A new study from the Interuniversity Research Center for Organizational Analysis (CIRANO) highlights the delays that Quebec is experiencing in breast cancer screening. In particular, it ranks among the last in Canada in terms of diagnosis times following an abnormal screening result. It also has no guidelines for women with a high risk factor like family history or breast density.
During their lifetime, one in eight women will be diagnosed with breast cancer. In Canada, it is the second leading cause of cancer death among women of all ages, but the leading cause among women aged 30 to 49.
In Quebec, when women turn 50, they receive a letter from the government informing them of their eligibility for the Quebec Breast Cancer Screening Program (PQDCS) and inviting them to make an appointment.
In 2024, the program was expanded to women aged 70 to 74. Quebec has thus followed in the footsteps of other provinces which have been offering screening up to age 74 for many years.
The CIRANO study highlights that Quebec performs poorly when it comes to monitoring an abnormal mammogram result. According to the research center, “an outdated cancer registry and a lack of standardization of care contribute to Quebec’s delays.”
“Opening the program is a step, but appointments for mammograms must also be accessible. So it’s not just about expanding the program, it’s also about ensuring that women can have the test, that specialists are able to read the results and that there is follow-up care that is quite available,” argued Erin Strumpf, co-author of the CIRANO study.
“With more mammograms, we will have more abnormal tests which will increase the need for follow-up. This risks causing delays to be even longer. We need to find a way to better organize [les suivis]not just to open access to mammography,” she adds.
Delays in diagnosis have tangible consequences on women’s health. They increase the risk “of diagnosing cancer at an advanced stage, which leads to heavier treatments and a less favorable prognosis,” the study indicates. According to the Canadian Cancer Society, the five-year survival rate is 99.8% for stage I cancers; 92% for stage II; 74% for stage III; and 23.2% for cancers diagnosed at stage IV.
Ms. Strumpf believes that it is possible for Quebec to do better, despite the context of labor shortage. For example, as soon as a mammogram is done, we can share an electronic file from remote regions to large urban centers where there are more staff to analyze the results. “There are certainly ways to increase the efficiency of the system,” she said. But it’s true that if we want to deploy and offer more services, we normally need more resources.”
Data access problem
Quebec data on organized screening programs are not available to researchers and journalists, deplores Ms. Strumpf. In addition, data from the Quebec cancer registry is not updated. The most recent data from this registry shared with the rest of Canada dates from 2017.
“These data are not just for the pleasure of researchers, it is to be able to understand: with the interventions we do, are we better or not? The request to INESSS is to predict whether it is a good idea or not, but then we also want to know if it was effective,” explains Mme Stocking.
The Ministry of Health makes public several data on various health issues on its dashboard. However, according to the researcher, this only constitutes fragments of data which are insufficient to understand, for example, the impacts of expanding breast cancer screening.
“It’s better than nothing, I imagine, but sometimes putting a few figures on a website allows the ministry or the government to say: ‘we have given information, we cannot be more transparent than that ”,” laments Ms. Strumpf, who is also a professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University.
The shortage of doctors, an obstacle
The idea of screening at age 40 would not be to screen all women at this age, but rather to make screening more accessible for women who believe it will benefit them. To do this, the government should also share and popularize information, believes Ms. Strumpf. “In my opinion, it is important that education does not only come from the doctor because we know that in Quebec, many people do not have a family doctor,” specifies the researcher.
“It will be important if we move in this direction that the information necessary for women to be able to measure the advantages and disadvantages is available and popularized so that people can better understand their situation,” she adds.
The CIRANO study maintains that the shortage of family doctors in Quebec “undoubtedly constitutes a serious obstacle to diagnosis.” In some cases, women with symptoms try to find information online, pay in private clinics or go to the emergency room.
Ms. Strumpf emphasizes that even if the ministry expands the screening program, there will not be “an obvious path” for a 40-year-old woman who wishes to be screened. She suggests not putting everything in the arms of oncologists by better using the skills of specialist nurses, for example.
INESSS should make its recommendations on screening at age 40 known by 2025. Elsewhere in Canada, New Brunswick and Ontario have recently followed the example of British Columbia, Nova Scotia and Prince Edward Island who have been offering screening from age 40 for several years. Manitoba announced this fall that by the end of 2025, the eligibility age will increase from 50 to 45, with the goal of eventually lowering it to 40.
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