Achi news desk-
A group of doctors say Canadian cancer screening guidelines set by a national task force are out of date and putting people at risk because their cancers aren’t being detected early enough.
“I am faced with treating too many patients who are dying of prostate cancer on a daily basis because of delayed diagnosis,” said Dr. Fred Saad, urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, 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 physicians and nurse practitioners decide whether and when to recommend screening and other preventive and early detection health care measures to their patients.
Its members include primary care physicians and nurse practitioners, as well as specialists, a spokesman for the task force said in an email Monday.
But Saad and other doctors associated with the Guidelines for the Coalition for Responsible Healthcare, which organized the news conference, said the task force’s screening guidelines for breast, prostate, lung and cervical cancer are based largely based on older research and conflicting with the opinions of experts in these. areas.
For example, the task force recommends against widespread use of the prostate-specific antigen test, commonly known as the PSA test, for men who have not already had prostate cancer. Saad called that advice, which dates back to 2014, “outdated” and “simplistic.”
The task force’s recommendation is based on the harm of having 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.
“We are well past the age of every abnormal screening test leading to a biopsy and every biopsy leading to treatment,” he said, noting that MRIs can be used to avoid some biopsies.
“Canadian men deserve (to) have the right to decide what is important to them, and family doctors need to stop being confused by recommendations that defy 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 guideline, which does not endorse mammograms for women under 50.
That’s despite the fact that the US task force says women age 40 and older could decide to get one after discussing the risks and benefits with their primary care provider.
A Canadian task force is due to update its guidelines on breast cancer screening in the coming months, but Yaffe said he’s still concerned.
“The leadership of the task force shows a strong bias against earlier detection of disease,” he said.
Like Saad, Yaffe believes it puts 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 recalled and being temporarily worried for a few days while things are sorted out, compared to the chance of have cancer go undetected and you either die from it or suffer. being treated for very advanced disease.”
But Dr Eddy Lang, a member of the task force, said that the harm of false positives should not be underestimated.
“We certainly have recommended screening when the benefits clearly outweigh the harms,” said Lang, who is an emergency physician and professor at the University of Calgary’s medical school.
“But we are careful and balanced and want to make sure we consider all points of view.”
For example, some men get prostate cancer that doesn’t progress, Lang said, but if they get treatments they face risks including possible urinary incontinence and erectile dysfunction.
Lang also said the task force is monitoring research “all the time for important studies that will change our recommendations.”
“And if one of them comes forward, we prioritize updating that particular guide,” he said.
The Canadian Cancer Society withdrew its endorsement from 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 include women between the ages of 40 and 50.
“(The Canadian Cancer Society) believes there is an obligation to ensure that guidelines keep pace with the changing environment and new research findings to ensure that people in Canada are supported with preventive health care,” he said in an emailed statement. Monday night post.
Some states have implemented more proactive early detection programs, including screening for breast cancer at a younger age, using human papillomavirus (HPV) testing to screen for cervical cancer and implementing CT scanning to screen for lung cancer, he said. doctors with the Guidelines of the Alliance for Responsible Healthcare.
But that leads to “fragmented” screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist with the University of Alberta.
Also, many primary care providers rely on the national task force’s guidelines in their discussions with patients, he said.
“The strongest link to a woman going for her breast cancer screen is whether or not her doctor recommends it to her. So if her doctor doesn’t recommend it for her, it doesn’t matter what the provincial guideline allows,” Appavoo said.
As well as updating its guideline for breast cancer screening this spring, the task force is due to revise its guidelines for cervical cancer screening in 2025 and for lung cancer and prostate cancer screening in 2026, in according to his website.
Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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