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Some doctors, patients want Canada to follow U.S. proposal for earlier mammograms
The co-chair of a Canadian health panel says there’s no need for women to start having routine mammograms at age 40, despite new draft recommendations from an American task force calling for that change.
Dr. Guylène Thériault of the Canadian Task Force on Preventive Health Care said she does not see any reason to change the guidelines. Regular mammography screening is currently recommended in both countries for women between the ages of 50 and 74.
However, Hannah Jensen, a spokeswoman for the Health Ministry in Ontario, said Thursday the province is “exploring” lowering the breast cancer screening age to 40. British Columbia will also review the U.S. draft recommendations to determine if any changes will be made to its screening program, the province’s health minister said.
The U.S. Preventive Services Task Force released draft recommendations Tuesday saying screening for average-risk women should start a decade earlier and be done every two years because recent evidence suggests that would have a “moderate benefit” in reducing deaths.
Thériault said the Canadian task force does not intend to update guidelines set in 2018 because the benefits of earlier screening do not outweigh the risks of false-positive results and overdiagnosis when harmless tumours are detected.
Out of 2,000 women who are screened over a decade between the ages of 40 and 49, one woman would die of breast cancer. About 295 false-positives would be detected among those cases, she said.
“Looking at the guidelines, we don’t see that there was anything new and we were a bit surprised,” Thériault said of the U.S. task force’s draft recommendations.
“In Canada, what we are saying is women should be empowered. They should have the information that they need to make a decision,” she said about the pros and cons of earlier mammograms.
Women should ask a family doctor for screening if there is a history of breast cancer in their family or if they have any specific concerns, Thériault added.
In its draft recommendations, the U.S. task force cited two studies that suggest there is adequate evidence of the “small” harms of biennial screening mammography, including false-positive results, when younger women are screened. It said false-positives are more likely with annual mammograms compared with longer intervals between screening.
Heather Campbell of Calgary said earlier routine screening could have spared her some painful treatments and surgery. She found a lump in her left breast on Oct. 13, 2017, at age 44 and was diagnosed with breast cancer two weeks later.
“I had no family history of breast cancer,” she said. “The tumours were too large to do radiation.”
That meant she first had chemotherapy, followed by surgery to remove about 40 per cent of her breast, then radiation. Two years later, she had a full hysterectomy to remove her uterus because her cancer was fuelled by estrogen, and an oophorectomy to remove both of her ovaries.
One important factor is often not taken into consideration by the medical community when it comes to breast cancer, said Campbell, a chemical engineer.
“I’m a Black woman. And Black women present with more aggressive cancers at earlier stages.”
Even the “breast catalogue” she looked at before considering reconstruction surgery featured white women’s breasts, she said.
The U.S. task force noted Black women are 40 per cent more likely to die of breast cancer than white women, and earlier mammograms could be especially important in addressing that disparity.
Race-based data in health care is not routinely collected in Canada and what’s available in the U.S. does not necessarily apply elsewhere, Campbell said.
“It’s really about understanding diversity within Black women in Canada. Black women in Canada are both African and Afro-Caribbean and European and that presents differently than the population of Black women who are in the U.S. Basically, you have to get to a place where you say, ‘We’re going to provide respectful health care to the full plurality of our population.'”
Dr. Andrea Covelli, a Toronto surgeon who looked at surgical decision-making in breast cancer as part of her PhD thesis, said her experience with patients has her calling for earlier mammography screening in Canada.
“I see many, many young patients with self-detected breast cancer. And if we were doing screening, those maybe would have been identified earlier. For some women, that might mean avoiding chemotherapy. For some women, that might mean avoiding mastectomy. So, it’s not without potential implications,” she said of later screening.
“And we see a shift in incidence in age of onset of cancers. I think we will eventually go to screening at 40.”
Covelli said the Canadian task force’s guidelines focus on standard screening for non-high-risk women.
“This is where I think people get confused, or say that the task force could be clearer,” she said.
A woman of any age should see a doctor about imaging if she has new symptoms, said Covelli, who is also an assistant professor at the University of Toronto.
“The challenge with that is that many women come to me who have had some doubts and have wanted to start screening at an earlier age. And their physician has said to them, no. That’s because of the guidelines that say (screening should start at) 50.”
She said Canadian guidelines should say “the option for screening can start earlier, at the discretion of the patient.”
“Right now, that’s not clear.”
The lack of clarity has created ongoing tension about screening guidelines because, according to data from the Canadian Cancer Society, some provinces offer mammograms to women in their 40s if they get a referral, or in the case of British Columbia, women can refer themselves for screening.
While saying that B.C. would take a look at the latest proposed screening guidelines in the U.S., Health Minister Adrian Dix added Thursday that the province has “led Canada in providing information on breast density and mammogram results.”
Breast density refers to the amount of glandular and fibrous tissue as well as fat in a woman’s breasts. Dense breasts make it more difficult for radiologists to see cancer on a mammogram because it’s hard to distinguish between cancer and dense tissue.
Covelli, who provided medical expertise for a program called Every Breast Counts, said its goal is to support Black women because “traditionally, breast cancer has been advertised as a white woman’s disease.”
The virtual initiative was launched two years ago by Women’s College Hospital in Toronto and helps Black women feel seen and heard because their experience with breast cancer is different, she said.
— With files from Brieanna Charlebois in Vancouver and The Associated Press
This report by The Canadian Press was first published May 12, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Camille Bains, The Canadian Press
Wellness and rejuvenation on a Whistler weekend
The freshness of spring is giving way to the languor of summer. It’s also that time of year when I step up my health and fitness habits, with the help of a wellness weekend getaway. Check out these ten wholesome ways to experience Whistler.
1. Eat well, be well at a new event series
Making its debut the Nourish Spring Series by Cornucopia celebrates the season every weekend in June with farm-to-table fare, farm tours, lavish wellness dinners, healthy brunches and activities to refresh both mind and body. Sit down to a four-course spring harvest tasting menu (Brome Lake duck breast with Pemberton beets, anyone?), brush up on grilling skills with an expert chef, pick up painting pointers on an art picnic or jump into an outdoor Zumba class. Order tickets online at whistler.com/events/spring-cornucopia.
2. Chill at a spa
With more than 12 spa facilities in town, it could be said that Whistler has everyone’s back. Pop into the Whistler Day Spa for a 75-minute stress relief massage using Swedish relaxation techniques or the Taman Sari Royal Heritage Spa for an 80-minute herbal steam massage using pouches filled with Javanese turmeric, ginger and other spices. Have more time? Dip into the hot-cold-and-relaxing thermal journey at the silent Scandinave Spa Whistler, home to open-air pools, cold-plunge baths, a Finnish sauna, Nordic showers and solariums in a tranquil forest setting.
3. Lace up for new guided hikes
Trek past alpine meadows flush with wildflowers on the way to glacier-fed Garibaldi Lake or meander through a fragrant rainforest before taking a dip in Crater Rim’s warm Loggers Lake. These are just a couple of guided hike options from Mountain Skills Academy & Adventures. Prefer to stay close to town? Sign up for the Whistler Alpine Hike and explore the gondola-accessed terrain of Whistler Blackcomb.
4. Embark on an ebike adventure
Sneak in some good clean fun with an ebike rental or guided tour. Explore Whistler’s car-free Valley Trail, a 46-km network of paved paths and boardwalks linking the resort town’s neighbourhoods and lakes, beaches, parks and viewpoints along the way. Go it alone or hop on a full-suspension electric-assist mountain bike with Whistler Eco Tours for a two-hour guided ride. Prefer an old-school ride or want to hit the alpine trails? Comfort cruisers, cross-country and downhill bikes are also on hand.
5. Expand the mind at an Indigenous exhibit
You have until October to view, the Squamish Lil’wat Cultural Centre’s Unceded: A Photographic Journey into Belonging. Shot at striking locales throughout the Sea to Sky Corridor, the exhibit brings together aspects of ancient traditions, modern Indigenous life, and colonization and development. Behold the bear dancer on Blackcomb Mountain, the cultural chief in the Fairmont Chateau Whistler lobby and the Squamish Nation chair standing in the middle of downtown Vancouver’s West Cordova St.
6. Get down, be healthy at a new café
Boogie back in time to the ’70s and ’80s at the new Rockit Coffee in Whistler Creekside. From the speaker-lined wall and vintage phones, radios and ghetto blasters to menu items like Espresso Greatest Hits and Drinks Just Wanna Have Fun, the colourful café exudes a decidedly retro vibe. Pull up a chair and order a nutritious Aero-Smoothie – choose from the Green Day, Bananarama or Strawberry Fields Forever – and pair it with a Veggie Eilish breakfast wrap or Prosciutto Rhapsody sandwich.
7. Check into wellness
Go for the Fairmont Chateau Whistler’s healthful options like daily yoga classes, guided excursions and access to pools, steam rooms, the fitness centre, tennis court and (soon) new pickle ball courts. But stay for the regionally sourced seasonal menus – complemented by the rooftop garden’s bounty from May to October – and no-proof cocktail selection in the Mallard Lounge.
8. Float down a winding river
Canoe, kayak or stand-up paddleboard along the meandering five-km-long River of Golden Dreams. After putting in at Alta Lake, paddle past riverbanks lined with wildflowers, foliage and forest, all the while keeping an eye out for beavers, otters, eagles and bears. Newbie paddlers are advised to go with a guide, as changing water levels can make for tricky steering and mandatory portages.
9. Connect with nature on a new birding trail
Watch for whiskey jacks, Clark’s nutcrackers and, come summer, lots and lots of swallows along the Sea to Sky Bird Trail. The fifth and most recent route to be added to the BC Bird Trail network along the Pacific Flyway, the new trail takes birders to alpine heights (lift ticket required) where they can spot olive-sided flycatchers and various raptors. Then it’s off to Rainbow Park on Alta Lake to spy common yellow throats and merlins.
10. Wake up beside a lake
Perched along the southern tip of Nita Lake in Whistler Creekside, Nita Lake Lodge checks off all the boxes for a dreamy wellness escape. Start with stunning water and valley views from luxe suites, currently undergoing a modern refresh slated to wrap in time for summer. Then there’s the new onsite restaurant, The Den, where plant-based alternatives share space with meat and seafood items on the seasonal menus. Topping off a salubrious stay at Whistler’s only lakeside hotel is an award-winning spa with rooftop hot tubs.
HIV stigma index researchers look for Manitobans with positive diagnoses to share experience
Manitoba researchers looking for people to take part in a national HIV Stigma Index project are only about halfway to their goal of hearing from at least 75 people living with a positive diagnosis.
The international peer-driven research project helps understand the stigma associated with HIV and supports those living with a diagnosis.
“I wouldn’t say that anybody ran out and said ‘I’m gonna go get HIV today and see how that happens.’ Things happen to people and it’s our duty as human beings to support people no matter what they’re going through,” research co-ordinator Arthur Miller told CBC Information Radio Wednesday.
The Canadian HIV Stigma Index is a community-led and community-based research study, part of the international implementation of the People Living with HIV Stigma Index project
Participants are interviewed by another person living with a positive diagnosis. Interviews are about an hour-and-a-half long and can be done in person, by phone or through a video conferencing platform, said Miller, a Mi’kmaw HIV activist based out of Nova Scotia and research co-ordinator of the project with REACH Nexus, under the MAP Centre for Urban Health Solutions at Unity Health Toronto.
The national project has been done in Ontario, Quebec, Atlantic Canada and British Columbia, and this is the second time it’s being done in Manitoba, with an updated survey.
Researchers collect information related to stigma, discrimination and human rights, with the aim of better understanding the social determinants and stigma across systems like health care, schools and legal fields. The research aims to help people develop supports and policies at both local and national levels.
Peer-driven aspect crucial
Jared Star, a research manager at Winnipeg’s Nine Circles Community Health Centre, which specializes in HIV prevention and care, said the HIV Stigma Index’s peer-driven aspect is crucial for participants.
“They know that they won’t be judged,” he said. “They won’t have to explain situations and details that come naturally for them, because they’re talking to somebody with the same experience.”
Star is also a research consultant and PhD student with expertise in sexual health, alongside his work with Nine Circles, which is working closely with Miller on the project.
“It’s better for the study if we can collect the data in a shorter period of time, but because it’s qualitative research, it tends to take longer than a survey,” said Star. “But the more we can get up front and faster, the better.”
Star said the information gained from the project will help people move from a place of supporting and sustaining stigma to actively challenging and resisting it.
“I think if we do a good job and we’re able to get that information and then develop interventions that target stigma, we will be able to contribute to a reduction in HIV infections in Manitoba,” he said.
Education key to understanding
Much more is known about HIV now than 30 years ago — like how to prevent transmission and that it’s no longer a death sentence.
With proper care, people who are HIV positive can lead long, healthy lives.
Miller said education is key and pointed to the fact that many don’t understand somebody with an undetectable viral load who adheres to treatment can’t transmit HIV through sexual intercourse.
“This is big for people with HIV,” he said. “For me, it felt like I got part of my life back.”
Manitobans willing to share their experiences through the HIV Stigma Index project can contact Miller at email@example.com or by phone at 1-877-347-1175 to begin the process.
“The great thing about this study is we’re building this network of people living with HIV,” Miller said. “You’re going to be talking with someone living with HIV, so they can relate and share some experiences.”
May 27, 2023 coronavirus update for Oakville
This is Oakville’s coronavirus update for Saturday, May 27, 2023. New, active cases of COVID-19 in Halton have nearly doubled for the second week in a row, and outbreaks at local long-term care homes are growing.
Oakville is reporting 22 new cases this week, about the same as the week before. But these last two reports from Halton regional health are the highest numbers of new cases in months – and active cases are now trending upwards by 50-100% weekly.
The outbreak that opened earlier this month at Oakville’s West Oak Village long-term care home has been contained to the Harbour floor. But there are two new outbreaks that have opened this week in other parts of Halton, including one at Oakville’s Northridge home on the Chisholm floor.
Halton continues to fall behind on our booster shots: only 1 of every 10 people in Halton have a full series of immunization, and the percentage of residents with outdated immunization has grown every week since the start of 2023. Among those 40 and under, those fully immunized is now below 5%.
The United States this week has said they and the CDC will no longer be tracking new, aggregate daily COVID-19 cases and deaths or new nationwide testing data.
The World Health Organization (WHO) has declared that after more than three years, the COVID-19 global health emergency is now over. WHO has determined that “COVID-19 is now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC).”
765 million cases of COVID-19 have now been recorded worldwide since the start of the pandemic; 6.9 million people have died.
**Vaccine booking: Fourth doses (second booster doses) of vaccine are now available for anyone in Halton age 5 and up, though fourth doses must be at least five months since your last dose and 90 days since having COVID-19.
Halton continues to book first and second-dose vaccinations for all residents age six months and older, plus third-dose boosters for anyone age 5 and up.
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