A group of doctors say Canadian cancer screening guidelines set by a national task force are out-of-date and putting people at risk because their cancers aren’t detected early enough.

“I’m faced with treating too many patients dying of prostate cancer on a daily basis due to delayed diagnosis,” Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, said at a news conference in Ottawa on Monday.

The Canadian Task Force on Preventive Health Care, established by the Public Health Agency of Canada, sets clinical guidelines to help family doctors and nurse practitioners decide whether and when to recommend screening and other prevention and early detection health-care measures to their patients.

Its members include primary-care physicians and nurse practitioners, as well as specialists, a spokesperson for the task force said in an email Monday.

But Saad and other doctors associated with the Coalition for Responsible Healthcare Guidelines, which organized the news conference, said the task force’s screening guidelines for breast, prostate, lung and cervical cancer are largely based on older research and conflict with the opinions of specialists in those areas.

For example, the task force recommends against wide use of the prostate specific antigen test, commonly known as a PSA test, for men who haven’t already had prostate cancer. Saad called that advice, which dates back to 2014, “outdated” and “overly simplistic.”

The task force’s recommendation is based on the harms of getting false positive results that lead to unnecessary biopsies and treatment, he said.

But that reasoning falsely assumes that everyone who gets a positive PSA test will automatically get a biopsy, Saad said.

“We are way beyond the era of every abnormal screening test leading to a biopsy and every biopsy leading to treatment,” he said, noting that MRIs can be used to avoid some biopsies.

“Canadian men deserve (to) have the right to decide what is important to them, and family physicians need to stop being confused by recommendations that go against logic and evidence.”

Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, raised similar concerns about the task force’s breast cancer screening guideline, which doesn’t endorse mammograms for women younger than 50.

That’s despite the fact that the U.S. task force says women 40 and older may decide to get one after discussing the risks and benefits with their primary-care provider.

The Canadian task force is due to update its guidance on breast cancer screening in the coming months, but Yaffe said he’s still concerned.

“The task force leadership demonstrates a strong bias against earlier detection of disease,” he said.

Like Saad, Yaffe believes it puts too much emphasis on the potential harm of false positive results.

“It’s very hard for us and for patients to balance this idea of being called back and being anxious transiently for a few days while things are sorted out, compared to the chance of having cancer go undetected and you end up either dying from it or being treated for very advanced disease.”

But Dr. Eddy Lang, a member of the task force, said the harms of false positives should not be underestimated.

“We’ve certainly recommended in favour of screening when the benefits clearly outweigh the harms,” said Lang, who is an emergency physician and a professor at the University of Calgary’s medical school.

“But we’re cautious and balanced and want to make sure that we consider all perspectives.”

For example, some men get prostate cancer that doesn’t progress, Lang said, but if they undergo treatments they face risks including possible urinary incontinence and erectile dysfunction.

Lang also said the task force monitors research “all the time for important studies that will change our recommendations.”

“And if one of them comes along, we prioritize the updating of that particular guideline,” he said.

The Canadian Cancer Society pulled its endorsement from the task force’s website in December 2022, saying it hadn’t acted quickly enough to review and update its breast cancer screening guidelines to consider including women between 40 and 50.

“(The Canadian Cancer Society) believes there is an obligation to ensure guidelines are keeping pace with the changing environment and new research findings to ensure people in Canada are supported with preventative health care,” it said in an emailed statement Monday evening.

Some provinces have implemented more proactive early detection programs, including screening for breast cancer at younger ages, using human papillomavirus (HPV) testing to screen for cervical cancer and implementing CT scanning to screen for lung cancer, doctors with the Coalition for Responsible Healthcare Guidelines said.

But that leads to “piecemeal” screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist with the University of Alberta.

Plus, many primary-care providers rely on the national task force guidelines in their discussions with patients, she said.

“The strongest association … with a woman actually going for her breast cancer screen is whether or not her doctor recommends it to her. So if her doctor is not recommending it to her, it doesn’t matter what the provincial guideline allows,” Appavoo said.

In addition to updating its guideline for breast cancer screening this spring, the task force is due to review its guidelines for cervical cancer screening in 2025 and for lung cancer and prostate cancer screening in 2026, according to its website.

This report by The Canadian Press was first published April 16, 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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Opioid-related deaths doubled in Canada between 2019 and the end of 2021, with Manitoba, Saskatchewan and Alberta experiencing a dramatic jump, mostly among men in their 20s and 30s, says a new study that calls for targeted harm-reduction policies.

Researchers from the University of Toronto analyzed accidental opioid-related deaths between Jan. 1, 2019 and Dec. 31, 2021 in those provinces as well as British Columbia, Ontario, Quebec, New Brunswick and Nova Scotia, and the Northwest Territories.

Manitoba saw the sharpest rise in overdose deaths for those aged 30 to 39 – reaching 500 deaths per million population, more than five times the 89 deaths per million population recorded at the beginning of the study period.

In Saskatchewan, the death toll for that age group nearly tripled to 424 per million, up from 146 per million, while Alberta’s rate spiked more than 2.5 times to 729 fatalities per million, up from 272 per million. Ontario’s death rate reached 384, up from 210 per million.

British Columbia, which has been the epicentre of the overdose crisis, recorded 229 deaths per million for that age group in 2019, climbing to 394 in 2020. All data for 2021 from that province’s coroners service was not yet available when researchers completed their work based on information collected by the Public Health Agency of Canada.

Nationally, the annual number of opioid overdose deaths surged from 3,007 to 6,222 over the three-year study period, which researchers note coincided with pandemic public health measures that reduced access to harm reduction programs and imposed border restrictions that may have increased the toxicity of the drug supply.

“In addition, for many, the pandemic exacerbated feelings of anxiety, uncertainty, and loneliness, contributing to increased substance use globally,” they said.

The study was published Monday in the Canadian Medical Association Journal.

Senior author Tara Gomes said one in four deaths involved people in their 20s and 30s. More than 70 per cent of the overall deaths were among men.

A spokesman with the coroners service in British Columbia said 78 per cent of people that fatally overdosed in that province between 2019 and the end of 2021 were men.

The sharp surge in fatal overdoses – especially among young adults in the Prairies – suggests provinces must act quickly, said Gomes, an epidemiologist who called for more harm-reduction services including supervised consumption sites.

“Being slow and not being as nimble as we would like to be in our responses can have really devastating impacts,” said Gomes, also lead principal investigator of the Ontario Drug Policy Research Network.

Bernadette Smith, Manitoba’s minister of housing, addiction, homelessness and mental health, said the province plans to open its first supervised consumption site in Winnipeg next year and will also offer drug-testing machines so people can check if their illicit substances are toxic.

“We came out of a previous government that didn’t take a harm-reduction approach, unfortunately,” said the New Democrat, whose party defeated the Progressive Conservatives last fall.

“We’re working with front-line organizations because they have not been listened to or worked with for the last seven years in our province, which has been a real problem.”

Manitoba plans to train family doctors to treat addiction with medications including Suboxone and methadone, said Smith, noting the physicians typically refer patients to detox for care.

“We’re creating a model so that folks aren’t having to go to a bunch of different places to get different services,” said Smith.

She declined to say whether Manitobans will have access to a prescribed safer supply of drugs.

Tanya Hornbuckle of Edmonton said her son Joel Wolstenholme was 30 when he died in 2022. He became addicted to illicit substances at about age 14, starting with cannabis before shifting to methamphetamine, cocaine and other drugs that were increasingly laced with fentanyl.

He also battled a mental illness but getting help for both that issue and addiction in a single service was challenging, Hornbuckle said.

Wolstenholme tried multiple times to detox but there were never enough beds at a clinic where people had to line up at 8 a.m., she said.

“It would happen over and over and then he would call me. I went and stood in line or I drove him there and waited with him in the lineup. They wouldn’t have enough beds.”

Her son’s anxieties and addiction worsened when pandemic restrictions prevented her from entering an emergency room with him because he did not trust staff, Hornbuckle said.

On Feb. 6, 2022, Hornbuckle went to her son’s home so they could cook together. She found him dead.

The Alberta government’s strategy of focusing more on recovery and abstinence-based treatment than harm reduction, mental health and housing is the wrong approach, said Hornbuckle, noting that for a time her son slept in parks and abandoned houses after losing his vehicle and apartment to addiction.

Rebecca Haines-Saah, an associate professor of community health services at the University of Calgary, called the deaths of young people from overdose a tragedy, and said many more suffer from brain injury due to toxic substances.

“Obviously, we have the incorrect response. We do not have the approach and services available to keep people alive,” said Haines-Saah, who also called for more harm-reduction services.

“We don’t have a full-scale public health response that is required. We don’t have any plans to fund anything that relates to what we would call harm reduction.”

Much of the current approach to addiction excludes a large number of recreational drug users, said Gomes. She said between a third and half of the deaths in Ontario involved people without an opioid use disorder diagnosis.

“So, focusing on (residential treatment) alone is something that really concerns me because we really need to make sure that we have different options for different people.”

READ ALSO: Stories from the overdose crisis’ front lines

READ ALSO: Make overdose education mandatory in B.C. schools amid drug emergency, advocates say

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A new study out of Ontario and posted in the Canadian Medical Association Journal is highlighting the significant increase in accidental opioid-related deaths in Canada leading into the COVID-19 pandemic, with Manitoba being one of the most impacted provinces in the country.

The research looked at opioid-related deaths between 2019 and 2021 in nine provinces and territories in Canada.

Across Canada, opioid-related deaths more than doubled from 2019 with 3,007, to 6,222 in 2021.

It also found the years of life lost per 100,000 people climbed from 3.5 years in 2019 to seven in 2021.

After dipping halfway through 2019, opioid-related deaths spiked dramatically through the first quarter of 2020 and spiked again in the third quarter of 2021.

People in their 20s and 30s were most impacted by opioid deaths as they represented 29.3 per cent of all deaths in people aged 20 to 29 and 29 per cent of all deaths for people between 30 and 39.

“The disproportionate loss of life in this demographic group highlights the critical need for targeted prevention efforts,” the report said.

The data also showed men were much more likely to suffer an opioid-related death compared to women, with more than 4,500 deaths in 2021 compared to more than 1,600 women.

Manitoba one of the most impacted provinces by opioid-related deaths

Breaking down the provinces individually, the research found the Prairie provinces were impacted the most by opioid-related deaths.

Alberta and Saskatchewan both recorded fatality numbers that more than doubled between 2019 and 2021 – 619 deaths to 1,618 in Alberta and 109 to 322 deaths in Saskatchewan.

Meanwhile, Manitoba’s opioid-related deaths spiked nearly five-fold by 2021. There were 54 deaths in the province in 2019 and by the end of 2021, there were 263.

“In Manitoba, 70 per cent of opioid toxicity deaths in 2019 had fentanyl or fentanyl analogues detected, increasing to 86 per cent in 2020,” the report said.

Arlene Last-Kolb, a member of Moms Stop the Harm, lost her son Jessie to fentanyl drug poisoning in 2014.

She said the toxic drug supply is one of the main issues that needs to be addressed.

“We’re losing a whole generation of young people like my son,” Last-Kolb said. “It’s going to take a lot more than safe spaces and more treatment to address the toxic drug supply, including opiates, fentanyl that we have on our streets.”

Proportion of all-cause deaths attributable to opioids in Manitoba in 2021. (Canadian Medical Association Journal)

The years of life lost also jumped dramatically in Manitoba, going from 1.8 per 100,000 to 8.5 per 100,000 in 2021.

Those in the 30 to 39 age range were most impacted by opioid-related deaths in Manitoba. Almost 30 per cent of deaths in that age group were attributable to opioids.

Marion Willis, the founder and executive director of St. Boniface Street Links, called the numbers horrifying. She says something needs to be done as soon as possible.

“If that is not the strongest statement ever to support that we need a plan to address the drug crisis in this city, in this province – I don’t know what it takes,” said Willis.

She said plans for a new safe consumption site are a good first step, but agreed the drug supply also needs to be addressed.

“Safe consumption needs to include safer supply, or will we still have people using the same toxic drugs off the street.”

Bernadette Smith, the minister of housing, addictions and homelessness, said the province has a number of items on its agenda to help deal with the problem.

“That’s exactly what our government is doing. So supervised consumption site, drug testing machines, that’s our first step – getting those up and running,” said Smith.

However, Willis and Last-Kolb want to see action now.

“This is a challenge that is impacting all members of our human family. We’re all losing our loved ones, you know, from the wealthiest families to the poorest families. This is affecting everybody,” said Willis.

“It’s frustrating to talk about things that are going to happen down the road when somebody dies here every single day,” said Last-Kolb.

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