Breast Cancer

For average-risk women aged 40 to 49, routine screening is not recommended whether by mammography, breast self-examination or clinical breast examination by a physician. According to Dr. Thombs, “Our recent breast cancer guidelines … really were transformed to avoid the “yes” or “no” dichotomy and to be “conditional” recommendations on mammography that explicitly emphasized that the job of healthcare providers is to support women to make an informed choice based on good information and their own values and preferences.” For women aged 50 to 74, screening by mam- mography is recommended every two to three years, but breast self-examination and clinical breast examination by a physician are not. No recommendation is made for women over 74 years of age because there is not

enough data to make a general recommendation.

For average-risk women, the evidence suggests that there may be more harm than benefit from breast self-examination and clinical breast examination by a physician.

Cervical Cancer

Recommendations are presented for screening asymptomatic women who are or have been sexually active. They do not apply to women with symptoms of cervical cancer, previous abnormal screening results (until they have been cleared to resume normal screening), those who do not have a cervix (due to hysterectomy) or who are immunosuppressed. The recommendation is for women aged 25 to 69 to be screened for cervical cancer every three years. Women aged 70 and older should continue being screened until they have three negative tests in 10 years, at which time screening can cease.

Colorectal Cancer

The recommendation is to start screening for colorectal cancer (CRC) at age 50 and continue until age 74. Screening is done with one of two tests, which detect microscopic amounts of blood in the stool – the FIT (fecal immunochemical) test or the gFOBT (guaiac-based fecal occult blood test), done every two years. Or flexible sigmoidoscopy (looking in the sigmoid colon with a camera) can be prescribed every 10 years.

For people with first-degree relatives with CRC, the recommendation is to begin colonoscopies 10 years earlier than the age of the first-degree relative diagnosed with CRC – or age 50, whichever occurs first, every five years.

Lung Cancer

The recommendation is for adults aged 55 to 74 with at least a 30 pack-year smoking history (smoking a pack a day for 30 years) who still smoke or quit less than 15 years ago to have up to three annual screenings with low-dose computed tomography (CT scan).

Prostate Cancer

The current recommendation from the CTFPHC is not to screen with the PSA (prostate specific antigen, a blood test) at any age. They also don’t recommend that doctors perform a rectal examination. This is quite different from some other organizations. For example, the Canadian Urological Association recommends offering PSA screening to men at the age of 50 (or 45 for men with a family history). They state that the decision of whether or not to pursue PSA screening should be based on shared decision-making after the potential benefits and harms associated with screening have been discussed.

For those who do get screened, the frequency of testing depends on the result of the previous test, with higher scores leading to more frequent screenings. When to stop screening also depends on PSA levels and life expectancy.

The CTFPHC does not recommend prostate cancer screening for:

Only a small proportion of prostate cancer causes symptomatic disease or death whereas the majority is slowly progressive and not life-threatening.

Screening with PSA may lead to a small reduction in prostate cancer mortality but does not reduce overall mortality.

No PSA value completely excludes prostate cancer.

Harms (such as bleeding, infection, urinary incontinence, false positives and over-diagnosis) are common following PSA screening.