In a move to reassess preventive care, Quebec’s Minister of Health, Christian Dubé, asked the Institut national d’excellence en santé et en services sociaux (INESSS) to examine whether the province should expand its breast cancer screening program. The INESSS published its opinion on Monday afternoon, outlining a nuanced view that proposes starting screening at 45 while emphasizing caution before any immediate broad changes.
INESSS’s position: start at 45, with careful consideration
The core suggestion is to explore the potential benefits of initiating routine screening at age 45, a shift from the current framework considered by the government. However, the consensus is not to roll out a blanket change right away. The agency stresses balancing early cancer detection with the realities of capacity, including radiology resources, follow-up care, and the risk of over-diagnosis. The aim is to determine whether an expansion would meaningfully reduce mortality without compromising the quality and timeliness of care for those already within the existing guidelines.
Why this approach now
Quebec faces varying breast cancer incidence and differences in access to screening across regions. By proposing a staged, evidence-based approach, INESSS seeks to identify whether an expansion would translate into better health outcomes while preserving the capacity to offer high-quality services to all residents. The recommendation reflects a cautious mindset: test the waters, measure impact, and avoid stretching resources too thin.
Key considerations
- Effect on the health system: more screening implies more mammograms, biopsies, and follow-up services; capacity and wait times must be managed.
- Age-specific impact: younger screening can be more complex due to tissue density and may require adjusted protocols.
- Cost-effectiveness: policymakers must weigh the program’s budget against potential gains in life-years saved.
- Equity: ensuring rural and underserved populations benefit from any expansion plan.
Minister Dubé’s plan and the road ahead
Christian Dubé indicated that the government expects the INESSS assessment to inform a policy decision. He underscored the importance of evidence-based changes and pledged transparent communication about timelines, pilots, and funding. No specific start date has been set, signaling that any expansion would be gradual and accompanied by monitoring measures to gauge real-world impact.
What residents should know now
For individuals currently within the standard screening window, there is no immediate change. Health professionals will continue to follow existing guidelines while the INESSS analysis unfolds. Women and individuals with higher familial or personal risk should consult their clinician to discuss personalized screening strategies in the interim.
Comparative context
Across Canada, programs vary widely in starting age and intervals. Quebec’s approach—framing an evidence-driven expansion rather than a rapid policy shift—fits within a broader public health practice that prioritizes patient safety, system sustainability, and the potential to improve cancer detection through thoughtful policy design.
Bottom line
The INESSS report represents a cautious, data-informed step in Quebec’s breast cancer screening policy. By exploring an earlier starting age while acknowledging resource considerations, the government aims to refine its preventive strategy for women across the province. The coming months will reveal whether broader changes are feasible and how they would be implemented, with ongoing updates to the public and healthcare providers.
