Quebec remains the only province or territory not to include women aged 45 to 49 in its breast cancer screening program, a year after the province’s health institute recommended expanding the program to women in that age group. In September 2025, the Institut national d’excellence en santé et en services sociaux (INESSS) recommended that the province expand its program to women aged 45 to 49. However, it also recommended improving the breast cancer screening program before expanding it — the same recommendation outlined by the Institut national de santé publique du Québec (INSPQ) in a report published that month. The proposed improvements include reducing the province’s high recall rate and examination wait times, improving its computer systems, and adding new indicators to better evaluate the program’s performance and impact on women’s health. Quebec’s Health Ministry (MSSS) came out in favour of improving the breast cancer screening program two months after the recommendation. However, a year later, it is still not ready to expand the program to women aged 45 to 49. “Work is still underway to put in place the various prerequisites recommended by the INESSS with a view to a possible extension,” the health ministry told CTV News in an email. “Ministry teams are working to identify strategies to improve the overall performance of the Quebec Breast Cancer Screening Program in its current form and to enhance its efficiency, including the relevance and accessibility of the prescribed screening tests.” Then-Health Minister Christian Dubé commissioned the institute to explore expanding the program as other provinces and territories across Canada began lowering the screening age from 50 to 40. The move came after the Canadian Cancer Society urged provinces to expand its programs to include women in their 40s, following research showing that breast cancer diagnoses were increasing among young women. Cancer advocates want action Most provinces and territories allow women in their 40s to access routine screening mammograms. Manitoba is expanding its program to women aged 40 by the end of the year, while Nunavut is also beginning implementation of an organized program for women aged 40 to 74 by year-end. Quebec’s current breast cancer screening program invites asymptomatic women at average risk of developing the disease, aged 50 to 74, to undergo screening every two years. The Quebec Cancer Priority Coalition said the delay in improving the program and including women aged 45 to 49 is disappointing. “Citing the excuse that we can’t adequately screen women above 50 yet, so we shouldn’t lower the age until we have the capacity to do so is neglecting the government’s responsibility to find solutions to improve the existing screening pathways to accelerate early diagnosis,” said Eva Villalba, director general of Quebec Cancer Priority Coalition. “We should be able to chew gum and walk at the same time. Let’s focus on lowering the screening age to 45 like INESSS recommended and improve the current screening program by deploying personalized risk assessments.” Breast cancer is the second-most commonly diagnosed cancer in Canada, with 32,700 cases projected in 2026, just below lung cancer, with 32,900 cases, according to the Canadian Medical Association Journal. In Quebec, 8,400 people are expected to be diagnosed in 2026. However, Quebec has the highest age-standardized incidence rate in the country for breast cancer, at 86.2 per 100,000 people. Given the disease’s prevalence, the Quebec Breast Cancer Foundation said women need timely access to screening to detect breast cancer earlier, ensuring treatment options are not limited and improving their chances of survival. “When every other province and territory either already allows screening starting at age 40 or is moving to implement it, Quebec’s delay is difficult to justify,” said Karine-Iseult Ippersiel, president and director general of the Quebec Breast Cancer Foundation. Risk-based screening INESSS outlined in its report that the province also considers implementing a screening approach that accounts for individual risk factors, including age, family history of breast cancer, ethnicity, breast density, lifestyle habits, hormone exposure, and genetic risk. While breast cancer predominantly affects women aged 50 and older, recent Canadian studies have shown rising diagnoses in young women, higher rates of aggressive breast cancer types in young women, and differing impacts on ethnic and racialized groups. Some provinces in Canada have organized screening programs for people at high risk of breast cancer and hereditary cancers, including Ontario, Nova Scotia, British Columbia and Manitoba. Quebec’s health ministry said it is also exploring risk-based breast cancer screening options. “The priority is to provide better support for the groups of women most likely to develop cancer, with a focus on prevention,” the health ministry told CTV News. However, Ippersiel said the Quebec Breast Cancer Foundation has been pushing for risk-based screening for several years. She said the foundation offered to fully fund and deploy a pilot project for women in Quebec using the local Canadian PERSPECTIVE project, a breast cancer risk assessment tool developed by Dr. Jacques Simard of Université Laval and his team. The test, which has been shown to be effective in a study involving more than 4,000 women, combines a saliva sample to extract DNA and a questionnaire. It assesses a woman’s risk of developing breast cancer and then provides a personalized screening plan based on her risk category. Ippersiel said combining this approach with population-based screening would help prioritize women who need screening but fall outside the age range covered by the province’s program. “It is false to think that all women have the same risk of breast cancer. Not all of them need bi-annual screening, and there are women aged 30 to 40 who need it,” Ippersiel said. “This innovation would prioritize women in a screening program according to their risk, not simply their age. Identifying women at a higher risk helps us in prevention, if the health ministry truly wishes to focus on prevention.” On Oct. 2, 2025, members of the official opposition tabled a motion in the National Assembly in collaboration with the Quebec Breast Cancer Foundation, calling for the modernization of breast cancer screening through risk-based approaches such as the PERSPECTIVE project. The motion, unanimously adopted, was accompanied by a petition signed by more than 42,000 people. But the pilot project never happened. “What is especially concerning is not only the delay itself, but the lack of agility and responsiveness to innovation that could help improve the program in a more targeted and effective way,” Ippersiel said. “We are no longer limited to a one-size-fits-all approach based only on age. Tools such as this test can help better identify and prioritize women at higher risk, including those in their 40s, and support a more intelligent, equitable use of screening resources.” Current approach leaves women behind The health ministry said although Quebec’s breast cancer screening program does not currently target women aged 40 to 49, they are still encouraged to consult with a health-care professional if they are at higher risk of developing the disease and want a screening. Beyond screening, women who have breast cancer symptoms should also speak with a health-care professional to request diagnostic imaging, the ministry added. However, Ippersiel said this approach leaves too many women behind and relies on individual advocacy rather than an equitable, standardized pathway. “If you are not medically informed, do not have a family doctor, or are not in a position to push repeatedly for care, it is often very difficult — if not impossible — to obtain a referral for screening before age 45,” Ippersiel said. “Many physicians still emphasize that the overall risk is lower in this age group, which can delay access even for women who are concerned or who may have significant risk factors.” Ippersiel said she hopes the next party to form the government, the Parti Québécois, will keep breast cancer prevention — including lowering the screening age and incorporating high-risk strategies — a top priority. “Quebec appears to be lagging at a time when other jurisdictions are adapting, modernizing, and recognizing the importance of earlier access to screening. That sends the wrong message to women who are trying to be proactive about their health, especially those who may already face barriers in accessing care,” she said.
