Under the Québec breast cancer-screening programme (PQDCS), approximately a million women in the province aged between 50 and 74 are routinely invited every two years to have a test to look for early breast cancer. Notwithstanding that serious studies have clearly demonstrated that the earlier breast cancer is detected, the better the chance of a cure, only 60 per cent of the women invited are taking advantage of Québec's breast cancer screening program.
The breast-screening test, mammography, is only the first step in the complex process for the early detection of breast cancer. Equally important to this first step taken by women, is the timely reading of the mammography by a competent breast radiologist. This is where in Québec, women are being failed by the medical system.
First, compared to the gold standards of Sweden and England, which have a recall rate for complementary exams of approximately 3 to 5%, the Québec recall rate of 10 to 20% [1] indicates serious deficiencies in the reading that in the end can endanger the survival of women, their quality of life and is definitely wasting taxpayer money.
A 10 to 20% recall rate means that for the 600,000 women (60% of a million) taking the screening test, 60,000 to 120,000 will be recalled for complimentary exams, compared to 30,000 women if the recall rate was at 5% as it is in most modern societies. Of note, is that irrelevant to the number of women recalled the same number of cancers is being found 5 to 8 per 1000 women screened. This is to say that from a human perspective, 60,000 to 120,000 women are being recalled and stressed for nothing or benign findings while the 3000 to 3600 women who actually have cancer are in long waiting lists and may not be seen within the expected timeframe of ten days, which certainly increases their morbidity. The impact of the high recall rate is compounded first by the thousands of women being miscategorised with the complementary exams that have no cancer, which again increase their stress for nothing and waste money and second by those also miscategorised that have cancer which increases their waiting time and delay their diagnosis.
The reasons for this discrepancy between the quality of service to women in Québec and other countries are well known: First, general radiologists instead of breast radiologists are reading the mammograms. Second, only one general radiologist instead of two to three breast radiologists is reading each mammogram. Third, the minimum reading volume ranges from 480-1000 mammograms per year in Québec while in countries such as Sweden and England, the minimum annual reading volume is above 5000 mammograms (10,000 in Sweden). In a nutshell, in Québec women are victims of some radiologists' incompetency and their lack of confidence in regards to breast imaging.
The solution is well known, but it will take a courageous minister of health to break the status quo and engage in negotiations with the Québec radiologists' association who has both medical and financial interests. First, an increase in the mandatory volume of mammograms that radiologists must read will have to be imposed. Secondly, there will have to be an acceptance that there is such a thing as a specialised breast radiologist like in Ontario, the USA, England and numerous other European and middle-east countries. In fact, a breast radiologist is a sub-specialty just like neuro-radiologist or interventional radiologists just to name a few.
Moreover, Québec breast cancer-screening programme (PQDCS) is a population-based national program in which asymptomatic women are requested to participate. Hence, the government has a moral responsibility to offer the best standard of care.
In conclusion, for the sake of women's health and their confidence in the Québec screening program, it is time that politicians assume themselves and go beyond the political campaign philippics and ensure that breast be taken seriously and not just treated as a toe or its examination like an insignificant medical act.
[1] PQDCS, Bilan 2012 Abitibi-Témiscamingue, septembre 2013, p.5.