Breast cancer: Quebec health institute recommends screening at age 45, but not right away

A new Quebec Health Institute report recommends expanding breast cancer screening to women aged 45-49.

The INESSS is recommending including women aged 45 to 49 in the Quebec Breast Cancer Screening Program, but not immediately, as it would place an additional burden on the health-care system. Experts recommend first reducing the recall rate — the highest in Canada — and upgrading the program’s computer system.

Health Minister Christian Dubé commissioned the Institut national d’excellence en santé et en services sociaux (INESSS) to analyze a possible expansion of the screening program in Quebec. The INESSS opinion was published on Monday afternoon.

“At the end of the deliberations, the committee members unanimously agreed on a main recommendation to reduce recall rates and examination delays and to modernize the program’s computer system before proceeding with the systematic addition of an additional cohort. Once these steps have been completed, they consider that a gradual integration approach could be envisaged, initially targeting women aged 45 to 49,” the opinion stated.

The INESSS specified that its work wasn’t intended to take a position for or against breast cancer screening in women under age 50.

“We identify issues and problems that will need to be addressed. It is quite possible that lowering the age for breast cancer screening in Quebec will have some impact on resources, but what we are proposing in our recommendations is the scenario that we believe is most realistic in our context,” explained Catherine Truchon, director of evaluation and relevance of health intervention methods at the INESSS, in an interview with The Canadian Press.

High recall rate a major obstacle

The members who worked on the report emphasized the impact that adding a large number of women to the Quebec Breast Cancer Screening Program would have, “considering the difficulties already present in several regions with regard to timely access to screening tests, but also to follow-up tests.”

This would increase wait times for all clients requiring imaging, pathology, and surgical services, not just for breast cancer. The high recall rate is a major obstacle to efficient screening, write the authors of the opinion.

“The recall rate is when a woman goes for her mammogram and then gets called back a few days or a week later. [...] The woman returns and undergoes another type of exam, such as an MRI or ultrasound. Sometimes she will even be called back for a second additional exam,“ Truchon explained.

”Generally speaking, these additional exams appear normal, meaning that no cancer is detected in the end. All these tests, which are ultimately irrelevant, muddy the waters a bit," she said.

Truchon pointed out that it’s normal to have a certain recall rate and that it’s prudent to confirm certain things, but in Quebec, the rate is particularly high and they’ll need further analysis to find out why.

For the first mammogram, 22 per cent of women were called back, more than three times the target of 7 per cent set by Quebec’s national public health institute (INSPQ). For subsequent mammograms, 8.5 per cent of women were called back, which is also higher than the target of 5 per cent.

On Monday, the INSPQ also published a report on expanding screening, providing an epidemiological overview and anticipating changes. If the screening program were expanded to women in their 40s, a quarter of new patients would have abnormal results on their first screening, representing between 40,000 and 90,000 “additional screenings classified as abnormal with recall of the woman for investigation.” There could be up to 15,000 recalls requiring a biopsy.

Since 2017, Quebec has had the highest recall rate in Canada. To reduce recall rates, an annual review of recall rates is currently provided to each radiologist as a feedback measure.

The idea of having a second radiologist read mammograms is seen as a “promising intervention,” but due to a lack of staffing, the measure is difficult to implement in Quebec in the short term, according to the opinion.

Mammogram invitations by email or text message?

It would be difficult for current computer systems to support an increase in data volume with the addition of new patients undergoing screening. It isn’t clear exactly what the required update entails, but already, the addition of the 70-74 age group (in January 2024) required work on the program platform.

As part of the IT system upgrade, INESSS suggested making it possible to send invitations by email or text message. Currently, women aged 50 to 74 receive a letter in the mail inviting them to have a mammogram every two years.

“Since most other provinces and territories already offer screening starting at age 40 or 45, committee members recognized the importance of avoiding the creation of inequalities between Quebec and the rest of Canada,” the INESSS advisory stated.

However, INESSS pointed out that expanding screening to women under 50 “would cost several hundred million dollars” and that “the health and social services network is facing enormous budget constraints.”

When will screening begin at age 40?

The Institute will not comment on the possibility of subsequently extending screening to women aged 40 to 44.

“We will monitor epidemiological data and cancer incidence. It is true that cancer incidence has increased in age groups under 50, particularly among 45- to 49-year-olds. We will see how this evolves among women aged 40 to 44. Perhaps we will conduct a further study at a later date, but we have not included this in our recommendations,” explained Truchon.

Breast cancer is the second leading cause of cancer death among Canadian women. One in six cancers is detected in women under the age of 50, according to the Quebec Breast Cancer Foundation.

In Canada, for every 1,000 patients screened, seven lives will be saved if screening is done between the ages of 50 and 69. If screening is also done between the ages of 40 and 49, nine lives will be saved.

Even if they’re not yet included in the screening program, women under the age of 50 can discuss it with their doctor and get a prescription for a mammogram. In 2023, approximately 20 per cent of women aged 40 to 49 had a mammogram.

To facilitate access for women in their 40s, INESSS recommends that collective prescriptions be developed to allow nurses to prescribe mammograms.

It’s so far unclear when the expansion of screening to age 45 could come into effect in Quebec or what the health minister’s targets would be for implementing this. The health minister’s office has said that the minister will announce whether he will proceed with the recommendation in the coming weeks.

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This report by The Canadian Press was first published Sept. 30, 2025