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Breast cancer rates on the rise for young women in Canada, study says

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Young women in Canada were more likely to get breast cancer in recent years than three decades ago, according to a new analysis that shows the rates increased most among patients in their 20s and 30s.

The study, published Friday in the Canadian Association of Radiologists Journal, found that young women are still much less likely to develop breast cancer than senior citizens, but their risk is increasing in a way that mirrors findings about early onset cancer in other countries and other parts of the body.

“Twenty years ago, we saw women with breast cancer in their 20s so rarely that it would be something we would show in rounds,” said Jean Seely, head of breast imaging at the Ottawa Hospital and one of the study’s authors. “Now we’re seeing it on a regular basis.”

The rising rates of breast cancer among Canadian women in their 20s and 30s – when many are in the prime of life, completing post-secondary education, raising young children and scaling the career ladder – is part of a larger trend toward increasing incidence of early-onset cancers in developed countries the world over.

Early-onset cancer, which is usually defined as cancer in adults younger than 50, is becoming more common in at least 14 different types of cancer, including breast, colorectal and pancreatic, according to a 2022 study in the journal Nature that asked, “Is early-onset cancer an emerging global epidemic?”

A separate study in BMJ Oncology found that, globally, incidence rates of early-onset cancer increased by nearly 80 per cent between 1990 and 2019.

“It’s a mystery,” said Shuji Ogino, a professor of pathology at Harvard Medical School and one of the authors of the Nature paper. “But we know many risk factors already for adult cancer. We have good hypotheses.”

Topping the list of suspects is what Dr. Ogino calls the “modernizing lifestyle,” including an obesity-promoting Western diet laden with processed foods. Other suspects include a lack of exercise, increased alcohol consumption, modern sleep patterns, stress, and exposure to chemicals and pollutants.

The new paper drew on Statistics Canada population and cancer registry data to analyze breast cancer incidence in Canada over time, broken down by age group.

The researchers found that among those in their 20s, there were, on average, 5.7 cases per 100,000 people of breast cancer annually between 2015 and 2019, up from 3.9 cases per 100,000 between 1984 and 1988 – a 45.5-per-cent increase.

For 30-somethings, there was a 12.5-per-cent increase over the same time span. The rate rose to 42.4 cases per 100,000 in the 2015-2019 period from 37.7 cases per 100,000 in 1984-1988.

Rates also increased for some groups of older women, including those in their 40s, but at slower rates than for their younger peers. Fortunately, overall breast cancer mortality rates have fallen significantly during the same period in Canada as treatments improved and organized screening mammogram programs, primarily aimed at women 50 to 74, detected cancer earlier in older women.

When it comes to breast cancer, another factor could be the trend of delaying or forgoing childbearing in wealthy countries, including in Canada. The new paper notes that the average age at which Canadian women give birth rose to 31.6 in 2022, up from 23.5 in 1966. Hormone changes that occur during pregnancy and breastfeeding are believed to lower risk for breast cancer.

Anna Wilkinson, a GP-oncologist at the Ottawa Hospital and another author of the new study, suspects a “combination of factors” are behind the rising incidence of breast cancer in young women.

“We know things like alcohol exposure and physical inactivity can increase your risk,” she said. “We see that women are having their first child at a later age and they’re not having as many children. So those protective factors, like progesterone exposure during pregnancy and breastfeeding, are lessened.”

One factor that isn’t contributing to the increase is screening. That’s because regular screening mammograms are not recommended for average-risk women in their 20s and 30s in Canada.

Dr. Seely and Dr. Wilkinson, who have been vocal advocates of screening for breast cancer starting at age 40, say the disease remains rare enough in women below 40 that widespread screening wouldn’t be a sensible use of health-care resources. However, they urged younger women who notice changes to their breasts, including discolouration or lumps, to get their symptoms checked out.

In 2019, the most recent year included in the paper, the breast-cancer incidence rate was 140.76 cases per 100,000 for Canadian women in their 40s, 42.47 per 100,000 for those in their 30s and 6.07 for women in their 20s.

The Canadian Task Force on Preventive Health Care, which issues national recommendations to primary-care providers, currently recommends against screening mammograms for average-risk women age 40-49, saying the risks of false positives and overtreatment outweigh the benefits for that age group. The task force is due to publish a highly anticipated update to its guidelines this spring.

 

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

The Canadian Press. All rights reserved.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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