Early detection of cancer is a critical element in successful treatment. However, a debate is brewing in Canada about whether the national cancer screening guidelines, set by the Canadian Task Force on Preventive Health Care (CTFPHC), are outdated and potentially delaying diagnoses.
Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, is one of the leading voices against the current guidelines. He expresses concern that the CTFPHC downplays the importance of early detection.
“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,” Saad stated to the Toronto Star.
He argues that the guidelines may discourage doctors from recommending certain screenings, such as the prostate-specific antigen (PSA) test, which can sometimes indicate cancer even when none exists. This can lead to unnecessary biopsies and treatments with potential side effects like incontinence or erectile dysfunction.
The task force defends its approach
The CTFPHC acknowledges the importance of early detection but emphasizes a balanced approach. Dr. Eddy Lang, a member of the Task Force and an emergency physician, highlights the potential downsides of screening.
“We’ve certainly recommended in favour of screening when the benefits clearly outweigh the harms,” Lang clarifies.
He emphasizes that the Task Force is “cautious and balanced” and wants to consider all perspectives. For example, some men diagnosed with prostate cancer may never experience any symptoms, and aggressive treatments can have serious side effects.
The CTFPHC also emphasizes its commitment to keeping guidelines up-to-date with new research. The task force monitors research “all the time for important studies that will change our recommendations,” said Lang.
The Task Force has scheduled reviews of its guidelines for various cancers over the next few years, including breast cancer (spring 2024), cervical cancer (2025), and lung and prostate cancer (2026).
Unequal access to screening across Canada
The Canadian Cancer Society withdrew its endorsement of the CTFPHC’s breast cancer screening guidelines in December 2022, citing concerns about slow updates. Some provinces have taken matters into their own hands, implementing more proactive screening programs. This creates a patchwork approach to cancer screening across Canada, with some provinces offering screenings not recommended by the national guidelines, and unequal access for Canadians depending on where they live.
Dr. Shushiela Appavoo, a radiologist with the University of Alberta, highlights the importance of consistent national guidelines. Many family doctors rely on the CTFPHC recommendations when discussing screening options with patients.
“The strongest association […] with a woman actually going for her breast cancer screen is whether or not her doctor recommends it to her,” Appavoo said to the Star.
“So if her doctor is not recommending it to her, it doesn’t matter what the provincial guideline allows.”
The debate surrounding Canada’s cancer screening guidelines highlights the complex issue of balancing potential harms with the benefits of early detection. It also emphasizes the clear need for consistent, evidence-based national guidelines that are regularly reviewed and updated. This ongoing conversation is crucial for ensuring that Canadians have access to the most up-to-date screening options and the best possible chance of early cancer detection.
Remember, early detection saves lives. Talk to your doctor about your cancer screening options, and together you can make the best decision for your health.
