Quebec should gradually expand its breast cancer screening program to women aged 45 to 49, the province’s national institute for excellence in health and social services (INESSS) concluded in a report released Monday.
The recommendation follows a study mandated by Quebec’s Health Ministry to explore screening options for women aged 40 and older.
Currently, the province’s program offers women aged 50 to 74 a mammogram every two years, covered by Quebec’s health insurance plan, RAMQ.
Women outside that age bracket need a referral to receive a breast X-ray. A growing concern, however, is the increasing rate of breast cancer among younger women over the past two decades. In 2023, about 20 per cent of women in their 40s received a mammogram.
“Right now, the risk factor of having breast cancer at 45 is the same as it was 30 years ago for 50-year-old females,” said Dr. Grégoire Bernèche, president of the association of radiologists in Quebec (ARQ).
He says the risk among 40 to 49-year-olds has increased by 20 per cent, though what’s driving the rise in cases of early onset cancer is still unknown.
“It’s probably a multiplicity of things, but it’s very concerning,” he said. “Still, let’s just face the fact that it happens earlier and let’s just act on it by screening earlier.”
Costs and trade-offs
Currently, Quebec is the only Canadian province where the recommended age to begin routine mammograms is 50 and not 45. The INESSS warns, however, that inviting more people into Quebec’s screening program won’t come without challenges.
Notably, expanding the screening program to those aged 45 to 49 would likely cost around $177 million over five years, the INESSS says in its report.
The province’s national institute for excellence in health and social services (INESSS) is recommending an expansion of Quebec’s breast cancer screening program to include women aged 45 to 49. However, it admits the cost would be significant and the province’s wait times for mammograms and radiologist shortage would need to be addressed.
Karine-Iseult Ippersiel, the president and CEO of the Quebec Breast Cancer Foundation, argues that this cost would help prevent more aggressive cancers from developing if detected earlier, before a woman turns 50.
“The earlier detection of breast cancer, the less costly for the system, the less invasive trajectory for curing that cancer and then the higher survival rate,” she said.
In a statement, the province’s Health Ministry said it welcomed the report and would issue a position shortly.
“The priority is to better support the groups of women most likely to develop cancer by prioritizing prevention,” the statement reads.
Screening program needs to be upgraded
For this to work in the first place, the entire breast cancer screening program needs to be upgraded, says the INESSS.
Quebec has some of the highest recall rates in the country following false positive results, and these rates would likely increase if younger women are included in the screening program, the institute warns. That’s because the breasts of women under 50 are typically more dense, making their mammograms more difficult for radiologists to read.
Wait times would also need to be reduced. In some areas of Quebec, it can take more than 20 weeks to get a mammogram. In the Lanaudière region, wait times for a first appointment can stretch to 30 weeks.The entire Quebec system, in fact, faces wait time delays at every stage of care, from obtaining follow-up appointments to receiving a diagnosis, the report says.
There are also significant staffing shortages to consider, says the INESSS. The system currently relies on volunteer professionals to follow up on 11.5 per cent of mammograms for women without a family doctor.
Last year, the screening program was expanded to include women aged 70 to 74. Radiologists, however, have struggled to keep up with that demand, according to the report.
“Radiologists are still understaffed. The technologists who perform the mammograms are still understaffed,” said Berchère.
He’s confident, though, they would be able to absorb the volume of younger patients, which he describes as “incremental.”
For Ippersiel from the Quebec Breast Cancer Foundation, the province’s screening program capacity as it currently stands is also a concern. She says basing admissibility to the program on individual risk factors would lead to a better use of resources than strict age brackets.
“That way, those with an actual higher risk of breast cancer, whether they’re 40, 45, will go through first and then the rest of the population can follow,” she said.
The foundation funded the development of a risk-assessment tool that combines a saliva test and survey to assess a woman’s likelihood of developing breast cancer.
Currently, the project is being piloted in Quebec City and the Lanaudière, but Ippersiel hopes to see this technology expanded across Quebec to ensure early screening for women at highest risk.
