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.
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.
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.
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.
