Opinion: Gaps remain in Quebec’s new breast screening policy

The extension of the program to age 74 is welcome and necessary, but some protocols continue to lag behind other Canadian jurisdictions.

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In a policy change on January 31, the Quebec Breast Screening Program finally expanded its mammography screening program to include women up to age 74, instead of age 69. While this move is an important step forward for continued breast cancer screening, it highlights a stark reality: Quebec is still 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 improves increases the chances of survival. Women who have mammograms are 40 percent less likely to die of breast cancer than women who do not have mammograms. Early detection too reduces the need for harsh treatmentsoffering patients a better quality of life.

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Additionally, the benefits of mammography extend beyond individual health outcomes. Early detection also reduces the burden on the healthcare system by decreasing the need for costly treatments associated with late-stage cancer. TO study 2023 by Canadian researchers showed that Treatment for stage 4 breast cancer can cost more than $500,000 per patient, depending on the subtype. This equates to a treatment that is 11 times more expensive than Stage 1 treatment.

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

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Additionally, 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 self-referring for mammograms after age 74, recognizing the importance of continuing screening.

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

Recent Canadian research found that women in their 40s living in provinces that do not get screened until age 50 are more likely to be diagnosed with stage 2, 3, and 4 cancers than their counterparts in provinces that get screened until age 50. 40 years. Furthermore, the research shows a peak incidence of breast cancer around age 40 for black, Hispanic and Asian women, compared to late 50s and early 60s for white women.

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Besides, eight jurisdictions Inform people about their breast density category directly in the mammogram results letter sent to them in the mail. Quebec does not. Seven jurisdictions Offer women annual, rather than biennial, higher-density mammograms. Quebec does not. Quebec urgently needs to address deficiencies 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 unnecessary suffering and 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 opportunities for early detection of breast cancer as women in the rest of Canada. Life depends on it.

Jennie Dale is co-founder and CEO of Dense Breasts Canadawhich advocates for optimal breast cancer screening. Annie Slight is director of Quebec advocacy and education at DBC.

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