Four new things to know about cancer screening and care

The Christopher Sharp Cancer Centre at Mount Sinai Hospital is home to one of the largest cancer programs in Ontario, bringing together specialized expertise and compassionate, patient-centred care. Across Sinai Health, clinical and research teams are also contributing to collaborative work that is changing how care is delivered.

“As our understanding of cancer grows, we’re better able to consider the individual factors that can shape a person’s care, from their risk factors to the characteristics of their cancer and their experience during treatment and survivorship,” said Dr. Christine Brezden-Masley, Medical Director of the Cancer Program at Sinai Health and Director of the Marvelle Koffler Breast Centre. “For patients, understanding the options available to them can support informed conversations with their care teams and decisions about their care.”

Here are four changes and advances you should know about:

1. More Ontarians can access breast cancer screening starting at age 40

In October 2024, the Ontario Breast Screening Program (OBSP) lowered the starting age for breast cancer screening from 50 to 40. People ages 40 to 74 who qualify for the program do not need a referral from a doctor or nurse practitioner and can make a mammogram appointment directly at an OBSP location.

Your age and family and personal medical history help determine when you should get screened:

• Ages 40 to 49: The OBSP encourages people in this age group to talk with their family doctor, nurse practitioner or a Health811 navigator to make an informed decision about whether breast cancer screening is right for them. Most people ages 40 to 49 who decide to get screened should get screened with mammography every two years.
• Ages 50 to 74: The OBSP recommends that people in this age group should get screened every two years with mammography. 
• Ages 30 to 69 at high risk: People who meet the High-Risk eligibility criteria are recommended to get screened once a year with mammography and breast magnetic resonance imaging (MRI), or screening breast ultrasound if breast MRI is not medically appropriate. People need a referral from their primary care provider to access screening through the High Risk OBSP.

What to know: If you are between ages 40 to 74 and qualify for regular screening through the OBSP, you can book a mammogram directly - you do not need a referral from a doctor or nurse practitioner.

The team at the Marvelle Koffler Breast Centre welcomes appointment requests from patients looking to learn more about breast screening or book an appointment. To book a screening, call 416-586-4800 ext. 4422, or visit Cancer Care Ontario to learn more.

*People over age 74 can continue to be screened through the OBSP but are encouraged to make a personal decision about screening in consultation with their family doctor or nurse practitioner. A referral from a primary care provider is required to continue screening through the program after age 74.

2. New evidence shows that exercise can improve colon cancer survival

A Canadian study has added to our understanding of how structured physical activity may support people undergoing treatment for colon cancer.

The CHALLENGE trial followed 889 people who had completed surgery and chemotherapy for colon cancer. Participants who took part in a three-year structured exercise program had better long-term outcomes than those who received education materials alone, including improvements in overall survival and disease-free survival.

What to know: If you are undergoing treatment for colon cancer, these findings offer another consideration for your wellbeing and recovery. Your care team can help you explore how physical activity may fit into your care.

3. Colorectal cancer screening has expanded to younger Ontarians

As of July 1, Ontario has lowered the starting age for colorectal cancer screening with the fecal immunochemical test, or FIT, from 50 to 45.

FIT is a safe, painless at-home test that checks stool for tiny amounts of blood, which could be caused by colorectal cancer or some types of polyps. The kind of screening test you get depends on whether you are at average risk or increased risk of getting colorectal cancer.

• Ages 45 to 74: People in this group should be screened with FIT every two years. Flexible sigmoidoscopy every 10 years is another screening option for those in this category. Either test must be ordered by a family doctor or nurse practitioner
• People at increased risk because of family history: Colonoscopy is recommended every five years, starting at age 40 or 10 years earlier than the youngest age a relative was diagnosed with colorectal cancer, whichever comes first. You are considered at increased risk if you have one first-degree relative (parent, sibling or child) diagnosed before age 60, or two or more first-degree relatives diagnosed at any age.
• Age 75 and older: People in this group should talk to their family doctor or nurse practitioner about whether colorectal cancer screening is right for them.

Screening is intended for people who do not have colorectal cancer symptoms. If you have new or unexplained symptoms that could be caused by colorectal cancer, speak with a health-care provider for further assessment rather than waiting for routine screening.

What to know: If you qualify for FIT, talk to your family doctor or nurse practitioner. They can order the test, and once it has been ordered, a FIT kit will be mailed to you. If you do not have a family doctor or nurse practitioner, you can call 811 or visit Health811 for help accessing screening. For more details on screening, go to Cancer Care Ontario or speak with your health-care provider.

The team in the Endoscopy Unit at Mount Sinai provides colonoscopy for patients who have a positive FIT result and for individuals who meet the criteria for increased risk (with primary care referral).

4. Collaborative research is uncovering new clues about aggressive breast cancers

Understanding the biology of aggressive cancers can help researchers identify new possibilities for how they may one day be treated.

Using a new gene-editing tool called CRISPR-KOALA, researchers at Sinai Health’s Lunenfeld-Tanenbaum Research Institute and the University of Toronto have identified 81 previously unrecognized genes that may help drive basal-like breast cancer, which includes many triple-negative breast cancers.

Among those findings, researchers identified a gene called PLGRKT as a potential target for further study. The gene appears to help cancer cells survive and grow in low-oxygen areas within tumours, offering researchers a new avenue to explore as they investigate potential treatments.

What to know: While these findings are still early-stage, they may help inform future approaches for aggressive breast cancers.

Continuing to advance cancer care

At Mount Sinai Hospital, teams are working across clinical care and research to continue advancing how cancer is understood and treated. This includes specialized, patient-centred care, innovative drug therapies, complex surgical approaches and targeted treatments, alongside research that is helping to inform future approaches to care.

As cancer care continues to evolve, understanding what is changing can help you make informed decisions about your health. Whether it’s knowing when you may be eligible for screening, understanding your options during treatment or learning about developments that could shape care in the future, staying informed can help you know what questions to ask and when to connect with your health-care provider or care team.