Summary

This article explores advances in breast cancer detection in Canada, from traditional mammograms to 3D tomosynthesis, MRI, AI-assisted screening, and innovative tools like smart bras. It highlights challenges in access, dense breast awareness, and how research and advocacy are shaping the future of early detection.

The Limits of Mammography

Every year, millions of Canadian women dutifully book their mammograms, a quick, slightly uncomfortable, but essential step in breast cancer prevention. Yet for some, especially those with dense breast tissue, that familiar scan might not tell the whole story.

“Mammography is still our first line of defence, it’s still the best way to go,” says Kimberly Carson, CEO of Breast Cancer Canada. “But women with dense breasts really should be getting ultrasounds or MRI follow-ups. That should be the standard of care.”

According to the Canadian Cancer Society, dense breast tissue is not visible by touch and is only measured via imaging and though having dense tissue doesn’t guarantee cancer, it both raises risk and reduces mammographic sensitivity because dense tissue and tumours often appear similarly on an X-ray. 

Across Canada’s organized screening programs, mammography (typically 2D digital mammograms) remains the default for average‐risk populations. But it’s well documented that overlapping tissue can obscure small cancers, especially in high-density breasts. In traditional 2D mammography, the breast is compressed into a single flat image. Because breast tissue contains layers of glands, ducts, and fat, these layers can overlap and create shadows or bright spots that either mimic or hide abnormalities. This overlap makes it difficult for radiologists to distinguish between healthy and suspicious areas, which can sometimes delay or complicate diagnosis.

That’s why researchers and clinicians are increasingly incorporating complementary and new technologies, from 3D imaging to AI-enhanced diagnostics, to help fill in what mammograms sometimes miss.

As technology continues to evolve, experts like Kimberly Carson, CEO of Breast Cancer Canada, say the goal is not to replace mammograms, but to strengthen them with new, smarter tools that can detect cancer earlier and more equitably.

When Mammograms Need Backup: Complementary Diagnostics

Depending on individual risk and breast density, physicians may recommend additional screening methods. Below are some of the main tools in use (or under study) in Canada today.

3D Tomosynthesis (Digital Breast Tomography or DBT)

Tomosynthesis, also known as 3D mammography, captures multiple X-ray slices through the breast, reconstructing a layered 3D view. This helps address the “tissue overlap” problem common in 2D mammography. Studies show it can detect more cancers and lower recall rates, which are the number of women called back for additional testing due to unclear or suspicious findings. Some estimates suggest it reduces false-positive recalls by 30–40%.  

In Canada, several provinces have adopted tomosynthesis in screening or diagnostic settings. For example, Alberta includes DBT (3D mammography) in its screening guideline options.

In some provinces, tomosynthesis is already used in screening exams, while in others it’s being piloted or gradually implemented. One Ontario centre is participating in the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) to evaluate whether tomosynthesis should replace standard mammography.

Still, accessibility remains uneven across Canada. “We need more equipment faster so that we can catch cancer faster,” says Carson. “We know that if we catch it at stage one or stage two, it’s curable, so investment in newer technologies is crucial.”

Ultrasound

Ultrasound is often used as a supplementary imaging tool, especially in women with dense breasts or when mammogram results are ambiguous. Being non‐ionizing, painless, and relatively accessible, it helps detect lesions that may not show up well on X-ray-based imaging.

However, use of ultrasound as a blanket supplemental tool is controversial. While it can find additional cancers, it also increases false positives (leading to biopsies or follow-ups), and cost-effectiveness is debated.

MRI (Magnetic Resonance Imaging)

MRI is among the most sensitive imaging tools for breast cancer detection. It’s commonly used for women at high risk. Many clinical guidelines and Canadian programs support combining annual MRI with mammography for high-risk screening.

The Canadian Association of Radiologists’ Breast Imaging and Intervention guidelines note: “MRI is the modality of choice for supplementary screening for breast cancer in high-risk populations.” They also discuss Contrast-Enhanced Mammography (CEM) as an alternative in settings where MRI is not feasible, citing that studies combining CEM with 3D mammography showed promising cancer detection rates in intermediate-risk populations. But CEM isn’t yet widely adopted as a substitute for MRI in high-risk cases.

That’s where organizations like Breast Cancer Canada are stepping in,  using ongoing research to push for policies that make these tools more available across provinces.

Expert Insight: What Breast Cancer Canada Says

Kimberly Carson, CEO of Breast Cancer Canada, says her organization is using research to advocate for better screening and equal access nationwide.

“We use research to drive patient advocacy,” Carson explains. “Our goal is to make sure every breast cancer patient in Canada gets treated the same, no matter where they live.”

Through initiatives like Progress Tracker, Breast Cancer Canada gathers ongoing, real-time data from patients, every three months for ten years, to monitor how and when cancers are being detected. 

“We’re collecting data all the time,” Carson says. “That constant feedback helps us show policymakers where care isn’t as standard as it should be.”

Carson’s team also collaborates with oncologists through the REAL Alliance to push for national screening consistency and faster integration of innovative diagnostic tools.

Breast Cancer Canada has been actively supporting research and advocacy in screening innovations, including pathways to pilot new imaging modalities, funding or collaborating on AI-based tools, and pushing for policy that considers breast density in screening guidelines.

The organization also emphasizes awareness about dense breast tissue, recognizing that many patients do not understand what “density” means or how it affects screening. In their advocacy materials, they stress that “one size does not fit all” in screening and encourage patients and physicians to discuss personalized screening options. 

The Future of Early Detection: Emerging Technologies in Canada

The next decade of breast cancer detection in Canada may look radically different and far more personalized.

“The future of screening is going to be technology-based,” says Carson. “Imagine if we could do blood tests in all those remote areas of Canada, and if something came back, we could immediately send women for a mammogram. We’d catch it earlier.”

Smart Bra for Early Detection

In partnership with AstraZeneca, Breast Cancer Canada helped fund a “smart bra” that detects changes in breast tissue, potential early indicators of cancer. The project is also supported by the Canadian Cancer Society and is currently undergoing trials to determine how well it can identify early abnormalities.

“We funded, in partnership with AstraZeneca, a bra that you wear, and the technology changes in breast tissue that could potentially be an indicator that you need to go get checked,” Carson explained.

The smart bra is intended to complement traditional screening methods, offering a non-invasive, early-warning tool that could eventually work alongside mammography, ultrasounds, and MRI to enable more personalized, risk-based screening.

AI-Assisted Mammography & Risk Stratification

Recently, iCAD’s ProFound Risk 2.0 received Health Canada approval, marking a major regulatory milestone. This AI system analyzes mammograms alongside individual risk factors,  such as age, breast density, and imaging features to estimate a woman’s short-term (1–2 year) risk of developing breast cancer. Unlike the traditional “one-size-fits-all” approach, this tool allows for more personalized screening pathways and earlier intervention.

AI-Enhanced MRI / Glowing Tissue Methods

Researchers at the University of Waterloo are developing an AI-enhanced MRI technique that can make cancerous breast tissue “glow.” Using advanced imaging algorithms and deep learning, this method highlights malignant regions more clearly, enabling detection in as little as two minutes. Innovations like this could reduce scan times, lower costs, and make high-sensitivity imaging more widely available.

Portable, Non-Ionizing Imaging

Pfizer Canada is championing new technologies through its “Empowering Early Breast Cancer Detection through Innovation” initiative. One highlighted project is Wave View Imaging, which aims to develop a portable, non-ionizing imaging device optimized for women with dense breasts (especially in underserved or rural areas). The idea is to bring advanced imaging capacity closer to patients rather than relying only on fixed imaging centres.

Access and Awareness in Canada

While technological advances accelerate, equitable access continues to lag in many places. Not all provinces have consistent policies for supplementary screening, dense breast notification, or MRI access.

  • A 2021–2022 review from the Canadian Partnership Against Cancer notes that tomosynthesis, MRI, and ultrasound are used variably across provinces, often contingent on individual risk.
  • In Ontario’s OBSP (Ontario Breast Screening Program), participants now receive breast density notification in their mammogram result letters, and those with BI-RADS D density may be recalled in one year rather than two.
  • Supplementary screening can improve cancer detection in dense breasts, but it also raises costs, false positives, and potential harms, trade-offs that policy makers must weigh.

A Hopeful Outlook

Each year, promising tools edge us closer to earlier, more precise breast cancer detection. Mammography will likely remain foundational, but complementary and emerging technologies are redefining what “early detection” means for more women.

“I believe we should be able to catch breast cancer at stage one or two,  a very curable stage, so that we’re no longer seeing metastatic disease,” Carson said.

With research, advocacy, and thoughtful deployment, the future of breast cancer screening in Canada looks more tailored, inclusive, and hopeful than ever.

~ Read more from The Health Insider ~


The information provided on TheHealthInsider.ca is for educational purposes only and does not substitute for professional medical advice. TheHealthInsider.ca advises consulting a medical professional or healthcare provider when seeking medical advice, diagnoses, or treatment. To read about our editorial process, click here.

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