INESSS Recommends Expanding Breast Cancer Screening to 45-49
In a highly anticipated advisory published this week, the Institut national d’excellence en santé et services sociaux (INESSS) recommends broadening the Quebec breast cancer screening program to include women aged 45 to 49, with a careful, phased rollout. The goal is to strengthen early detection, reduce late-stage cancers, and promote more equitable access to screening services across the province.
The proposal arrives after a period of debate about how best to balance benefits and harms of screening, particularly for younger age groups. INESSS notes that while screening can save lives, it must be implemented in a way that minimizes overdiagnosis, anxiety from false positives, and unnecessary follow-up procedures. The advisory emphasizes evidence-based criteria, informed decision-making, and close monitoring to guide any eventual policy changes.
What this means for Quebec’s screening program
The current Program québécois de dépistage du cancer du sein historically targets women typically in the 50-69 age range, with regional variations and physician discretion guiding invitations and recommendations. The new recommendation envisions a gradual inclusion of younger women, starting with risk-based approaches in selected areas before broader implementation. It is framed as a measured step toward expanded access rather than an immediate, province-wide mandate.
Crucially, INESSS stresses that expansion should be paired with rigorous evaluation. Data on participation rates, diagnostic yield, wait times, and downstream costs will shape ongoing decisions. The aim is to maximize lives saved while containing potential harms and ensuring that the health system can absorb increased demand for imaging, biopsy, and follow-up care.
Why expansion matters—and the potential trade-offs
Breast cancer can develop in women in their 40s, and earlier detection often improves treatment outcomes. Proponents argue that extending screening to 45-49 could reduce late-stage diagnoses among a segment of the population historically less likely to participate in screening. It could also address disparities in access, benefiting women in rural areas or communities with lower screening uptake.
On the flip side, expanding screening carries risks: overdiagnosis, overtreatment, psychological distress from false alarms, and higher system costs. The advisory underscores that any rollout must include clear communication about benefits and limitations, along with robust monitoring to adjust protocols as new evidence emerges.
How a gradual rollout could work
Expected to unfold in phases, the plan would likely begin with pilot programs in selected regions, paired with careful data collection and predefined milestones. Invitations could be tailored to individual risk profiles, with shared decision-making guiding whether a 45- to 49-year-old should initiate screening. If pilots demonstrate net benefit, broader adoption would be considered over several years, accompanied by investments in radiology capacity and support services.
Practical considerations for implementation
Expanding screening will require careful budgeting for additional imaging resources, personnel training, and patient navigation supports. Health authorities would need to ensure that increased screening does not compromise access for other groups or extend diagnostic wait times. Equity considerations would guide implementation, ensuring that rural and underserved communities receive appropriate access and information.
What patients and providers should know
Women in the 45-49 bracket should not expect automatic invitations immediately. Instead, discussions with primary care providers will be central to determining individual risk and the appropriateness of screening. Those with family history, prior chest radiation, or other risk factors may be prioritized in early phases. Healthcare professionals will be essential in communicating potential benefits, harms, and alternatives to screening.
Next steps and public input
INESSS’s advisory invites public and stakeholder input as policymakers study the implications and design the final policy. Government planners will weigh pilot outcomes, budget implications, and regional health needs before finalizing guidelines and timelines. The process underscores a commitment to evidence-based reform in Quebec’s cancer screening landscape.
Bottom line
The recommendation to expand breast cancer screening to women aged 45-49 reflects a broader effort to detect cancers earlier and promote equity in access. If adopted, the phased rollout would demand meticulous planning, ongoing evaluation, and clear communication to ensure that more women can benefit from screening while minimizing harms.
