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Some doctors, patients want Canada to follow U.S. proposal for earlier mammograms

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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

 

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Helping people living with dementia ‘flourish’ through dance

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Dr. Pia Kontos, a Senior Scientist at UHN’s KITE Research Institute, is co-leading an initiative to help people living with dementia flourish. (Photo: Tim Fraser/UHN KITE Studio)

Dr. Pia Kontos believes in the power of the arts to support people to live well with dementia.

The Senior Scientist at UHN’s KITE Research Institute focuses on challenging policies and practices that discriminate against those living with dementia and developing and evaluating arts-based and digital knowledge translation initiatives to reduce stigma, improve social inclusion and quality of care for them.

“The predominant assumption is people living with dementia don’t have the capacity to be creative,” says Dr. Kontos, who is also a professor in the Dalla Lana School of Public Health at the University of Toronto. “However, we know through extensive research that dance…powerfully supports people living with dementia to be creative and to flourish.

“And flourishing should be a goal that we all have.”

Dr. Kontos co-produced in 2023 Dancer Not Dementia, a short documentary film. It captured the power of a dance program for seniors – Sharing Dance Older Adults (SDOA) – to challenge the stigma associated with dementia, support social inclusion and enrich lives. It’s told through the eyes of residents and staff at Alexis Lodge Dementia Care Residence and Cedarhurst Dementia Care Home in Toronto.

SDOA was jointly developed by Canada’s National Ballet School (NBS) and Baycrest Centre in 2013 for older adults with a range of physical and cognitive abilities, including dementia.

Typically, dance programs in dementia care settings are provided as a therapeutic intervention for older adults. However, SDOA’s goal is to provide a creative outlet for participants and opportunities for social interaction with other people living with dementia, staff and loved ones.

Now, Dr. Kontos will look to incorporate traditions from marginalized communities into SDOA through a $750,000 Canadian Institutes of Health Research (CIHR) Institute of Aging Implementation Science Team Grant. Dr. Rachel Bar, Director of Research and Health at NBS is co-principal applicant for the grant.

This CIHR funding supports projects that evaluate the effectiveness of existing programs, services and models of care that show promise for those impacted by cognitive impairment and dementia. An important focus is improving equitable and inclusive access to care and support.

The three-year grant to Drs. Kontos and Bar will support SDOA efforts to partner with organizations in Black, Chinese and South Asian communities to integrate their cultural practices into its programming.

Training dancers from these communities to teach the adapted program is central to these partnerships.

“People living with dementia from marginalized communities rarely have their traditions honoured with art and leisure programming,” says Dr. Kontos.

“It’s important to align dance programs with the cultural traditions of these communities. Otherwise, the music and movements wouldn’t reflect the experiences of ethno-culturally diverse populations, and the programs wouldn’t be inclusive.

“We wouldn’t be supporting their capacity to be creative or to be in relationships with others through dance. We would be falling short.”

SDOA has already partnered with Alexis Lodge, Alzheimer Society of Canada, Baycrest, NBS, Indus Community Services, Social Planning Council of Ottawa, and Yee Hong for this initiative.

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CDC: Heat may have contributed to four human cases of bird flu in Colorado

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Credit: Alexas Fotos from Pexels

Heat probably played a role in at least four cases of bird flu in poultry workers confirmed by U.S. health officials Sunday—the first cases in poultry workers in two years.

Sweltering temperatures in Colorado rose to at least 104 degrees, which is suspected to have contributed to the human cases, according to Dr. Nirav Shah, principal deputy director at the Centers for Disease Control and Prevention. The barns where poultry workers were culling chickens were “no doubt even hotter,” Shah said during a press conference on the most recent outbreak of bird flu in humans.

The new cases bring the U.S. total to at least nine cases since the first human case of the current outbreak was detected in 2022, also in a Colorado poultry worker. Eight of the nine were reported this year.

The workers were separating chickens that were going to be killed to stop the spread of the virus. The fans may also have contributed to the human infections because, while helping to keep the environment cooler, they “also spread things like feathers around which are known to carry the virus,” Shah added.

The large and strong fans also make it difficult for protective goggles and face masks to stay in place, he said.

About 60 workers at the poultry farm showed symptoms of illness and were tested for bird flu. Four tested positive for bird flu and one additional presumptive case is awaiting confirmation.

The illnesses were relatively mild, with symptoms including conjunctivitis and common respiratory infection symptoms like fever, chills, coughing, and runny nose, according to the CDC. None were hospitalized, officials said. The other U.S. cases have also been mild.

Officials said they are bracing for more cases.

The CDC says the risk to the general public remains low and the health agency is not recommending livestock workers be vaccinated against bird flu given the “mild symptoms noted thus far,” Shah said.

An initial analysis of virus samples from an infected poultry worker does not show any changes in the virus that would make it easier to spread among people and there is no evidence of person-to-person spread in the U.S.

“It’s important to note that this assessment is based on what we know today and may change,” Shah said. “CDC is constantly looking for key changes that may alter our risk assessment of the virus, such as the severity of illness that it causes, the ease with which it can transmit to humans or changes to its genetic fingerprint.”

At the request of Colorado’s officials, the CDC sent a 10-person team to Colorado to help the state manage the bird flu outbreak in humans and poultry. The team included epidemiologists, veterinarians, clinicians and industrial hygienists.

Shah also noted it was a bilingual team. Overall in the U.S., it is estimated about half of farm workers are Latino.

An analysis of the virus from an infected worker indicates that the infections at the chicken farm are “largely the same” as the strain detected in dairy herds in Colorado and other states, according to Shah. But an investigation is ongoing to determine exactly how the outbreak is spreading between wild birds, chicken and cattle.

Since 2022, a highly contagious strain of bird flu has spread across the U.S. at an unprecedented rate.

Georgia’s powerhouse poultry industry, which produces more broiler chickens than any other in the country, has mostly dodged the kinds of major outbreaks that have resulted in the deaths of more 90 million birds in commercial and backyard poultry flocks in the U.S.

About 1.8 million chickens will be killed at the Colorado poultry farm after these latest bird flu cases were detected.

In late 2023, ducks at a commercial breeding farm in Sumter County, Georgia, tested positive for H5N1. This year, in March, the virus made a jump to a mammal species that surprised many scientists: cows.

With a significant dairy industry, plus even larger beef and poultry interests, the potential arrival of the virus here threatens Georgia’s economy and the health of residents.

As of Monday, the H5N1 virus has been confirmed in 158 dairy herds in 13 states, according U.S. Agriculture Department.

So far in Georgia, there have been no bird flu cases in cattle, and there have been no human cases.

Since the unprecedented spread of H5N1 in poultry in 2022, the Georgia Department of Public Health has quietly monitored 132 people for signs of the virus, according to DPH spokeswoman Nancy Nydam. Those tracked were either first responders to one of the state’s few virus outbreaks in backyard and commercial poultry flocks or farmworkers where the infections occurred. Of those monitored, fewer than 10 people were tested for H5N1 and none came back positive.

Since the virus was discovered in cattle, a small number of first responders from Georgia who went to other states to help with investigations—fewer than 15—have also been monitored for signs of illness.

Federal officials said Tuesday they still believe they can eliminate the bird flu virus from , even as the number of herds infected continues to grow. The latest state to recently report infected dairy cattle was Oklahoma. North Carolina is the only state adjacent to Georgia to report an infected dairy herd.

Eric Deeble, acting senior adviser for the H5N1 response at the USDA, said investigations show the is spreading among cattle through cattle moved from one herd to another and the shared use of milking equipment. It can be contained through enhanced biosecurity measures such as thoroughly cleaning milking “parlors” and equipment, separating sick cows, and having dairy workers wear protective equipment.

Deeble also noted USDA scientists are also working with partners to develop a cattle-specific H5N1 vaccine—a process requires many steps and will take time.

The USDA is also exploring the possibility of developing a poultry vaccine as the number of cases soar, and outbreaks lead to the slaughter of millions of farmed birds. But USDA and industry stakeholders point to challenges that would hinder a vaccination program.

The biggest sticking point is around trade.

Mike Giles, president of the Georgia Poultry Federation, said mass vaccination would be impractical for several reasons, including the fact that the industry would lose its lucrative export market: The United States and many of its trade partners restrict the import of products or eggs from countries affected by the highly pathogenic strain or flocks that have been vaccinated against it.

“(Bird flu) has been, from an animal health standpoint, our top concern,” Giles said. “The challenge, and I think the industry has responded to it well, has been maintaining the state of preparedness and urgency and focus on biosecurity, and I think that has been accomplished.”

2024 The Atlanta Journal-Constitution. Distributed by Tribune Content Agency, LLC.

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CDC: Heat may have contributed to four human cases of bird flu in Colorado (2024, July 17)
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Here is the new guidance for RSV vaccines

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Health officials recently changed the guidelines for respiratory syncytial virus vaccines. Here’s what Canadians need to know about the guidance and the virus itself.

New guidance on vaccines

As of July 12, the National Advisory Committee on Immunization (NACI) now recommends RSV vaccines for individuals who are 75 years old and older, especially those who have a greater risk of developing severe RSV.

Based on current evidence and expert opinion, NACI said in a news release, it also strongly recommends vaccines for those aged 60 and older who live in nursing homes and other chronic care facilities.

What is RSV?

RSV is a common contagious virus that often causes bronchiolitis, a lung infection, and pneumonia.

Infants face the highest risk of developing severe RSV disease, however, this risk also increases with age and with certain medical conditions, according to the Public Health Agency of Canada (PHAC). It can lead to serious complications for older people, including hospitalization and death.

What are the symptoms?

RSV typically causes mild, cold-like symptoms that usually begin two to eight days after exposure to the virus, according to PHAC.

Those with RSV may experience a runny nose, coughing, sneezing, wheezing, fever and less appetite and energy. Infants may be irritable, have trouble breathing and have less appetite and energy.

What is the treatment?

RSV infections are usually mild and last about one to two weeks. If you are infected, health officials recommend you stay home and limit contact with others.

They also recommend lots of rest and drinking plenty of fluids. Take over-the-counter products, such as acetaminophen or ibuprofen, if you have a fever. Seek immediate care or go to the hospital if you’re having trouble breathing or become dehydrated, PHAC adds.

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