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.
MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
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AP data journalist Kasturi Pananjady contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
How a sperm and egg fuse together has long been a mystery.
New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.
“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.
The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.
Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.
It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.
Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.
Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.
The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.
The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
