Don’t Have A Family Doctor? Here’s How To Get A Mammogram Without One

Across Canada, women who are 50 or older can book a mammogram every two years through their provincial breast screening program without a doctor’s referral. But in eight provinces, women in their 40s at average risk who want to stay on top of their breast health still need a requisition for a mammogram from a doctor or nurse practitioner. 

More than six million Canadians—one in five people—currently don’t have access to a family doctor. If you fall into this group and don’t qualify for self-referral, what are your breast cancer screening options? Chatelaine asked two experts for their advice on navigating this situation.   

Which provinces still ask for a referral from a healthcare provider for mammograms?

If you’re in your 40s and you live in Nova Scotia, Prince Edward Island or Yukon, you can call to book an appointment through your provincial breast screening program without a referral. Last fall, New Brunswick and Ontario announced they would also follow suit, starting in early and late 2024 respectively. 

But at the time of publication, New Brunswick and Ontario—along with Quebec, Saskatchewan, Newfoundland, Manitoba, Alberta and the Northwest Territories—still require a requisition. And in B.C., while you can schedule a mammogram directly with the provincial screening program, you’ll still need to share your primary care provider’s name. 

Can I get a mammogram without a doctor?

If you’re not registered with a family practice, a walk-in clinic is usually the next best option, says Dr. Anna Wilkinson, a family physician and general practitioner-oncologist at the Ottawa Hospital. “Preventative health care is not typically a walk-in clinic’s function—their function is to look at acute medical issues,” she says. “But if you have no other way to get screening and you go in to ask for it, there’s no reason why you shouldn’t be able to discuss that and have that ordered.” 

In certain parts of the country, you can also take advantage of new screening services that are dedicated to providing referrals to those without a family doctor, Wilkinson adds. For example, through an initiative she spearheaded called the Champlain Screening Outreach Program, Ottawa-area residents can book a virtual appointment and get a referral from a “super screener” nurse practitioner, whose role specifically focuses on referrals and follow-ups. In B.C and Alberta, residents can similarly obtain requisitions from doctors through virtual services such as CancerScreening.ca and CanScreenBC.

Virtual health clinics can also connect patients with doctors for referrals, while community health centres—typically focused on helping newcomers, refugees, seniors and other vulnerable groups without family doctors—may be an option for some.

What should I say if the doctor or nurse practitioner refuses to give me a referral for a mammogram?

Getting access to a doctor or nurse practitioner sometimes means only half the battle has been won. “Because our current Canadian Preventive Task Force guidelines say that we should recommend against screening women in their 40s, even if you do get into see a family doctor, they may say, ‘It's not aligning with what the task force is saying. I don't think you need to be screened,’” explains Wilkinson. 

That’s why it’s important for women to be informed and advocate for themselves, she says. This can look like taking a printout of the task force’s July 2023 newsletter to the doctor’s office, which includes updated wording to clarify that after risks—such as overdiagnosis, false positives and anxiety—have been discussed, it’s the patient’s choice to decide whether or not to be screened. 

“It’s there in black and white,” says Jennie Dale, a breast cancer survivor and co-founder of Dense Breasts Canada, a nonprofit that advocates for better access to breast screening. “All women have to say is, ‘I understand the harms and benefits [of], and it’s my decision. I would like a mammogram.’” 

If age is used to deny screening, Dale suggests responding with the fact that 17 percent of breast cancers happen to people in their 40s. If a lack of family history is cited, mention that statistics show 80 percent of those diagnosed don’t have a family history of breast cancer, she says.

Women under the age of 50 with dense breasts should also advocate for additional screening, such as an ultrasound, for more accurate results, Dale says. In addition, Black, Hispanic and Asian women can argue that studies show their ethnicity puts them at higher risk at a younger age than white women. 

What should I do if I find a lump or experience other symptoms but don’t have a family doctor?

A walk-in clinic is still the best option, says Wilkinson, but in some smaller towns or rural areas, there may not be one nearby. In that case, she suggests seeking medical attention wherever you can find it, which may mean visiting an urgent-care clinic or a hospital emergency room. 

After performing a physical exam, a doctor should recommend an ultrasound or mammogram, sometimes both, based on findings. However, some can be dismissive of lumps—believing them to be cysts, for example—and other symptoms because of a patient’s age, Wilkinson says.  

If that’s the case, say, “‘I'm glad to hear that you think it’s not cancerous, or something I need to worry about. I’d rather be safe than sorry. I’d like a mammogram or an ultrasound,’” Dale suggests. 
If that doesn’t work, she recommends finding someone else who will listen. “My own personal experience—and that of so many women—is that sometimes when you have cancer, there’s a gut feeling that something isn’t right,” Dale says. “Sometimes your gut knows best, and you have to follow it.”

Correction: This story was updated to correct the ages of women who require a requisition for a mammogram.