A group of doctors say Canadian cancer screening guidelines set by a national task force are out-of-date and putting people at risk because their cancers aren害羞草研究所檛 detected early enough.
害羞草研究所淚害羞草研究所檓 faced with treating too many patients dying of prostate cancer on a daily basis due to delayed diagnosis,害羞草研究所� Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, 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, sets clinical guidelines to help family doctors and nurse practitioners decide whether and when to recommend screening and other prevention and early detection health-care measures to their patients.
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 Healthcare Guidelines, which organized the news conference, said the task force害羞草研究所檚 screening guidelines for breast, prostate, lung and cervical cancer are largely based on older research and conflict with the opinions of specialists in those areas.
For example, the task force recommends against wide use of the prostate specific antigen test, commonly known as a PSA test, for men who haven害羞草研究所檛 already had prostate cancer. Saad called that advice, which dates back to 2014, 害羞草研究所渙utdated害羞草研究所� and 害羞草研究所渙verly simplistic.害羞草研究所�
The task force害羞草研究所檚 recommendation is based on the harms of getting false positive results that lead to unnecessary biopsies and treatment, he said.
But that reasoning falsely assumes that everyone who gets a positive PSA test will automatically get a biopsy, Saad said.
害羞草研究所淲e are way beyond the era of every abnormal screening test leading to a biopsy and every biopsy leading to treatment,害羞草研究所� he said, noting that MRIs can be used to avoid some biopsies.
害羞草研究所淐anadian men deserve (to) have the right to decide what is important to them, and family physicians need to stop being confused by recommendations that go against logic and evidence.害羞草研究所�
Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, raised similar concerns about the task force害羞草研究所檚 breast cancer screening guideline, which doesn害羞草研究所檛 endorse mammograms for women younger than 50.
That害羞草研究所檚 despite the fact that the U.S. task force says women 40 and older may decide to get one after discussing the risks and benefits with their primary-care provider.
The Canadian task force is due to update its guidance on breast cancer screening in the coming months, but Yaffe said he害羞草研究所檚 still concerned.
害羞草研究所淭he task force leadership demonstrates a strong bias against earlier detection of disease,害羞草研究所� he said.
Like Saad, Yaffe believes it puts too much emphasis on the potential harm of false positive results.
害羞草研究所淚t害羞草研究所檚 very hard for us and for patients to balance this idea of being called back and being anxious transiently for a few days while things are sorted out, compared to the chance of having cancer go undetected and you end up either dying from it or being treated for very advanced disease.害羞草研究所�
But Dr. Eddy Lang, a member of the task force, said the harms of false positives should not be underestimated.
害羞草研究所淲e害羞草研究所檝e certainly recommended in favour of screening when the benefits clearly outweigh the harms,害羞草研究所� said Lang, who is an emergency physician and a professor at the University of Calgary害羞草研究所檚 medical school.
害羞草研究所淏ut we害羞草研究所檙e cautious and balanced and want to make sure that we consider all perspectives.害羞草研究所�
For example, some men get prostate cancer that doesn害羞草研究所檛 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 害羞草研究所渁ll the time for important studies that will change our recommendations.害羞草研究所�
害羞草研究所淎nd if one of them comes along, we prioritize the updating of that particular guideline,害羞草研究所� he said.
The Canadian Cancer Society pulled its endorsement from the task force害羞草研究所檚 website in December 2022, saying it hadn害羞草研究所檛 acted quickly enough to review and update its breast cancer screening guidelines to consider including women between 40 and 50.
害羞草研究所�(The Canadian Cancer Society) believes there is an obligation to ensure guidelines are keeping pace with the changing environment and new research findings to ensure people in Canada are supported with preventative health care,害羞草研究所� it said in an emailed statement 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 screen for cervical cancer and implementing CT scanning to screen for lung cancer, doctors with the Coalition for Responsible Healthcare Guidelines said.
But that leads to 害羞草研究所減iecemeal害羞草研究所� screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist with the University of Alberta.
Plus, many primary-care providers rely on the national task force guidelines in their discussions with patients, she said.
害羞草研究所淭he strongest association 害羞草研究所� with a woman actually going for her breast cancer screen is whether or not her doctor recommends it to her. So if her doctor is not recommending it to her, it doesn害羞草研究所檛 matter what the provincial guideline allows,害羞草研究所� Appavoo said.
In addition to updating its guideline for breast cancer screening this spring, the task force is due to review its guidelines for cervical cancer screening in 2025 and for lung cancer and prostate cancer screening in 2026, according to its website.
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