Overview: INESSS recommendation and the next steps for Quebec
Quebec health authorities are weighing changes to the province’s breast cancer screening program. In a public advisory published Monday afternoon, the Institut national d’excellence en santé et en services sociaux (INESSS) advised that starting breast cancer screening at age 45 could improve outcomes, but cautioned that any expansion should not be implemented immediately. The guidance comes as the minister of health, Christian Dubé, has ordered INESSS to analyze a potential broadening of the screening program to better align with evolving evidence, population needs, and resource capacity.
What the INESSS advisory says and what it implies
The advisory positions 45 as a potential starting age for routine screening, reflecting a shift in thinking about when women should begin mammography based on balancing benefits against harms. Importantly, INESSS emphasizes a careful, phased approach rather than a rapid province-wide expansion. The recommendation signals openness to change but recognizes the practical considerations of capacity, follow-up care, and the risk of overdiagnosis.
Why now? The rationale behind considering an expansion
Proponents of earlier screening argue that detecting cancers sooner can improve treatment outcomes and survival. Critics, however, warn about overdiagnosis, unnecessary biopsies, anxiety, and strain on radiology services, especially for women in their late 40s. INESSS’s tempered stance seeks to maximize life-saving potential while limiting potential harms and system strain. The minister’s directive to study expansion indicates a broader national trend toward data-driven policy making that weighs clinical benefit, patient experience, and cost effectiveness.
The plan for evaluation: what Quebec will study
Under the directive from the health minister, INESSS will assess multiple dimensions, including: the estimated lives saved and cancers detected at earlier stages, potential harms from screening and false positives, and the cost and resource implications (mammography capacity, radiology staffing, and follow-up services). The analysis will also consider incorporating risk-based strategies, where screening intensity could be tailored to individual risk factors such as family history or genetic predispositions.
Possible models under consideration
Quebec could pursue a staged expansion, starting at 45 in a controlled rollout with clear eligibility criteria, then broadening the program based on observed outcomes. Another option might combine age-based screening with targeted outreach to higher-risk groups while maintaining current practices for average-risk individuals. Any changes are likely to come with public engagement, physician education, and transparent performance metrics to guide future decisions.
Context: how Quebec fits into the national conversation
Across Canada, screening guidelines vary by province, reflecting differences in evidence interpretation, healthcare capacity, and population needs. Quebec has historically prioritized evidence-based, resource-conscious policies. The current review — and INESSS’s public-facing assessment — feeds into a broader national discussion about the optimal starting age, frequency of screening, and how to reduce harms while ensuring timely detection of breast cancer.
What residents should know now
There is no immediate change to the screening invitation schedule. Women who are approaching eligibility should continue to follow existing provincial guidance or consult their healthcare providers about personal risk and timing. The government expects to release more concrete steps after INESSS completes its analysis and any required public consultations. The goal is to update the screening program in a way that improves outcomes without overburdening the system.
Looking ahead
As the review progresses, Quebecers should stay tuned for timelines, pilot results, and opportunities to participate in public input processes. The approach underscores a commitment to evidence-based policy and to expanding access to effective screening where it is most beneficial while guarding against unnecessary procedures.
