cost-cutting measure: It's meant to bring procedures in this province in line with national guidelines.

Those guidelines on breast screening come from the Canadian Task Force on Preventive Health Care, which says that clinical breast examinations are not a recommended method of screening for breast cancer.

A report published in the Canadian Medical Association Journal in 2011 states: "We recommend not routinely performing clinical breast examinations alone or in conjunction with mammography to screen for breast cancer. 

Eastern Health said Newfoundland and Labrador was the only province to still offer clinical breast exams.

Research does not support

Dr. Marcello Tonelli, chair of the Canadian Task Force on Preventive Health Care, said he can understand a patient's concerns, but research simply doesn't support the idea of clinical breast exams for all women.

"We reviewed the evidence about what was known about clinical breast examination and we found no evidence that doing the breast exam actually helps women," he said.

"There's no evidence that it detects cancers earlier, there's no evidence that it helps them avoid a death from breast cancer, and there is some evidence that it leads to false positive results and the need for unnecessary tests."

In fact, Tonelli says research shows that one in 10 clinical breast exams result in a false positive, which can lead to further procedures, including biopsies or even surgery.

"In healthy women, most of the time, these lumps which don't have symptoms, they're not actually cancer. And so the follow-up tests that we do, they have harms," he said.

Tonelli stressed this recommendation against clinical breast exams is only for women who are at average risk of getting breast cancer, and not for women who have a family history or previous history of breast cancer.

"If a woman has a concern about her breast, if there's any symptoms, like a lump or pain or discharge or anything like that, women should go to their doctors or their health provider in that case, and they should have a breast exam done."

Tonelli had some words of reassurance for women like Donna Davis who'd still like to have the option of a clinical breast exam: "She's doing the right thing. She's being aware. She's asking good questions but, in this case, we can assure her that a clinical breast examination is not needed."