Most assume that the Canadian task force guidelines are led by content expert specialist clinicians. But this is not the case. The task force says it excludes content experts from genuine involvement in guideline development to avoid conflicts of interest. However, in the Canadian health-care context, this is not a valid argument.
In 2022, the Canadian Task Force on Preventive Health Care released recommendations against using a tool (the Edinburgh Postnatal Depression Scale – EPDS) to screen for depression during pregnancy and the postpartum. These recommendations do not agree with those made by experts in B.C. and Ontario; and around the world in Australia, the United States, England and Scotland. It is important that we look closely at these recommendations and try to understand why they differ.
The Canadian Ophthalmological Society, which represents all ophthalmologists in Canada, recognizes the importance of guidelines but also appreciates the challenges around them. For guidelines to be effective, they need to involve a variety of stakeholders with varying expertise from the beginning to ensure inclusion of all the evidence and consideration of issues where there may not be published data.
The last guideline on prostate-cancer screening was published in 2014. At the time, the task force approached the Canadian Urologic Association (CUA) and asked that it provide an expert panel of “stakeholders” to provide input....We found that the task force guideline utilized only data from a small number of randomized trials and ignored scores of other relevant studies. The analysis of the studies that were reviewed was superficial and the guideline was flawed.
One would expect that the priority of the Canadian Task Force on Preventive Health Care on breast-cancer screening would be to recommend practices that would maximally reduce mortality and morbidity from disease. In the case of breast cancer, this suggests focusing on effective guidelines for those who are at increased probability of developing disease or increased risk of late diagnosis and the consequent higher likelihood of premature death or morbidity associated with treating advanced disease.
Past President, Canadian Psychiatric Association
Clinical lead of Ontario Cervical Screening Program
On task force recommendation against HPV screening, issued 2013: “We believe that the evidence strongly supports primary HPV screening is a significant step toward both increasing the efficacy of screening and decreasing its harms.”
On behalf of Board of Directors, Ontario Association of on colorectal screening issued 2016: “The Task Force suggests that colonoscopy does harm… As the incidence of colon cancer (1:19) far outweighs risk associated with colonoscopy, we are concerned that there could be more harm done when cancers are missed by inferior tests.”
John C Leblanc
On Developmental Delay screening guideline issued 2016: “We believe that GRADE criteria for a strong recommendation have not been met … These facts, outlined in the statement itself, justify a ‘weak’, not a ‘strong’ recommendation.”
Hepatologist and Chair of Canadian Liver Foundation Medical Advisory Committee
Chris De Gara
Bariatric surgeon, Past President, Canadian Association of General Surgeons, Former Director of Bariatric Surgery Revision Clinic, Alberta Health Services
On adult obesity screening issued 2015 (overturned with new bariatric specialist guidelines published in CMAJ in 2020). “To not present a balanced picture of the care available to the obese patient is a disservice and to misrepresent the evidence for Bariatric Surgery in patients with severe obesity is unfortunate.”
Canadian Society of Breast Imaging
Position statement on breast screening guidelines issued 2018
Canadian Association of Radiologists
Position statement on breast screening issued 2018
“Task force recommendation against using tomosynthesis on average risk women, cited in the guidelines as a “strong recommendation, no evidence” ignores the very large body of evidence on tomosynthesis which has been summarized in 2015 by the Canadian Agency for Drugs and Technologies in Health (CADTH)”
Canadian Urological Association
Position statement on prostate cancer screening issued 2014
B.C. Reproductive Mental Health Program and Perinatal Services BC
Statement on pregnancy and postpartum depression screening issued 2022
“We disagree with the task force conclusion that the evidence in support of instrument -based screening for perinatal depression is very uncertain. Our position aligns with the conclusions of the US Preventive Services Task Force and American College of Obstetricians and Gynecologists (ACOG) that there is evidence in favour of screening for depression in the perinatal period.”