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In Faces of Healthcare (See all 4 Faces)

258

Are breast cancer screening programs justified?

Millions of Canadians happily sign up for breast cancer screening every year. After all, we’re told that it “saves lives” for women aged 50 to 74. Yet, there is no evidence that it does. Most - but not all - studies conclude screening mammography reduces a woman's chance of dying of breast cancer. But in randomized controlled trials on breast cancer screening tests, those who received the screening didn’t live longer…

228

Interpreting randomized trial evidence around mammography

The Canadian Task Force on Preventive Health Care recently released recommendations about screening for breast cancer.  These recommendations have been criticized by some because they emphasize the results of randomized trials.  This article explores the advantages and limitations of randomized trial evidence regarding screening mammography.  The recent recommendations by the Canadian Task Force on Preventive…the scientific evidence regarding screening mammography, specifically basing their assessment of the benefits of screening almost entirely on randomized trials andignoring the advances that have been made in mammography technology in the last two decades. In this article, we explore what underlies these criticisms. What is a randomized controlled trial? A randomized controlled trial is a…

Mammography screening in Comments (See all 19 Comments)

Martin Yaffe – 01/03/2012

“…of mammography. Furthermore, they included data from studies that used mammography that is entirely inadequate by today’s standards. While it…benefits, meta-analysis was particularly important to determine the efficacy of screening women in their forties, since most trials were not…”

Marcello Tonelli MD SM FRCPC Chair Richard Birtwhistle MD MSc FCFP Vice Chair, Canadian Task Force on Preventive Health Care – 12/14/2011

“…Dr. Yaffe that reporting both absolute and relative benefits of screening is important – which is why we provided both…data were not reported in the randomized trials of screening mammography. More importantly, these data are unlikely to influence the…”

Anthony B. Miller – 12/19/2011

“…be refuted. First, he states that nearly all the breast screening trials performed in the past should be discarded as the quality of mammography has improved so much. In fact, as the quality…”

All other results for mammography screening

206

Presenting the benefits of mammography

The results of research on screening for breast cancer with mammography can be presented in ways that make the benefits seem larger or smaller  Similarly, the benefits can be described as avoiding deaths from breast cancer or avoiding deaths from any cause Part of the debate about the benefits of screening mammography may be related …

186

Weighing the harms and benefits of mammography

Healthydebate.ca has run a series of stories on breast cancer screening mammography, stimulated by the recent guidelines from the Canadian Task Force on Preventive Health Care.  This last story focuses on how women and policy makers must balance the benefits and harms of screening mammography. The issues raised in this series are relevant to screening for other diseases, such as PSA for prostate cancer. The Canadian Task Force on Preventive Health Care recently issued recommendations about screening mammography for women at average risk of breast cancer. For women between 40 and 49 years of age, the Task Force recommended against screening. For women older than…

169

Did mammography save her life?

Some breast cancers detected by screening mammography are cured and would have led to death had they not been detected early. Other breast cancers detected by screening can be treated just as effectively if diagnosed later, may not have needed treatment at all, or may be so advanced that treatment does not prevent death from …

129

The mammography controversy

In medical journals, doctors and scientists continue to debate the relative benefits and harms of breast cancer screening for women who are at average risk of developing breast cancer. This debate is not always reflected in screening programs, most of which strongly recommend mammography to average risk women within a certain age bracket. Some experts believe that many women are not being provided with complete information about both harms and benefits…

118

Colorectal cancer screening can save lives – so why don’t more Canadians do it?

…cancer is the second-most common cancer in Canada, and the second-leading cause of cancer death in the country, estimated to have killed 9,300 Canadians in 2016 alone. Yet a simple screening test can not only detect cancer but also prevent cancer from developing by identifying pre-cancerous polyps which can then be removed before they turn cancerous. That's far better…

104

Are patients being informed about prostate cancer screening risks?

Get screened. It could save your life. Don’t get screened. There’s no evidence that screening saves lives. Get tested in your 40s. Wait until you’re 55. Get the test every year. Every four years is enough. When it comes to screening for prostate cancer, the messages from doctors, major medical organizations and media campaigns are…

97

Breaking the silence: Should health workers ask about domestic violence?

…Linda McCracken trains emergency department and urgent care centre nurses to initiate these discussions with every patient over 14 years old. All Calgary Zone EDs have a universal screening program in place – meaning everyone who comes through the ED is asked about intimate partner violence, and whether they feel safe in their homes. According to…

88

Screening mammography

…only transportation expenses but time from work and home. Increasingly patients are being forced to travel again and again after having tests. A good example is breast screening which causes many false alarms. For every woman who has a lethal breast cancer caught in time for a cure, several more have cancers diagnosed that would…

68

The role of nurses in Ontario’s colon cancer screening program

Colon cancer screening is more effective than breast cancer screening, but uptake in Ontario is still low. Screening more individuals each year would prevent many needless deaths. Nurses can safely and effectively screen patients for colon cancer. Despite this, efforts to increase the number of screening procedures performed by nurses in Ontario are not widespread. …

63

There’s a better way to screen for cervical cancer

…to improve cervical cancer screening. Before I get into the HPV test, I need to explain what’s wrong with the 70-year-old Pap test, our current cervical cancer screening method. For the Pap test to produce an accurate reading, cervical cells have to be properly spread and stained on a glass slide that’s viewed under a…

55

Why does cervical cancer screening start at different ages in different provinces?

…services. That means local authorities are in charge of setting up health programs—such as cancer screening—and sometimes opinions vary about what’s the best approach. As a result, screening can differ from one part of the country to the next. But there’s now a growing consensus in the medical community that pap testing should be started…

54

Canadian Blood Services researching screening changes for plasma

Canadian Blood Services and Héma-Québec are supporting research for screening plasma donors differently from whole blood donors as a way to expand the eligibility criteria for men who have sex with men, according to Canadian Blood Services representative Catherine Lewis. Lewis says this is the next step in evolving the blood-screening process. Blood plasma is…

54

Chlamydia, gonorrhea and syphilis on the rise: Is Tinder to blame?

…may be because they don’t have the same concerns about pregnancy or have outdated information about safer-sex practices and the risks for STIs. Is chlamydia and gonorrhea screening falling through the cracks? Some also question whether the shift away from annual physicals and reduced frequency of Pap tests may have unintentionally led to less STI…

53

Prostate cancer screening: It’s time for advocates to put up or shut up

In 2014, the Canadian Task Force on Preventive Health Care (of which I was a member) published its recommendations against screening for prostate cancer, saying that there was inconsistent evidence for a small benefit, but clear evidence that many men would be harmed by the follow-up of a false positive test. Prostate Cancer Canada, an organization…

53

Arithmetic Operations: Breast Cancer Screening Choices and Anticoagulation Bridging

Nathan discusses a randomized trial about breast cancer screening that found that sending women information about both the risks and the benefits of breast cancer screening resulted in more women making an "informed choice" and fewer wanting to undergo screening mammography. Amol discusses the BRIDGE trial, which found that not bridging patients' anticoagulation around the time of elective surgeries or procedures was not inferior to bridging. What do…

47

Evidence does not support blanket prostate cancer testing recommendation

…in prostate cancer research are small: less than half of breast cancer. It is also incontrovertible that men would like to have the benefits of an effective screening procedure for prostate cancer. While five year survival from prostate cancer diagnosis in Canada now exceeds 95%, this is cold comfort to those men who die prematurely…

46

Are colon cancer screening promotions convincing enough new immigrants and poor people?

…of cancer death in Canada. And, it’s recommending patients visit their family doctor or nurse practitioner to talk about getting a Fecal Occult Blood Test (FOBT), a screening test that can catch colorectal cancer early when it’s more likely to be curable. An FOBT is a simple test, but it can make some people queasy.…

42

We should aggressively screen for cancers early… right?

How can the idea of early detection and screening for cancers even be a debate? What could possibly be the downside of catching cancers early, and treating them before they cause great harm, even death? Logic says if you can’t prevent a cancer in the first place, then diagnose it as early as you can,…

42

Pap smears: paranoia or peace of mind?

The thought of the annual Pap smear causes me as much discomfort as it does any young woman. When I read the new guidelines for cervical cancer screening in Ontario, reported in last month’s issue of Journal of Obstetrics and Gynaecology of Canada, I was slightly relieved at the recommendations being put forth. Rather than…

41

A patient asks: does my ancestry put me at higher risk of breast cancer?

…no family history of breast cancer and you have no other significant risk factors, then your risk in only slightly increased by your aunt’s cancer and breast screening every 2 years is perfectly appropriate, Dr. Warner said. If you carry the genetic mutation, each of your children has a 50 per cent chance of carrying…deal with that,” said Dr. Warner, noting that women who carry either of the breast cancer genetic mutations, will undergo a special type of screening that includes mammography but also magnetic resonance imaging, which is far more sensitive at finding tumors. You could also be offered a drug such as tamoxifen to lower your risk…

40

Non-invasive prenatal testing and chromosomal microarray: changing the landscape of prenatal genetic testing

…a “non-invasive” alternative to amniocentesis. In 2013, non-invasive cell-free fetal DNA testing became available in Canada. This development offers pregnant women a safer, more accurate option for screening for the most common chromosome abnormalities, which could dramatically reduce the need for amniocentesis. However, at the same time another new technology called chromosomal microarray is allowing…

38

Screening for poverty: identifying an important social determinant of health

…Bloch, a Family Physician at Toronto’s St. Michael’s Hospital and a founding member of Healthcare Providers Against Poverty (HPAP), is an advocate for poverty screening. “Just as screening is important for other conditions or risk factors, like smoking, high cholesterol or domestic violence, so too is screening for poverty,” he says. Dr. Bloch and HPAP…

36

We’re off to an EPIC Start! Cancer Screening Cessation and Coffee Drinking & Mortality

…listen – we’re back with a brand new episode to kick off the fourth season of The Rounds Table. How do older adults prefer to discuss cancer screening cessation with their clinicians? Does regular coffee consumption impact mortality? Kieran Quinn and Emily Hughes cover two thought provoking new studies. Choosing Wisely recommends that clinicians should…

36

Rapid Fire to Keep the Blood Pumping – BP Management, Lung Cancer Screening, and Intubation During Cardiac Arrest

…for hypertension. Are patients more likely to take a single combination pill compared to multiple individual pills? Listen to find out! What happens when a lung cancer screening program is launched in the real world? The third study examines the results of the implementation of lung cancer screening in the Veterans Health Administration. Finally, a…

36

Together Again: Aromatase Inhibitor for DCIS and New Colorectal Cancer Screening Recommendations

…found that there was no difference in breast cancer recurrence in using anastrozole or tamoxifen. The Canadian Task Force on Preventive Health Care authored new recommendations for colorectal cancer screening in primary care. The new guidelines recommend that in 50 to 74 year olds, fecal occult blood test (FOBT) or flexible sigmoidoscopy be used as the initial…

32

Motherhood Statements: Cardiovascular Effect of Liraglutide and Syphilis Screening

…Task Force (USPSTF) reviewed the evidence on syphilis and recommends that adult patients at higher risk for syphilis should be screened. This is based on evidence that screening for syphilis in high risk patients provides substantial benefit, treatment of early syphilis is highly effective and no direct evidence of harm has been found from screening.…

32

Health care system is failing people with alcohol addiction, say experts

…In other words, a disorder is diagnosed once one’s alcohol use is damaging relationships or affecting a person’s ability to work or take part in leisure activities. From screening to treatment, we look at why health care providers have been slow to adopt proven approaches when it comes to risky and harmful drinking. Why don’t family…

31

We need to do better at screening for—and mitigating—illiteracy

…controlling for variables such as income and education, both of which are likely contributors to literacy level, individuals with low literacy had lower vaccination rates and lower screening rates for breast cancer than the general population. Similar effects were observed when examining the impact of a patient’s literacy on their ability to take medications: Patients…

28

Lung cancer is no longer a death sentence. Why aren’t we saving more lives?

…It is time for our health care system to provide the programs and resources so these research findings can benefit patients. In addition to emerging treatments, better screening has the potential to play a role in improving the state of lung cancer in Canada. Organized programs would provide routine screening, usually every two to three…

27

I’ve got cancer. Will I get the care I need during a pandemic?

…in the early days many people missed scans and diagnostic screenings (which has now led to backlogs). Overall, mammograms done as part of the Ontario Breast Cancer Screening Program were down 49 per cent in March, falling to 30,877 tests from 60,435 for the same month in 2019. Diagnostic Pap tests done as part of…

25

Let’s not confuse measurable with meaningful in primary care

…a positive, trusting relationship with their doctor, whom we’ll call “Dr. Williams.” During separate health visits, Williams takes the opportunity to discuss the benefits and downsides of mammography for breast cancer screening. But in the end, Smith schedules a mammogram, while Johnson does not. Did Williams provide better quality care to Smith? These kinds of measurable indicators of primary care…

23

Improving quality and access in Ontario’s privately owned colonoscopy clinics

…five years, quality in private colonoscopy clinics appears to have improved, and for the first time, Cancer Care Ontario (CCO) is exploring expanding its provincial colon cancer screening program into these clinics. Quality and access concerns Concerns about quality in privately owned colonoscopy clinics began in 2007, with the release of several research papers.  This…

22

“Private” is not a curse word in medicine

…improve quality of life for our patients, but also help them live longer. Colorectal cancer deaths are widely agreed to be up to 90% preventable by regular screening with colonoscopy. A major barrier is getting people to participate in screening programs. Now that awareness is increasing, another limiting factor is availability of endoscopy time. Hospitals…

21

Improving the appropriateness of diagnostic tests

…tiredness or shortness of breath, and not on testing done to screen for cancer. Healthydebate has previously published several articles and blogs on the controversy about mammographic screening for breast cancer, which you can view here. Benefits of testing CT, MRI, and echocardiography are among the “miracles” of modern medicine. They have helped physicians make…

20

Speed is of the essence: Canada falling behind in rapid COVID testing

…to their complexity, PCR tests can cost up to $150 each and may have turnaround times of up to 9 days. Consequently, they are not efficient at screening for the virus on a population scale to contain disease spread. Alternative rapid antigen tests have been developed to supplement testing efforts. Unlike conventional tests, rapid tests…

20

Why are low-income babies less likely to be screened for jaundice?

…But hidden inside that statistic lies an even more discouraging story – one that ties into issues of socioeconomic barriers and unequal access to care. Universal jaundice screening recommendations might not be that universal We set out in our study to see how factors like poverty or education might influence access to jaundice screening in…

19

“Choosing Wisely” – time to import an American initiative into Canadian health care?

Here’s a startling but true story. In 2008, the Ontario Ministry of Health and Long-Term Care paid about 10 million dollars for 13 million blood sugar test strips. They were used by 49,000 Ontarians aged 65 or older who had diabetes. What’s so startling about that? The people who used the strips were not receiving…

18

Primary care quality improvement: Is data the future?

Family doctors are being offered personalized reports that identify gaps in the quality of care they provide, from cancer screening to diabetes management. But can data really drive better performance?   Alberta’s Chinook Primary Care Network serves more than 170,000 residents, bringing together health-care groups that include 140 physicians, as well as nurse practitioners and…

18

Tackling poverty through medical education

…little evidence to suggest that medical students are adequately trained to meet the unique health needs of people living in poverty. The virtual absence of education around screening and interventions to address poverty is puzzling, when contrasted with countless hours of medical training devoted to managing other common risk factors for diseases such as hypertension.…

17

Are we ready for a second wave?

…the healthcare sector still hasn’t recovered from the disruption caused by the first wave of the pandemic. There is a huge backlog of delayed surgeries and postponed screening tests. A second wave would probably add more patients to existing wait lists. Even so, a big second wave isn’t inevitable, says Dr. McCready, adding that, “it…

17

Rolling out the welcome mat: Hospitals making visits less intimidating

…staffed by clinical personnel able to address longer discussions about hospital entry, assistance with appointments and masking policies. An impasse no more, the entryway now moves efficiently, screening more than 3,000 visitors, patients and staff per day and is also decorated with cards of compassion and other posters made by school children for patients and…

17

Quarterbacking healthcare: The central role of family doctors

…is a large body of research supporting the effect of good primary care and continuity of care for patients, including receiving better evidence-based care such as cancer screening and diabetes care and reducing the number of hospitalizations. According to Dr. Walter Wodchis, an associate professor at the Institute of Health Policy, Management and Evaluation at…

17

Raising the bar on our haphazard end-of-life transition from hospital to home

…to poorer transitions. Over the past three years, we have researched solutions to improve the transition and explored how to build on these solutions.  Evidence-based interventions include screening patients to identify who would benefit from palliative care consultation, using palliative care as a discharge planning team and having palliative care providers conduct pre-discharge and post-discharge…

17

Simple ‘miracle cure’ for many conditions is available to all

…now recognize that another benefit of physical activity is that it does not prompt overdiagnosis, unlike “intensive precision screening” looking for disease. Proponents of this type of screening refer to the use of genome analysis and other “big data” and artificial intelligence technologies that enable unprecedented monitoring of the human body. However, the proponents of…

17

Financial Abuse: An Early Sign of Domestic Violence

…for more visceral types of abuse - physical, sexual…” For this reason, it’s difficult for researchers to collect data on it, he adds. In the emergency room, screening tools also focus on the visceral forms of abuse. Victims who present to the ER with signs of distress may not be screened for abuse if there…

16

Pandemic highlights the need for homecare

…stepped up to ensure our staff and clients were safe, including limiting the number of healthcare providers in any one client’s home. We moved quickly, developed strict pre-screening processes, COVID-19 infection and prevention practices and more importantly, we did it early. Enhanced safety measures and additional training and education have made a significant difference in…

16

The ABCs of ACEs: Addressing the long-term health effects of Adverse Childhood Experiences

…caring adults outside the household, a supportive school environment or recreational programs. So what can healthcare providers do? The jury is out on the value of systematic screening for ACEs in routine clinical encounters. More studies are needed to assess whether screening actually leads to better health outcomes down the road. In 2000, the Canadian…

16

Direct-to-consumer genetic testing comes to Canada

…behavioral and clinical wellbeing of 2000 people who took the tests.  Overall, the study found no effect on the psychological health, diet, activity level or use of screening tests by those who had received genetic profiling information. The researchers were skeptical about the health benefits of genetic profiling. Going beyond conventional screening approaches Genetic testing…

15

Innovative solutions to domestic violence during pandemic are temporary Band-Aids

…groups to maintain a level of secrecy from abusers. Dr. Kerrie Shaw, a family physician at Trillium Health Partners, advocates for primary care providers to continue routinely screening for IPV during virtual visits. However, there are unique challenges with asking these questions over the phone or in a video call.   “You don’t know if that…

15

The end of hallway medicine?

…exposed,” Bota says. The extra space may not be enough. Social distancing is not feasible in crowded waiting areas and roughly half of incoming patients fail triage screening for possible symptoms of COVID-19, meaning they need to be separated from others and must be treated by doctors and nurses in full protective gear. As Bota…