About 150 hospitals and clinics across Canada are operating breast-cancer screening machines that have failed a national quality test, have never been tested, or are no longer being tested, causing health-care experts to worry that cancers may be missed.
For thousands of Canadian women, that means they are being screened on equipment that is too old or of questionable quality. Or they are being sent to a facility that has let its accreditation with the Canadian Association of Radiologists lapse, or has never applied for it.
"If the accreditation was lost for quality reasons, there is a concern that cancers could be missed if the quality is really bad," said Normand Laberge, chief executive officer of the association. "Or women could be falsely told they may have cancer."
Unaccredited machines can be found in small clinics in rural areas and in big cities. Two of Ontario's 51 unaccredited machines are in Canada's biggest cancer hospital, Princess Margaret Hospital in Toronto. Further west, accreditation on a North Battleford machine run by the Saskatchewan Cancer Agency was suspended, a Globe and Mail investigation has found.Fewer than half of New Brunswick's machines are accredited, while Prince Edward Island has none. In Newfoundland and Saskatchewan, almost one-third of the machines are not accredited, Mr. Laberge said.
The accreditation process involves testing the machines and scrutinizing the qualifications of the people operating them and the doctors interpreting the mammography films. There are also surprise inspections.
In much of the country, accreditation is voluntary. Only Alberta, Nova Scotia and Quebec demand breast-screening mammograms be done on accredited machines; British Columbia plans to do the same by the end of this year.
For the rest of Canada, nothing stops the 50 machines that have failed accreditation from being used.
Another 48 machines were never evaluated and 50 others have allowed their accreditation to lapse. Currently, 540 mammography machines have accreditation or are in the process of renewing it, Mr. Laberge said.
Dr. Rene Shumak, chief radiologist of the Ontario Breast Screening Program, does not recommend any woman get a mammogram at an unaccredited centre.
"If somebody hasn't gotten accredited by now, they aren't keen enough and maybe they shouldn't be doing screening mammography," Dr. Shumak said.
"If you go to a site that is not accredited, we don't know that it's no good but they haven't made the effort to prove that it is good."
Clinics are under no obligation to post their accreditation, or lack thereof, and women must consult the association's website to find clinics and hospitals that have passed the test.
Due to confidentiality agreements, Mr. Laberge could not identify clinics and hospitals that have failed accreditation. However, he would confirm or contradict information that clinics and hospitals provided for this article.
Some clinics told The Globe and Mail that the process is too costly, with it averaging $400 annually for three years, at which time the accreditation has to be renewed. A few have moved to digital machines and have had difficulty fulfilling the printing requirements.
Such is the case at Princess Margaret Hospital, in downtown Toronto, where 11,500 diagnostic and screening mammograms are performed each year.
Dr. Marcus Dill-Macky, who heads the hospital's breast-imaging department, said the quality available there is as good or better than at any accredited centre. The hospital, he said, let its accreditation lapse on one analog machine as there were plans to replace it. However, its replacement didn't work out.
Due to printing and bureaucratic issues, the hospital has not been able to obtain accreditation for the second machine, a digital one.
Princess Margaret Hospital plans to join the Ontario Breast Screening Program, which demands accreditation, by the end of summer, said Jennifer Kohm, the hospital's spokeswoman.
The accreditation on the Saskatchewan Cancer Agency's mobile North Battleford machine has been suspended, said Lois Harrison, executive director of the prevention and early detection division. She said the association believed an uncertified radiologist was interpreting the films when, in fact, a certified radiologist from Saskatoon was the one reading them.
