A group of doctors says Canadian cancer screening guidelines set by a national task force are outdated and putting people at risk because their cancers are not detected early enough.
“I am faced with treating too many patients who die daily from prostate cancer due to late diagnosis,” he said at a news conference in Ottawa on Monday.
The Canadian Task Force on Preventive Health Care, established by the Public Health Agency of Canada, establishes clinical guidelines to help family physicians and nurse practitioners decide whether to recommend screening and other preventive and screening health care measures to your patients early and when to do it.
Its members include primary care physicians and nurse practitioners, as well as specialists, a spokesperson for the task force said in an email Monday.
But Saad and other doctors associated with the Coalition for Responsible Care Guidelines, which hosted the news conference, said the task force’s breast, prostate, lung and cervical cancer screening guidelines are largely based on in older research and conflict with the opinions of specialists on those topics. areas.
For example, the task force recommends against widespread use of prostate-specific antigen testing, commonly known as a PSA test, for men who have not yet had prostate cancer. Saad called that advice, which dates back to 2014, “outdated” and “overly simplistic.”
The task force’s recommendation is based on the harms of obtaining false-positive results that lead to unnecessary biopsies and treatments, he said.
But that reasoning wrongly assumes that everyone who tests positive for PSA will automatically receive a biopsy, Saad said.
“We are far beyond the era where every abnormal screening test led to a biopsy and every biopsy led to a treatment,” he said, noting that MRIs can be used to avoid some biopsies.
“Canadian men deserve the right to decide what is important to them, and family physicians must stop being confused by recommendations that fly in the face of logic and evidence.”
Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Cancer Research Institute, raised similar concerns about the task force’s breast cancer screening guidelines, which do not support mammograms for women under 50. .
This despite the US task force saying that women age 40 and older can decide to get one after discussing the risks and benefits with their primary care provider.
The Canadian task force is due to update its guidelines on breast cancer screening in the coming months, but Yaffe said he is still concerned.
“The leadership of the task force demonstrates a strong bias against earlier detection of the disease,” he said.
Like Saad, Yaffe believes he places too much emphasis on the potential harm of false positive results.
“It’s very difficult for us and for patients to balance this idea of being called back and being temporarily anxious for a few days while things are sorted out, versus the possibility that the cancer goes undetected and they end up dying from it.” him or being treated for a very advanced illness.”
But Dr. Eddy Lang, a member of the task force, said the harms of false positives should not be underestimated.
“We certainly have recommended screening when the benefits clearly outweigh the harms,” said Lang, an emergency physician and professor at the University of Calgary faculty of medicine.
“But we are cautious and balanced and want to make sure we consider all perspectives.”
For example, some men get prostate cancer that doesn’t progress, Lang said, but if they undergo treatments they face risks including possible urinary incontinence and erectile dysfunction.
Lang also said the task force monitors research “all the time for important studies that will change our recommendations.”
“And if one of them appears, we prioritize updating that particular guideline,” he said.
The Canadian Cancer Society withdrew its endorsement of the task force’s website in December 2022, saying it had not acted quickly enough to review and update its breast cancer screening guidelines to consider including women aged 40 to 50 years.
“(The Canadian Cancer Society) believes there is an obligation to ensure that guidelines keep up with the changing environment and new research findings to ensure that people in Canada are supported with preventive health care,” he said in a statement emailed Monday evening.
Some provinces have implemented more proactive early detection programs, including screening for breast cancer at younger ages, using human papillomavirus (HPV) testing to detect cervical cancer, and implementing CT scans to detect lung cancer, said doctors with the Coalition for Responsible Care Guidelines. .
But that leads to “fragmented” screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist at the University of Alberta.
Additionally, many primary care providers rely on the national task force’s guidelines in their conversations with patients, he said.
“The strongest association… with a woman actually getting screened for breast cancer is whether her doctor recommends it or not. So if her doctor doesn’t recommend it, it doesn’t matter what the laws allow.” provincial guidelines.” Appavoo said.
In addition to updating its breast cancer screening guidelines this spring, the task force should review its guidelines for cervical cancer screening in 2025 and for lung and prostate cancer screening in 2026, according to its site. Web.
This report by The Canadian Press was first published April 16, 2024.
The Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.