Concept: Breast Cancer Screening / Mammography

Introduction

This concept provides information on breast cancer screening / mammography provided in Manitoba. This includes a brief description of the Breast Screening / BreastCheck program operated by CancerCare Manitoba, the methods of identifying breast cancer screening / mammography in the MCHP Data Repository, a list of breast screening guidelines provided by the Breast Screening / BreastCheck program, and a list of MCHP research that has reported breast screening / mammography rates.

Breast Screening / BreastCheck Program

In Manitoba, a mammography is provided through CancerCare Manitoba's provincial breast screening program. This program was started in mid-1995 as the Manitoba Breast Screening Program and is now called BreastCheck. The Program contacts women directly for screening and rescreening, and sends out reminder notices if necessary. The program recommends that a specific target group of women be screened every two years for breast cancer. See the Breast Screening Guidelines section below for more specific information / recommendations.

Methods of Identifying Breast Cancer Screening / Mammography

The methods used at MCHP to identify breast screening / mammography have changed over time. Prior to the establishment of the Breast Screening BreastCheck program in 1995, mammography was entered twice in the Medical Services (Physician Claims) database; once as a physician claim and once as a laboratory bill. Double counting is prevented by the presence of the (encrypted) personal health identification number (PHIN) on each claim. Physician claims and laboratory bills show very high levels of agreement. With the program, mammography is entered once with a special code. The limited numbers of mammograms done in hospitals are billed by the physicians involved and are recorded in available administrative data.

NOTE : Screening and diagnostic mammography are not explicitly separated by coding in the Medical Services data. To deal with this, Roos, Traverse & Turner (1999) used data from 1994 through 1996 and tallied the percentage of women having at least one mammogram in 1, 2, or 3 years.

The method to identify breast cancer screening / mammography in the Medical Services data uses tariff codes for screening and diagnostic mammograms. To be included, one of the following tariff codes must be present in at least one physician visit over a two-year period:


• 7098 (Radiology, Intraluminal Dilatation, Mammography, Bilateral)
  
• 7099 (Radiology, Intraluminal Dilatation, Mammography, Unilateral)
  
• 7104 (Screening Mammography Bilateral)
  
• 7110 (Radiology, Intraluminal Dilatation, Xeromammography, Unilateral)
  
• 7111 (Radiology, Intraluminal Dilatation, Xeromammography, Bilateral)

In 2015, MCHP added the Breast Screening data from CancerCare Manitoba to the Data Repository, beginning with data in 1995. This data can also be used to investigate the occurrence of breast cancer screening / mammography in Manitoba.

Breast Screening Guidelines

The following guidelines provide an historical account of the recommendations for breast screening by CancerCare Manitoba's BreastCheck program:


• Prior to September 2008, the goal of the Manitoba Breast Screening Program was to screen 70% of Manitoba women age 50-69 every two years; approximately 33,000 women per year.
  
  
• Since September, 2008, the current guidelines recommend that most women between the ages of 50-74 should have a screening mammogram every 2 years. Women can be screened at BreastCheck if they are 50 years of age and over and:
  
  
  • do not have breast symptoms such as unusual lumps or bloody nipple discharge,
    
  • do not have a personal history of breast cancer, and
    
  • do not currently have breast implants.
  
  
• Women who are not eligible to be screened at BreastCheck should speak with their health care provider about the best breast health program for their individual needs.

For more general information, see the CancerCare Manitoba Web Site - BreastCheck.

Breast Cancer Screening Rates from MCHP Research

In MCHP research, breast screening rates have typically been calculated for women aged 50-69, but in more recent research (2016), this has been expanded to include women aged 50-74, as per the latest guidelines from CancerCare Manitoba.

The following links provide access to results and findings on breast cancer screening rates in MCHP research over time:


• see section 6.6 Screening Mammography in The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study deliverable (2002) for breast cancer screening rates by Tribal Council, comparing Registered First Nations versus All Other Manitobans by RHA, and comparing Off Reserve versus On Reserve Registered First Nations by RHA.
  
  
• see section 6.6 Breast Cancer Screening Rates in The Manitoba RHA Indicators Atlas: Population-Based Comparison of Health and Health Care Use deliverable (2003) for breast cancer screening rates by RHA and RHA Districts.
  
  
• see section 11.3 Mammography Rates (Breast Cancer Detection) in the Manitoba RHA Indicators Atlas 2009 deliverable (2009) for breast cancer screening rates by RHA, RHA Districts and Winnipeg Neighbourhood Clusters.
  
  
• see section Chapter 3: Prevention and Screening - Breast Cancer Screening in the Physician Integrated Network: A Second Look deliverable (2014) for breast cancer screening rates related to the implementation of Physician Integrated Network (PIN) clinics.
  
  
• see section Chapter 6 Cancer: Screening – Mammography (Breast Cancer Screening) in The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba deliverable (2019) for breast cancer screening rates by; RHA (On and Off reserve First Nations vs all other Manitobans), On Reserve First Nations by Tribal Council Area, Income Quintile (On and Off reserve First Nations vs other Manitobans).

Data Cautions / Limitations

Mammography data can be found in several data sources (e.g. Medical Services / Medical Claims, laboratory tests, CancerCare Manitoba screening program data). If using more than one data source, please check for duplication to avoid over counting.