Cancer experts say current recommendations use old data, lack expert advice and are too slow to update
Carolyn Holland can’t help wondering how many years of her life she’s lost because her breast cancer was diagnosed late.
The Ottawa mom first discovered lumps in her breasts while in the shower. At 43 years old, she’d never had a mammogram.
After seeing her doctor, she was sent for a scan, which confirmed the cancer. But at that point it had already advanced. Holland needed two types of chemotherapy, radiation, the removal of her lymph nodes and a double mastectomy.
This shouldn’t happen to other women. It’s preventable, Holland said.
Holland’s doctors told her that her treatment could have been less drastic had the cancer been detected sooner. But Canada’s national guidelines do not recommend routine breast cancer screening for women under the age of 50.
Had I been able to access screening at 40, this wouldn’t have been my outcome, she said.
A group of medical experts say Canadian lives are at risk because family doctors are using outdated guidelines to decide whether, and when, to send their patients for routine cancer screenings.
The guidelines are issued by the Canadian Task Force on Preventive Health Care (new window), an arms-length panel of 15 doctors and other primary care providers set up by the federal government. The independent volunteer panel examines the research on screening and preventing various illnesses, including cancer.
These guidelines impact millions of Canadians. The consequences are grim. Current task force guidelines often limit access to critical life-saving screening, said Dr. Shiela Appavoo, an Edmonton-based radiologist.
She’s with the Coalition for Responsible Healthcare Guidelines, a group of cancer specialists, family doctors and patients calling for changes to how the guidelines are created.
The coalition says the task force is using outdated research, doesn’t properly take in the advice of experts and is far too slow to update its recommendations.
Family doctors taught to follow national guidelines
The task force’s breast cancer screening guidelines are set to be updated next month. The current recommendations (new window), last updated in 2018, recommend against broad screening of women in their 40s.
The Canadian Cancer Society withdrew its support for the guidelines in December 2022, citing concerns that they were not keeping pace with new research, in particular the growing incidence of cancer (new window) in younger populations around the world. The latest statistics (new window) show the cancer most commonly diagnosed in Canadians aged 30 to 49 is breast cancer.
WATCH |Cancer screening guidelines are out of date, experts say:
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Canada’s cancer screening guidelines are out of date, doctors say
A group of cancer experts say Canadian national screening guidelines are a decade out of date, which is leading to people getting diagnosed later, when they are more difficult to treat.
Many provinces have ignored the task force guidelines by lowering the age when they offer breast cancer screening to include women in their 40s.
While some provinces have expanded screening eligibility to younger women, many doctors still might not send their patients for the test because the national guidelines recommend against it, Appavoo said.
Unfortunately, a lot of family physicians are taught and trained to follow the task force guidelines, Appavoo said.
That’s a problem, she said, because a patient is most likely to go for cancer screening if their doctor recommends it.
So it is really important to give family doctors appropriate and adequate information on who to screen and when to screen, Appavoo said.
Just Askingwants to know:What questions do you have about cancer screening in Canada? Are the current guidelines adequately serving you?Fill out the details onthis form(new window)and send us your questions ahead of our show on April 27.
The lack of leadership on national guidelines has also led to piecemeal coverage across the country, she said, because some Canadians have access to cancer screening sooner than others.
Cancer research from 1960s still being used
Dr. Anna Wilkinson saw firsthand the impact of those guidelines she was taught to follow. As an Ottawa family physician who treats oncology patients, she’s worked with many women in their 40s dying of breast cancer.
They asked for a mammogram and they were told, ‘No, you don’t need one because you’re in your 40s,’ Wilkinson said. It’s heartbreaking.
That prompted Wilkinson to co-author a study (new window) that compared breast cancer statistics from provinces that screened women in their 40s to stats from provinces that followed the task force guidelines. Her study found that earlier screening led to significantly improved survival rates.
Despite new evidence from Canada and around the world about the benefits of screening women at younger ages, Wilkinson said the task force continues to weigh outdated data when making its recommendations.
The task force is still using data from a 1963 trial to determine whether women should be screened today, she said.
That is completely irrelevant at this point, Wilkinson said. There is nothing about the way that breast cancer screening was done or treatment was done in the 60s that reflects today’s practices.
Other cancer guidelines out of date, experts say
The task force screening guidelines for several other types of cancer also lag behind what many experts, cancer organizations and other jurisdictions recommend.
They are harming Canadians because they are leading us to diagnose cancers at a later stage when we know survival is worse and when the costs of treatment are more, Wilkinson said.
The guidelines for cervical cancer haven’t been updated since 2013 and aren’t due to be revisited until 2025.
The task force currently recommends against screening for HPV (new window), citing concerns the research is too premature. HPV is the virus that causes most cases of cervical cancer and it can be detected much sooner than a Pap test detects changes in cervical cells.
The task force’s guidelines for lung cancer screening (new window) were last updated in 2016 and are not due to be revamped until 2026. The task force gives what it calls a weak recommendation to screen heavy tobacco users with low-dose CT scans, despite research (new window) that has found CT scans help to detect lung cancer early and decrease the number of deaths.
Half of the time when we diagnose people with lung cancer, it’s already Stage 4, which is incurable, said Dr. Paul Wheatley-Price, who leads the lung cancer program at the Ottawa Hospital Cancer Care Centre.
He said the amount of time it takes the task force to update its guidelines is baffling.
The task force’s guidelines on prostate cancer (new window), which won’t be updated until 2026, recommend against prostate specific antigen (PSA) blood tests. The Canadian Urological Association has criticized that advice (new window) since it was issued in 2014; it argues that trials show screening reduces prostate cancer deaths by up to 44 per cent.
Those (task force) guidelines are about 10 years old and we’ve made a huge amount of progress, said Dr. Fred Saad, director of prostate cancer research at the Montreal Cancer Institute. The input that came from experts was basically ignored.
The task force also doesn’t offer different guidelines for screening based on a patient’s ethnicity, despite research that shows some populations are diagnosed with certain cancers at earlier ages. Inuit, for example, are more than twice as likely as the rest of the population to be diagnosed with lung cancer, according to the Canadian Partnership Against Cancer. (new window)
The risk of ‘over-diagnosis’
New studies are coming out all the time, said task force member Dr. Eddy Lang — but they don’t always offer enough evidence for the panel to change its recommendations.
<q data-attributes=""lang":"value":"fr","label":"Français","value":"html":"Our system is arguably in crisisand it may not be the best use of resources to be detecting things early,","text":"Our system is arguably in crisisand it may not be the best use of resources to be detecting things early,"”>Our system is arguably in crisis and it may not be the best use of resources to be detecting things early, Lang said, who works as an emergency room physician in Calgary.
While the task force does consult with cancer experts, Lang said, those experts don’t get to set the guidelines — and there’s a good reason for that.
Someone who’s been researching and advocating in the breast cancer or prostate cancer field for their whole career might have a different view than a neutral group that is trying to make recommendations for family doctors, he said.
<q data-attributes=""lang":"value":"fr","label":"Français","value":"html":"Experts in the area will often focus a bit more on the benefits of screening and may not have as much attuned understanding or awareness of the harms that [are]often seen more at the primary care level, and that is our audience.","text":"Experts in the area will often focus a bit more on the benefits of screening and may not have as much attuned understanding or awareness of the harms that [are]often seen more at the primary care level, and that is our audience."”>Experts in the area will often focus a bit more on the benefits of screening and may not have as much attuned understanding or awareness of the harms that [are] often seen more at the primary care level, and that is our audience.
Lang said the task force needs to factor in the risks associated with over-diagnosis — of subjecting patients to cancer treatments that can be more harmful than the cancer itself, or of treating a cancer that never would have caused a problem in the first place.
I thought it was common knowledge, you screened for cancer, you catch it early, you nip it in the bud. But when I joined the task force and started looking at the evidence, I was actually blown away at how significant the harms can be of early detection, he said.
But cancer survivor Carolyn Holland said Canadians have the right to know if they have cancer, and then make informed decisions about treatment.
What I would tell the task force is, you are not saving us from harm, she said. You’re actually putting us in harm’s way by denying us screening, by denying us the chance to catch cancers early.
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
