Surgical oncologist Saima Hassan says Quebec’s need to lower its breast cancer screening age is ‘urgent’
Despite the success of mammography in reducing breast cancer mortality, the diagnosis of Canadian women under 50 has soared, recent studies have shown.
That’s why the Quebec Breast Cancer Foundation (QBCF), which is celebrating 30 years this month, wants the province to lower the recommended screening age for breast cancer.
“The problem is almost similar to what we were kind of experiencing before our whole screening program had started, and now we’re seeing younger breast cancer patients with presentations of breast cancer at a much later stage,” says Dr. Saima Hassan, a surgical oncologist at the Centre hospitalier de l’Université de Montréal (CHUM) who works closely with the QBCF. “This is necessitating greater treatments of chemotherapy, especially prior to even getting their surgery.”
In every other Canadian province and territory, the screening program starts at age 40 or 45. Ontario lowered the screening age from 50 to 40 Tuesday, and Manitoba announced Thursday that they will do so as well by 2026.
“We’re not in a province with a mindset of prevention. We’re in a province that has the mindset of curing,” says Karine-Iseult Ippersiel, CEO of the QBCF.
The Quebec Health and Social Services Ministry wrote in a statement to The Gazette that a request has been submitted to the Institut national d’excellence en santé et services sociaux to assess the relevance of including women under 50 in systematic breast cancer screening. It is awaiting those recommendations before making a decision. They noted that “in its preliminary report published on May 30, 2024, the Canadian Task Force on Preventive Health Care did not recommend systematic screening for women aged 40 to 49. …
“Although women aged 40 to 49 are not currently targeted by the (screening program), doctors and specialist nurse practitioners may prescribe a screening mammogram for a woman of this age (or younger) depending on the individual risk assessment or if there are symptoms.”
Before the 1990s, mammography was not ubiquitous in Canada the way it is today. The medical world focused largely on treatment and mastectomies, rather than prevention.
Hassan and Cédric Baudinet from the QBCF both agree that beyond lowering the screening age, individualized screening based on cancer risk is a key step in early diagnosis.
“Age is one of the risk factors, as we know,” says Baudinet. But other risk factors, such as the breast cancer or “BRCA” gene, smoking, alcohol consumption and not having children can increase the risk of breast cancer for women of all ages, according to Hassan.
The intense side effects of cancer treatment and discomfort of mammograms can discourage people from seeking them out, Hassan says. For young people especially, “it’s hard to convince them to undergo the full treatment. … Sometimes they are in denial.”
Improving the patient experience is a priority in Hassan’s research. In one of her areas of expertise, triple-negative breast cancer, “we have five types of intravenous treatment for chemos, plus one immunotherapy.”
“We know that we are probably over-treating triple negative breast cancers with all this treatment, and the side effects of that can be intense,” she says.
Triple-negative is one of the most aggressive strains of breast cancer because it is not responsive to hormone therapy. Hassan says the goal is to simplify the treatment. Clinical trials are under way in her lab.
Wait times are another factor in the accessibility of breast cancer screening in Quebec. Ippersiel says the wait times in Montreal are “not so bad,” but in places like Gatineau and Abitibi, the wait is up to 29 weeks.
Hassan is also studying a blood test that can screen whether a patient needs a mammogram, which she says would be faster and more comfortable for the patient and would reduce the bottleneck in the screening program.
“For a detection, there is no proven blood test. A lot of efforts have been made in the past,” she says. For Hassan, developing the blood test is no small task.
“I’ve always been interested in confronting challenges. That’s why I’m interested in getting better options out there for our patients.”