Breast Imaging

The Ontario Breast Screening Program (OBSP) expanded to offer screening to people ages 40-74, this also includes those with breast implants. Which offers patients the chance to book their screening mammogram without the need for a physician's requisition. To book, call: 519-941-2410 ext. 2842.

People over age 74 can be screened; however, they are encouraged to make a personal decision about breast cancer screening in consultation with a family doctor or nurse practitioner. A requisition will be required for anyone who is not eligible for OBSP.

eReferrals: All of our Diagnostic Imaging services are now using Oceans eReferral.

Faxed mammography requisition referrals are accepted; however, faxed referrals have a longer processing time than eReferral.

If you did not receive a letter or misplaced it, you can also call to review your eligibility or when you are due for your next screening mammogram.

More Information

About OBSP and eligibility, refer to CCO - Screening for Breast Cancer.

The Ontario Breast Screening Program is part of Cancer Care Ontario. They recommend that women become familiar with what is normal in their breasts.

A mammogram is a diagnostic procedure using low dose X-ray of the breasts to detect any abnormalities or changes in the breast. Regular routine screenings improve early detection of breast cancer.

Schedule wisely: Book your mammogram for a time when your breasts are less tender, usually a week after your menstrual period. Avoid caffeine a few days prior to your exam, this may help with discomfort.  

Inform our Clerical team upon booking: 

• Patients experiencing breast symptoms are advised to see their physician as we will require a requisition for a diagnostic mammogram in conjunction with a breast ultrasound.
• If you have any previous Breast Imaging at another facility within 10 years. Please let us know the name of the facility so those images can be retrieved prior to your appointment for comparison.
• If you have breast implants or mobility restrictions.

Wear a two-piece outfit: You will need to remove your top and bra for the exam. Keep long hair tied or pinned up if possible.

Avoid deodorant, lotions and perfume: Do not apply any deodorant, antiperspirant, powders, or lotions on your underarms or chest, as they can appear as white spots on the X-ray, resulting in repeat imaging. Please no fragrance, as we are a scent free facility.

Clinical History Intake: A technologist, who specializes in mammography, will call you into the exam room, a brief clinical history form will be completed together. 

Please inform your technologist if you:

• Are pregnant or breastfeeding
• Have breast implants
• Had any prior breast surgeries or biopsies
• Are experiencing any breast symptoms (lumps, pain, nipple discharge, etc.)

Positioning: The technologist will position one breast at a time and may lift, turn and/ or change your position to get all the breast tissue into the image. 

Compression: Pressure will be applied to the breast to spread out the tissue for a clearer image. You will stay in place until the image is taken, within a few seconds. This may be uncomfortable but should not be painful. This pressure does not harm the breast. For those with Implants, the technologist will further explain how we position and alter the compression for optimal imaging. 

Imaging: Two or more X-ray images are taken of each breast from different angles, Average exam takes 4-6 images total.

Duration: The procedure on average takes 10-15 minutes. More time is provided for those with implants and with mobility restrictions. 

• Results can take a few days no more than a week. 
• Radiologist’s report may request additional imaging to get a more detailed view of certain breast tissue. 
• You may be called to return for an additional mammogram and/or breast ultrasound. 
• Your family physician will receive results.
• Those enrolled in OBSP will receive a letter by mail.

If results are normal, continue with regular screenings as recommended. 

• Routine screening is every 2 years.

Yearly screening may be recommended if,

• Patient has a close family history of breast or ovarian cancer
• Radiologist Report indicates - High Breast Density (type D)
• For more information, visit CCO - Breast Density Information.

If results require additional imaging, you may be called back for Diagnostic Mammogram/follow up Imaging appointment.

Probably benign findings – short term follow up, is an area of concern that has a very low chance of becoming cancer. It is helpful to be extra safe and see if the area in question does change over time.

• You will likely need follow-up with repeat imaging in 6 to 12 months and regularly after that until the finding is known to be stable (usually at least 2 years).
• This approach helps avoid unnecessary biopsies, but if the area does change over time, it still allows for early diagnosis.

Suspicious abnormality – biopsy recommended, these findings indicate an area the radiologist is concerned enough to recommend a biopsy.   

• A needle is guided by either ultrasound, mammogram guidance (stereotactic 3D) or MRI to sample the amount of small tissue.  

The biopsy sample will be sent to a lab for Pathologist to test and complete a pathology report.

After an initial screening mammogram, the radiologist may indicate further evaluation needed to take a closer look with more detailed imaging. 

Reasons for a recall include:

• The radiologist sees an area that needs a closer look.
• These images were unclear or incomplete.
• Dense breast tissue makes evaluation difficult.

If recalled do not panic, most follow-up tests confirm Benign (non-cancerous) findings.

Additional imaging services:

3D tomosynthesis (3D mammogram)

• Provides a more detailed, multi-layered view of breast tissue, by moving the x-ray tube in an arc. Reconstruction of these images produces the final 3D image. 
• Helpful for women with dense breasts or those with inconclusive screening results.
• Positioning and compression are the same as a routine mammogram.

Spot magnification views

• Specialized mammogram technique using a special platform to magnify the area of the breast. 
• Needed to further evaluate microcalcifications (tiny calcium deposits). This provides greater detail and sharpness, helping to differentiate between benign (non-cancerous) and suspicious findings.

Breast ultrasound

• Uses sound waves to examine a specific area of concern.
• Often recommended for dense fibrous breast tissue or to further evaluate a mass, cysts or lymph nodes detected on a mammogram.

Breast MRI 

• Recommended in certain high-risk cases, such as strong family history or genetic predisposition.
• May be used to further evaluate complex breast findings.
  

This appointment will include a traditional 2D mammogram and further evaluation, with additional imaging while a radiologist is onsite to review. This is done for those with new clinical concerns, or those requiring following up from their screening mammogram.

It is another method to perform a mammogram. The positioning is the same as a traditional mammogram, except the x-ray tube moves in an arc and takes pictures of multiple layers of the breast tissue. Reconstruction of these images produces the final 3D image for assessment.

Benefits: Provides greater detail than regular mammography and can reduce the need for biopsies. Tomosynthesis is especially helpful for imaging dense breast tissue, and at low radiation exposure.
Preparing for this exam is the same as a regular mammogram. The technologist will explain how the procedure is done, review your brief medical history, and answer any questions.

A biopsy performed under mammographic imaging to accurately target and guide the biopsy needle into the lesion. The lesion is sampled and sent to a lab for testing.  This is a highly accurate procedure that aims to target deep lesions.  

Preparing for a stereotactic 3D biopsy: You will go through an intake form prior to your biopsy identifying any risks or contraindications to having the procedure done. The technologist will answer questions with you on the day of your procedure. A radiologist will perform the biopsy and help provide more information. They will freeze your breast tissue using local anesthetic, insert a needle to take samples, obtain images to confirm needle placement, and then remove the needle. A very small Breast Clip marker will be left in your breast as an indication this specific area was biopsied for imaging and/or future surgical reference. You will be provided with post-procedural care instructions.  

eReferrals: All of our Diagnostic Imaging services are now using Oceans eReferral. 

Faxed breast biopsy requisition referrals are accepted, however, faxed referals have a longer processing time than eReferral.

Women, trans and nonbinary people ages 30 to 69 can get screened through the High Risk OBSP if they have a referral from their primary care provider, a valid Ontario Health Insurance Plan number, no breast cancer symptoms and meet criteria listed in Category A or B.

• Category A – Eligible for direct entry into the High Risk OBSP based on personal and family history. To fall under this category, at least one of the following criteria must be met:
  • Known carrier of a pathogenic or likely pathogenic gene variant (e.g., BRCA1, BRCA2, TP53, PALB2) that increases their risk for breast cancer
  • Have not had genetic testing, but have had genetic counselling because they are a first-degree relative of a carrier of a pathogenic or likely pathogenic gene variant (e.g., BRCA1, BRCA2, TP53, PALB2) that increases their risk for breast cancer
  • Previously assessed by a genetics clinic (using the IBIS or CanRisk risk assessment tool) as having a 25% or greater lifetime risk for breast cancer based on personal and family history
  • Have had radiation therapy to the chest to treat another cancer (e.g., Hodgkin lymphoma) before age 30 and at least eight years ago
• Category B – Genetic assessment required (i.e., counselling and/or testing) to determine eligibility for the High Risk OBSP. To fall under this category, at least one of the following criteria must be met:
  • An identified pathogenic or likely pathogenic gene variant that is associated with breast cancer risk (e.g., BRCA1, BRCA2, TP53, PALB2) in a close blood relative
  • A personal or family history of a cancer suggestive of a hereditary breast cancer syndrome

People with a personal history of breast cancer and/or breast implants may get screened through the High Risk OBSP if they meet program eligibility criteria.

The High Risk OBSP does not accept new participants over age 70. However, when participants already in the High Risk OBSP turn 70, the program will continue to screen them with mammography only every year until they are age 74.

High Risk OBSP sites do not send letters to people over age 74 about participating in the program. To continue screening through the High Risk OBSP, a referral is required from a primary care provider.

Once the High Risk OBSP Requisition Form and relevant supporting material is received, the High Risk OBSP site will:

1. Arrange for screening for people who are eligible for direct entry into the program; or
2. Refer people on to genetic assessment (i.e., counselling and/or testing) to determine if they are eligible for the program.

The High Risk OBSP site will recall people annually if their results are normal. If screening results are abnormal, the High Risk OBSP site will arrange for follow-up testing.

Genetics clinics are responsible for completing genetic assessments to determine eligibility for screening through the High Risk Ontario Breast Screening Program (OBSP).

Risk assessments (using the IBIS or CanRisk risk assessment tools) should be completed by genetics clinics to ensure consistent and standardized care for everyone across the province. In addition to conducting the risk assessment, genetics clinics will provide genetic counselling to patients. This includes reviewing their breast cancer risk score, as well as discussions about genetic testing (if appropriate), personal risk factors, family history and options for screening and prevention of breast cancer.

As a primary care provider, you can help facilitate an accurate breast cancer risk assessment by completing the High Risk OBSP Requisition Form and providing relevant supporting documentation along with the referral.