https://www.cfp.ca/content/67/1/27
Hey @sweetiepie I was doing my CME stuff and this was one of the articles that had CME points.
Thought you might find it informative especially with reference to our previous discussions about prostate cancer screening?
Canadian Family Physician January 2021, 67 (1) 27-29; DOI: https://doi.org/10.46747/cfp.670127
Family physicians are routinely asked to carry out cancer screening tests not in keeping with current guidelines or existing organized screening programs. It can be challenging for primary care providers to choose wisely and follow guidelines while also promoting patient-centred care. In these instances, an informed and shared decision approach between patients and physicians is essential. The Canadian Task Force on Preventive Health Care (CTFPHC) provides cancer screening guidelines and helpful resources for both patients and providers to aid in the cancer screening decision-making process (https://canadiantaskforce.ca). This article summarizes current CTFPHC guidelines for cancer screening of prostate, lung, colorectal, cervical, ovarian, and breast cancers, and offers clinical pearls for practice.
Hey @sweetiepie I was doing my CME stuff and this was one of the articles that had CME points.
Thought you might find it informative especially with reference to our previous discussions about prostate cancer screening?
Cancer screening in Canada
What’s in, what’s out, what’s coming
Genevieve Chaput, M. Elisabeth Del Giudice and Ed KucharskiCanadian Family Physician January 2021, 67 (1) 27-29; DOI: https://doi.org/10.46747/cfp.670127
Family physicians are routinely asked to carry out cancer screening tests not in keeping with current guidelines or existing organized screening programs. It can be challenging for primary care providers to choose wisely and follow guidelines while also promoting patient-centred care. In these instances, an informed and shared decision approach between patients and physicians is essential. The Canadian Task Force on Preventive Health Care (CTFPHC) provides cancer screening guidelines and helpful resources for both patients and providers to aid in the cancer screening decision-making process (https://canadiantaskforce.ca). This article summarizes current CTFPHC guidelines for cancer screening of prostate, lung, colorectal, cervical, ovarian, and breast cancers, and offers clinical pearls for practice.
Prostate cancer screening
Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death in men.1 A steady decrease in prostate cancer mortality rates has been noted in the past decade.2 Considerable debate remains regarding the benefits of screening for prostate cancer using prostate-specific antigen (PSA) testing.3What is recommended
- In men younger than 55 years of age, PSA testing is not recommended (strong recommendation, low-quality evidence).4
- In men aged 55 to 69 years, PSA testing is not recommended (weak recommendation, moderate-quality evidence).4
- In men 70 years of age and older, PSA testing is not recommended (strong recommendation, low-quality evidence).4
Lung cancer screening
Lung cancer remains the most frequently diagnosed cancer and principal cause of cancer death in Canada.1 Increasing evidence supports lung cancer screening using low-dose computed tomography (LDCT), as it detects earlier-stage lung cancers, therefore statistically significantly reducing mortality.6 Provincial pilot studies are under way and will inform future organized lung cancer screening program implementation across Canada.7,8What is recommended
- Annual screening with LDCT is recommended up to 3 consecutive times for adults aged 55 to 74 years with at least a 30 pack-year smoking history, who currently smoke or quit fewer than 15 years ago (weak recommendation, low-quality evidence).9
- Screening with LDCT should only be performed in settings where early screening and treatment expertise are readily available.9
- Chest x-ray scan, with or without cytology screening, is not recommended for lung cancer screening (strong recommendation, low-quality evidence).9
Colorectal cancer screening
Colorectal cancer (CRC) is the third most diagnosed cancer in Canada.1 Recent declines in CRC mortality rates are partially owing to increased screening, allowing for detection of more treatable earlier-stage disease and precancerous polyps.1 Among high-risk patients including those with a personal history of known genetic mutation,11 inflammatory bowel disease,12 or a first-degree relative with CRC,13 screening colonoscopy remains the criterion standard investigation for detecting cancer and high-risk precancerous adenomas. In asymptomatic average-risk patients, diagnostic colonoscopy following positive stool-based test results (fecal occult blood tests, fecal immunochemical tests) has shown high-yield pathology results.14 Current evidence supports the use of stool-based tests as a safe, convenient, and effective CRC screening method among average-risk adults.15What is recommended
- For average-risk adults aged 50 to 74 years, screening with fecal occult blood testing or fecal immunochemical testing is recommended every 2 years or flexible sigmoidoscopy every 10 years (50 to 59 years: weak recommendation, moderate-quality evidence; 60 to 74 years: strong recommendation, moderate-quality evidence).15
- Screening of adults aged 75 years or older is not recommended (weak recommendation, low-quality evidence).15
Cervical cancer screening
Cervical cancer is one of the most preventable and treatable cancers. The advent of screening using the Papanicolaou test has led to dramatic declines in Canadian cervical cancer incidence and mortality,18 which is currently estimated at 1350 new cases and 410 deaths per year.1 The World Health Organization is currently leading a global effort aiming to eradicate this cancer by 2040. This includes a comprehensive human papillomavirus (HPV) vaccination and primary HPV screening strategy.19 Based on an abundance of RCT evidence,20 during the next decade there will likely be a transition to primary HPV screening in most provinces across Canada.21 Moreover, the outcomes of comprehensive HPV vaccination on initial cohorts now reaching cervical screening age are expected to soon emerge, which will further inform future cervical cancer screening practices.What is recommended
- Pap test screening remains the standard of care and is recommended every 3 years for asymptomatic women who are or who have been sexually active aged 25 to 69 years (25 to 29 years: weak recommendation, moderate-quality evidence; 30 to 69 years: strong recommendation, high-quality evidence).22
- For women 70 years of age and older, if adequate screening has been performed (ie, 3 successive negative Pap test results in the past 10 years), screening can cease (weak recommendation, low-quality evidence).22
Ovarian cancer screening
To date, ovarian cancer survival rates remain poor.1 It is estimated 3100 Canadian women will receive an ovarian cancer diagnosis in 2020: among these, nearly 2000 deaths are expected.1,23 Currently, there are no organized ovarian cancer screening programs, and early detection procedures remain limited.24 The CTFPHC guidelines report an absence of evidence to support the effects of screening on mortality.25 The US Preventive Services Task Force’s 2018 updated evidence report and systematic review further indicated no difference in ovarian cancer mortality among screened versus unscreened average-risk asymptomatic women.26What is recommended
- Screening of asymptomatic women using transvaginal ultrasound or cancer antigen 125 is not recommended (high screening harms compared with any small potential benefit).25
Breast cancer screening
Approximately 1 in 8 women will develop breast cancer, and an estimated 1 in 33 will die from this disease.27 Average risk of breast cancer is defined as no personal history of breast cancer, no first-degree relative family history of breast cancer, no known mutations in the BRCA1 and BRCA2 genes, and no previous exposure to radiation of the chest wall.28 The CTFPHC’s updated guidelines focus on shared decision making, as recommendations are conditional on a patient’s relative value of potential harms and benefits of screening.28What is recommended
- In women aged 40 to 49 years, mammography is not recommended (conditional recommendation, low-certainty evidence).28
- In women aged 50 to 74 years, mammography every 2 to 3 years is recommended (conditional recommendation, very low–certainty evidence).28
- Magnetic resonance imaging, computed tomography, and ultrasound scans are not recommended for screening (strong recommendation, no evidence).28