A landmark advisory from INESSS
In a long-awaited move, the Institut national d’excellence en santé et services sociaux (INESSS) released an advisory on Monday recommending the gradual expansion of Quebec’s breast cancer screening program to include women aged 45 to 49. The recommendation aims to integrate this age group into the Programme québécois de dépistage du cancer du sein (PQDS) over the coming years, subject to capacity and ongoing evaluation.
The advisory stresses that the goal is to improve early detection, reduce late-stage diagnoses, and ultimately improve outcomes for a segment of the population that has historically experienced barriers to screening access. It also acknowledges the need to balance benefits with potential harms, ensure high-quality screening, and manage resource implications as the program widens.
What the advisory proposes
Key recommendations include a phased integration of women aged 45–49 into the PQDS, alongside enhanced outreach to encourage informed participation. The plan envisions expanding screening opportunities while maintaining robust quality controls, wait-time targets, and standardized follow-up procedures. Importantly, the advisory calls for ongoing monitoring to assess the impact on detection rates, false positives, overdiagnosis, and overall program cost-effectiveness.
INESSS emphasizes patient education and shared decision-making, recognizing that screening decisions should consider individual risk factors, preferences, and potential harms alongside potential benefits. The push for a careful, data-driven rollout aims to minimize unnecessary procedures while maximizing the chance of catching cancers early.
Why expand now: the rationale
Supporters argue that extending screening to 45–49 can catch cancers at a more treatable stage and improve survival rates. The move aligns with broader public health goals to reduce cancer mortality and equity gaps in access to preventive services. However, the advisory also notes that population-level screening must be balanced against the risk of overdiagnosis and anxiety from false positives, especially in younger women whose breast tissue can yield different imaging results.
The recommendation reflects a synthesis of international evidence and Quebec-specific data on incidence, screening performance, and healthcare capacity. By planning a gradual rollout, health authorities aim to build the necessary radiology capacity, ensure consistent quality, and adapt the program based on real-world results.
How the rollout could work
A phased approach is proposed, beginning with pilots in select regions to test logistics, referral pathways, and patient uptake. As capacity grows, additional sites would participate, with equipment upgrades, staff training, and enhanced data collection to monitor outcomes. Central to the plan is ensuring a seamless experience for patients: clear eligibility criteria, convenient scheduling, and timely communication of screening results.
Quality assurance remains central, including standardized imaging protocols and interpretive criteria, second opinions when needed, and transparent metrics that help inform future adjustments to the program.
What this means for patients and clinicians
For women aged 45–49, the advisory suggests engaging in open conversations with primary care providers about screening eligibility and personal risk factors. Women with a higher familial risk or genetic predispositions may have different screening pathways, and clinicians will play a pivotal role in guiding those decisions within the PQDS framework.
Clinicians should prepare to adapt workflows, manage increased referrals, and participate in ongoing training to maintain screening quality as the program expands. Clear counseling and patient education materials will help individuals understand the benefits and potential downsides of screening in this age group.
Next steps and public health impact
The INESSS advisory sets the stage for policy discussions, budget considerations, and stakeholder consultations. Health authorities are expected to outline concrete timelines, resource needs, and evaluation plans to measure progress and inform any future adjustments to the program. If implemented, the expansion could mark a significant shift in Quebec’s preventive health strategy and set a precedent for other provinces weighing similar changes.
