Health

Provinces with organized breast-cancer screening for women in their 40s linked to higher survival rates

Published

1 year ago

August 4, 2023

Canadian provinces and territories that allowed women aged 40-49 to self-refer for organized breast cancer screening programs had lower breast cancer mortality rates compared with those that did not, a new study says.Michael Hanschke/Reuters

Canadian women diagnosed with breast cancer in their 40s were more likely to be alive 10 years later if they lived in a province with an organized screening program that permitted women of their age to refer themselves for mammograms, a new study says.

Researchers from Statistics Canada and the Ottawa Hospital concluded that, in provinces they defined as “screeners,” 84.8 per cent of women diagnosed in their 40s survived for at least a decade, compared with 82.9 per cent of women in provinces that make it difficult to get a mammogram before age 50 – an absolute difference of 1.9 percentage points.

The study could not determine whether it was mammogram access or something else that improved survival. (Only a randomized control trial might be able to do so.) It just shows that higher 10-year survival rates correlate with residing in a province where organized breast-cancer screening programs include women in their 40s.

However, University of Ottawa radiology professor Jean Seely, an author of the study, believes the findings are, “such an underestimation of the benefit of screening,” because even in provinces with the most welcoming approach, Statscan surveys suggest barely half of women in their 40s get regular mammograms.

The new paper, published Friday in the Journal of Clinical Oncology, is the latest salvo in the Canadian mammogram controversy, which is expected to heat up again this fall. That’s when the Canadian Task Force on Preventive Health Care is scheduled to release the first update to its breast-cancer screening advice since 2018.

The study, which drew on data from the Canadian Cancer Registry, included 21,103 cases of invasive breast cancer diagnosed in women 40 to 49 between 2002 and 2007, with follow-up data to 2017.

In May, the United States Preventive Services Task Force released a draft recommendation lowering the starting age for mammograms to 40 from 50.

The current Canadian guidelines recommend against screening mammograms for average-risk women under 50, largely because the authors consider the risks of false positives and over diagnosis to outweigh the benefits for young women, who have lower rates of breast cancer than their older counterparts.

However, the Canadian guidelines, which don’t apply to women with known risk factors such as a family history of breast cancer, say that women 40 to 49 who want a mammogram should be able to get one through “shared decision-making” with a doctor.

Although the Canadian guidelines are national, provincial and territorial governments take different approaches to mammograms, which are low-dose X-rays of the breast.

Some allow women in their 40s to self-refer, without a doctor’s endorsement, to an organized program that includes annual recalls. Others require women in that age bracket to find a doctor willing to refer them for a screening mammogram. (Screening refers to tests done on people with no symptoms. A woman who finds a lump in her breast can ask her doctor for a mammogram referral, but that wouldn’t count as screening.)

Dr. Seely, who is also the head of breast imaging at the Ottawa Hospital, and her co-authors took advantage of divergent provincial and territorial policies to design a study that divided jurisdictions that screen women in their 40s – defined as places with organized programs that include self-referral and annual recall – and those that don’t.

The screening jurisdictions were British Columbia, Alberta, Nova Scotia, Prince Edward Island and the Northwest Territories. The rest were designated as comparators, except for Nunavut, which was excluded because of lack of data.

The study found a 1.9 percentage point difference in 10-year net survival rates between women in screening and comparator jurisdictions.

The survival benefit was more pronounced in women 45 to 49. There was a 2.6 percentage point survival benefit for women in that bracket, which Anna Wilkinson, a GP-oncologist at the Ottawa Hospital and another author of the study, said approached the survival benefit seen with tamoxifen, a widely used treatment for breast cancer.

For women 40 to 44, however, the difference was a statistically insignificant 0.9 percentage points.

Backers of the Canadian task force’s current recommendation against screening women for breast cancer in their 40s have long been critical of taking into account observational studies that can’t prove cause and effect, preferring to rely on randomized control trials of screening mammography, the majority of which are decades old.

However, the task force has indicated it is widening its net beyond RCTs in the current review. Ottawa gave the panel an extra $500,000 to expedite the process.

Guylène Thériault, a Quebec family physician and co-chair of the Canadian task force, said panel members would evaluate the new study to see whether it fits their criteria.

“We want to hear from as many sources as possible to help inform the breast cancer screening guideline update,” Dr. Thériault said in a statement.

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Health

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

Published

1 day ago

September 13, 2024

Anne Joseph

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.

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Health

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

Published

3 days ago

September 11, 2024

Anne Joseph

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.

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

Published

4 days ago

September 10, 2024

Anne Joseph

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.

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