Opinion: Gaps remain in Quebec's new breast-screening policy

The program’s extension to age 74 is welcome and overdue, but some protocols continue to lag those of other Canadian jurisdictions.

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In a policy shift on Jan. 31, the Quebec Breast Screening Program finally extended its mammography screening program to include women to age 74, up from 69. While this move is important progress for continued breast cancer detection, it highlights a stark reality: Quebec still lags far behind other provinces and territories in offering optimal breast cancer screening.

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Breast cancer is the most diagnosed cancer in women in Quebec, with an estimated 9,559 cases in 2023. It remains one of the deadliest cancers affecting women, with 1,400 deaths every year. Early detection through screening significantly increases the chances of survival. Women who have mammograms are 40 per cent less likely to die of breast cancer than women who do not have mammograms. Early detection also reduces the need for harsh treatments, offering patients better quality of life.

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Furthermore, the benefits of mammography screening extend beyond individual health outcomes. Early detection also reduces the burden on the health-care system by decreasing the need for costly treatments associated with advanced-stage cancer. A 2023 study by Canadian researchers demonstrated that treating Stage 4 breast cancer can cost over $500,000 per patient, depending on the subtype. This equates to treatment that is 11 times more expensive than treating Stage 1.

The screening program’s previous policy limiting screening to age 69 left a critical gap in preventive care as we know breast cancer risk increases with age. The decision to extend screening to age 74 is long overdue but brings Quebec only on par with the 11 provincial and territorial screening programs that have offered screening until age 74 for decades.

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Moreover, women in Quebec are not eligible to continue self-referring for mammograms after age 74, putting Quebec at odds with seven other jurisdictions across Canada where screening programs allow women to continue to self-refer for mammograms after 74, recognizing the importance of continued screening.

Quebec also lags behind much of the country in other breast screening practices that promote the early detection of breast cancer. By fall 2024, there will be six jurisdictions allowing self-referral at 40 — British Columbia, Nova Scotia, Prince Edward Island and Yukon have been screening at 40 for decades, and Ontario and New Brunswick will join them this year. Screening begins only at age 50 in Quebec, even though 17 per cent of breast cancers happen in the 40s. Cancer in this age group is more aggressive, which leads to increased mortality and more aggressive treatment and surgery. 

Recent Canadian research found that women in their 40s who live in provinces that don’t screen until 50 are more likely to be diagnosed with Stage 2, 3 and 4 cancers than their counterparts in provinces that screen at 40. Furthermore, research shows a peak incidence of breast cancer in the 40s for Black, Hispanic, and Asian women as compared to the late 50s and early 60s for white women.

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In addition, eight jurisdictions inform individuals of their breast density category directly in their mammogram results letter mailed to them. Quebec does not. Seven jurisdictions offer women with the highest density annual rather than biennial mammograms. Quebec does not. There is an urgent need for Quebec to address gaps in its breast cancer screening practices.

The delay in adopting optimal screening practices raises questions about the Quebec government’s commitment to women’s health and equitable access to health-care services. To reduce suffering and needless deaths, the government must prioritize the implementation of evidence-based policies that ensure equal access to preventive care. This includes allowing self-referral for screening, starting at age 40 and continuing after age 74.

Women in Quebec deserve the same opportunity for early detection of breast cancer as women in the rest of Canada. Lives depend on it.

Jennie Dale is co-founder and executive director at Dense Breasts Canada, which advocates for optimal breast cancer screening. Annie Slight is the Quebec director for advocacy and education at DBC.

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