CAR breast referral navigator

Keep screening, symptoms and modality practice in separate lanes.

Choose the presentation first. The result states the initial examination, the next step after an equivocal study, and the point at which negative imaging must not end the workup.

Clinical lane

Do not mix screening and symptomatic algorithms.

Exact presentation

Age and risk qualifiers are preserved in the result.

Modality-role guardrails

The 2026 practice series governs how the study is performed.

Mammography/DBT: the standard screening and diagnostic x-ray platform; use the 2026 CAR technical, dose, reporting and QA guideline.
Ultrasound: targeted diagnosis, selected supplemental screening, axillary assessment and intervention; correlate with all other breast imaging.
MRI: highest-sensitivity adjunct for defined high-risk screening, staging, problem-solving and treatment monitoring; bilateral imaging and MRI-guided intervention capability matter.
CEM: diagnostic problem-solving, preoperative staging and selected screening when MRI is unavailable or contraindicated; iodinated-contrast screening and reaction readiness apply.
Biopsy: use image-guided percutaneous biopsy when the target is visible and perform formal radiologic–pathologic concordance.

CAR B01A · average risk

Age sets the baseline screening interval.

Under 40: no routine mammography. Age 40–49: consider annual mammography/DBT through shared decision-making. Age 50 and older: mammography/DBT every 1–2 years.

Imaging pathway

Under age 40: recommend against routine mammography screening.
Age 40–49: discuss annual mammography/DBT; if the patient requests screening after shared decision-making, offer it.
Age 50 and older: mammography/DBT every 1–2 years.
Individualize interval and discontinuation using benefits, risks, preference and life expectancy.

Do not overextend this branch

These intervals apply to females at average risk, with or without implants; symptomatic findings use a diagnostic pathway.
For mammographically confirmed ACR D density, CAR suggests supplemental imaging. For ACR C density, CAR suggests it depending on capacity. Modality varies by regional practice and resources.

<40 ↓↓ · 40–49 ↑ · ≥50 ↑↑ · density supplement ↑CAR Breast Referral Guideline

Evidence register

What governs this draft

Dated primary sources and their role in this draft.

Recommendation wording is condensed for point-of-care use. The dated primary source remains authoritative and must be rechecked before publication or institutional adoption.

CAR Breast Referral 2023Breast Disease Referral GuidelineFormal Canadian referral guideline · June 2023

All screening, symptom and special-population branches in this navigator.

Open source ↗CAR Breast Practice 2026Breast Imaging and Intervention seriesFive-part modality-specific practice guideline · 2026

Technical practice, multimodality correlation, reporting and quality assurance.

Open source ↗CAR CEM 2026Contrast-Enhanced MammographyCAR practice guideline · 2026

CEM indications, technique, contrast safety, reporting and QA.

Open source ↗CAR MRI 2026Breast Magnetic Resonance ImagingCAR practice guideline · 2026

MRI indications, technique, reporting, safety and intervention readiness.

Open source ↗