Periodic Screening – Canadian Task Force

Screening for Prostate Cancer (2014)

  • For pt with no previous Dx of prostate Ca.
  • This includes men with lower urinary tract symptoms (nocturia, urgency, frequency and poor stream) or with benign prostatic hyperplasia (BPH).
RECOMMENDATIONS – don’t use PSA for screening prostate Ca
  • <55yo or >70 yo , no screening for prostate cancer with PSA. (Strong recommendation; low quality evidence)
  • 55–69 yo, no screening for prostate cancer with PSA. (Weak recommendation; moderate quality evidence)

Screening for Depression (2013)

  • Pt ≥18yo who present at a primary care setting with no apparent symptoms of depression.
  • These recommendations do not apply to people with known depression, with a history of depression or who are receiving treatment for depression.
RECOMMENDATIONS FOR ADULTS – no routine screening for depression
  • For adults at average risk of depression or increased risk of depression, i we recommend not routinely screening for depression. (Weak recommendation; very-low-quality evidence)

FOOTNOTES

  1. The average-risk population includes all individuals 18 years of age or older with no apparent symptoms of depression who are not considered to be at increased risk.
  2. Subgroups of the population who may be at increased risk of depression include people with a family history of depression, traumatic experiences as a child, recent traumatic life events, chronic health problems, substance misuse, perinatal and postpartum status, or Aboriginal origin.
  3. Clinicians should be alert to the possibility of depression, especially in patients with characteristics that may increase the risk of depression, and should look for it when there are clinical clues, such as insomnia, low mood, anhedonia and suicidal thoughts.

Screening for Cervical Cancer (2013)

  • For asymptomatic women who are or have been sexually active.
  • They do not apply to women with symptoms of cervical cancer, previous abnormal screening results (until they have been cleared to resume normal screening), those who do not have a cervix (due to hysterectomy), or who are immunosuppressed.

RECOMMENDATIONS

  • For women aged < 20 (strong & high) and 20-24 (weak & moderate) we recommend not routinely screening for cervical cancer.
  • For women aged 25 to 29 (weak & moderate) and 30-69 (strong & high)  we recommend routine screening for cervical cancer every 3 years.
  • For women aged ≥ 70 who have been adequately screened (i.e., 3 successive negative Pap tests in the last 10 years), we recommend that routine screening may cease.
  • For women aged ≥ 70 who have not been adequately screened we recommend continued screening until 3 negative test results have been obtained.(Weak recommendation; low quality evidence)

Screening for Hypertension (2012)

  • Pt aged ≥18yo without previously diagnosed with hypertension.
  • Recommendations apply to the general population including adults with average baseline blood pressure and those at higher than average risk of hypertension and vascular risk.
  • These recommendations do not apply to individuals who have already received a confirmed diagnosis of hypertension.

RECOMMENDATIONS

  • We recommend blood pressure measurement at all appropriate primary care visits. (Strong recommendation; moderate quality evidence)
    • ‘Appropriate’ visits may include new patient visits, periodic health exams; urgent office visits for neurological or cardiovascular related issues, medication renewal visits, and other visits where the Primary Care Practitioner deems it an appropriate opportunity to monitor blood pressure. It is not necessary to measure blood pressure on every patient at every office visit if not clinically indicated.
  • We recommend that blood pressure be measured according to the current techniques described in the Canadian Hypertension Education Program CHEP recommendations for office and out-of-office (ambulatory) blood pressure measurement.(Strong recommendation; moderate quality evidence)
  • For people who are found to have an elevated blood pressure during screening, the CHEP criteria for assessment and diagnosis of hypertension should be applied to determine whether the patient meets diagnostic criteria for hypertension.(Strong recommendation; moderate quality evidence)
  1. The frequency and timing of blood pressure screening may vary between patients. The risk of high blood pressure and the risk of stroke or heart disease change over a person’s natural lifespan and increases with age, comorbidities, and the presence of other risk factors. Therefore appropriate screening frequency may increase accordingly, especially in patients with more than one vascular risk factor.
  2. Adults identified as belonging to a high-risk ethnic group (South Asian, Aboriginal, African ancestry) may benefit from more frequent monitoring. Having recent consistently normal blood pressure measurements may decrease the need for monitoring, whereas a tendency toward high-normal blood pressure could indicate that more frequent monitoring is needed.

Screening for Breast Cancer (2011)

  • Recommendations are presented for the use of mammography, magnetic resonance imaging, breast self exam and clinical breast exam to screen for breast cancer.
  • These recommendations apply only to women at average risk of breast cancer aged 40 to 74 years.
  • They do not apply to women at higher risk due to personal history of breast cancer, history of breast cancer in first degree relative, known BRCA1/BRCA2 mutation, or prior chest wall radiation.
  • No recommendations are made for women aged 75 and older, given the lack of data.

RECOMMENDATIONS (MAMMOGRAPHY)

  • For women aged 40–49 we recommend not routinely screening with mammography.(Weak recommendation; moderate quality evidence)
  • For women aged 50–69 years (weak, moderate) and 70-74 (weak, low) we recommend routinely screening with mammography every 2 to 3 years.

Screening for Type 2 Diabetes (2012)

  • For screening asymptomatic adults for type 2 diabetes.
  • They do not apply to people with symptoms of diabetes or those at risk of type 1 diabetes.
RECOMMENDATIONS
  • For adults at low to moderate risk of diabetes (determined with a validated risk calculatoriii), we recommend not routinely screening for type 2 diabetes.(Weak recommendation; low-quality evidence)
  • For adults at high risk of diabetes (determined with a validated risk calculatoriii), we recommend routinely screening every 3–5 years with A1Ciii.(Weak recommendation; low-quality evidence)
  • For adults at very high risk of diabetes (determined with a validated risk calculatoriii), we recommendroutine screening annually with A1Ciii.(Weak recommendation; low-quality evidence)

NOTES

  1. Risk calculation for 10-year risk for diabetes:
    Low Risk
    1 ÷ 100 to 1 ÷ 25 = 1% to 4%
    Moderate Risk
    1 ÷ 6 = 17%
    High Risk
    1 ÷ 3 = 33%
    Very High Risk
    1 ÷ 2 = 50%

    For adults ≥ 18 years of age, we suggest risk calculation at least every 3–5 years (when risk factors exist (e.g., obesity & hypertension).

  2. FINDRISC (the Finnish Diabetes Risk Score) has been selected as the preferred validated risk calculator, but CANRISK (the Canadian Diabetes Risk Questionnaire) is an acceptable alternative.
    1. Factors considered in FINDRISC and CANRISK are age, obesity, history of elevated glucose levels, history of hypertension, family history of diabetes, limited activity levels, and diet with limited intake of fruits and vegetables. The CANRISK questionnaire can be found on the CTFPHC website or on the PHAC website.
  3. A1C has been selected as the preferred blood test, but fasting glucose measurement and the oral glucose tolerance test are acceptable alternatives. An A1C level of 6.5% or greater is recommended as the threshold for diagnosing diabetes, but values less than 6.5% do not exclude diabetes diagnosed using glucose tests. A1C should be measured using a standardized, validated assay.

References:

http://canadiantaskforce.ca/ctfphc-guidelines/overview/
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Posted in 12 Cancer, 72 Periodic Screening, 99 Priority Topics, Cancer, FM 99 priority topics

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