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Supporting Patients

As a healthcare provider, your recommendation impacts your patient's decision to participate in cancer screening. The CancerCare Manitoba Screening Program Screening Guidelines (pdf) aim to ensure individuals Physicianreceive thegreatest benefit from cancer screening while minimizing the potential harms. We encourage healthcare providers to facilitate this discussion with patients to:

  • foster the patient's understanding of the test, its benefits and potential hards, and
  • support patient participation in the clinical decision - one that is informed and consistent with the individual's preferences and values.

To support your patient discussions we publish education and health promotion resources. Click here to order resources online. Below is a list of information to assist you in facilitating an informed decision-making process for each screening test.

BreastCheck
Eligibility | Test | Follow-up tests | Potential Benefits | Potential Harms |Key Messages | Pathway (pdf)

CervixCheck
Eligibility | Test | Follow-up tests | Potential Benefits | Potential Harms |Key Messages | Pathway (to come)

ColonCheck
Eligibility | Test | Follow-up tests | Potential Benefits | Potential Harms |Key Messages | Pathway (pdf)

Forms

BreastCheck

Eligibility

  • Females age 50-74Mammogram

Test

  • Screening mammogram

Follow-up Tests

  • Diagnostic mammogram
  • Ultrasound
  • MRI
  • Biopsy
  • Surgical consultation

Test Access

  • Clients are encouraged to call 1-855-95-CHECK to make a screening mammogram appointment. No referral is required.
  • Clinicians can also refer eligibile clients age 50-74 who are unlikely to make their own appointment. Clinicians can complete this form (pdf) and fax to BreastCheck.
  • There are 4 fixed screening mammography clinics in Winnipeg, Thompson, Brandon and Morden/Winkler. To view when the BreastCheck mobile will be in or nearby your community, click here.

Potential Benefits

  • Randomized controlled trials (RCT) have demonstrated a 21% reduction in deaths from breast cancer among women who are screened. For women screened through BreastCheck the reduction was 23%.
  • Detecting cancer at an early stage may result in simpler treatment, more treatment options, and less need for chemotherapy.
  • May provide peace of mind knowing cancer was not found on a screening mammogram.

Potential Harms

  • False positives.
  • False negatives.
  • Screening and follow-up may cause anxiety.
  • Overdiagnosis. Screening may result in detection of conditions which may not have become clinically significant in a patient's lifetime and may result in unnecessary interventions and/or treatment.
  • Discomfort or pain from the mammogram.
  • Radiation exposure.

Key Messages

  • Routine clinical breast exams and breast self-exams are not recommended. Encourage women to know how their breasts normally look and feel.
  • The balance of benefits and harms differs by age. Refer to the Canadian Task Force on Preventive Health Care Recommendations and Public Health Agency of Canada Aid for Breast Cancer (English | French) (pdf) to support decision making.
  • Women at higher risk for breast cancer should have individualized assessment as general screening recommendations do not apply. Higher risk is based on factors such as:
    • previous diagnosis of breast cancer,
    • significant family history, and/or
    • mutations in the BRCA1/BRCA2 genes.
  • The sensitivity of mammography is about 80% and the specficity is about 95%.
 

CervixCheck

Eligibility

  • Most females age 21-69 who have ever had sexual contact
  • Sexual contact can include oral, genital and/or rectal skin-to-skin contact, or sex with sex toys Pap test

Test

  • Pap test

Follow-up Tests

  • Colposcopy
  • Biopsy
  • Loop Electrosurgical Excision Procedure (LEEP)
  • Cryosurgery
  • Laser surgery

Test Access

  • Clients are encouraged to make an appointment with their regular healthcare provider.
  • Clients can also visit our website or call 1-855-95-CHECK to find a Pap test clinic.

Potential Benefits

  • Observational data have shown declines of up to 80% in cervical cancer mortality following introduction of organized screening with Pap tests.
  • Cervical dysplasia can be removed with procedures during colposcopy.
  • Detecting cancer at an early stage may result in simpler treatment, more treatment options, and less need for chemotherapy.

Potential Harms

  • False positives.
  • False negatives.
  • Screening and follow-up may cause anxiety.
  • Discomfort or bleeding may result from the Pap test or colposcopy.
  • Treatment with cold knife conisation and large loop excision of the transformation zone (LLETZ) may increase a woman's risk for pre-term delivery, low birth, caesarean section, and premature rupturing of membranes.

Key Messages

  • 90% of HPV infections will spontaneously regress within 2 years.
  • High grade lesions and cervical cancer are very rare in young women <21 years of age.
  • There is a long latent period between exposure to HPV infection and the development of precancerous lesions and invasive cervical cancer.
  • Annual screening offers little benefit over screening performed at 2 to 3 years intervals and exposes women to unnecessary risks and anxieties.
  • The sensitivity of the Pap test is about 51% and the specificity is about 98%.

 

ColonCheck

Eligibility

  • Most poeple age 50-74 should do a home screening test every two years.
  • If you have not done a test like this in the past two years, or have not had a colonoscopy in the past five years, then you should get checked.fobt

Test

  • Home screening test (Fecal Occult Blood Test, FOBT)

Follow-up Tests

  • Colonoscopy
  • Biopsy

Test Access

  • Clients can request a home screening test through ColonCheck:

Benefits

  • RCTs have shown regular screening with the FOBT can reduce deaths for colorectal cancer by up to 25%.
  • Polyps and other abnormal tissue can be removed during a colonoscopy.
  • Detecting cancer at an early stage may result in simpler treatment, more treatment options, and less need for chemotherapy.

Harms

  • False positives.
  • False negatives.
  • Screening and follow-up may cause anxiety.
  • Colonoscopy, recommended for individuals with a positive FOBT result, can cause bleeding and perforation of the colon.

Key Messages

  • Evidence shows that screening regularly with the FOBT will lead to a reduction in mortality from colorectal cancer (CRC).
  • A colonoscopy is recommended for any individual with a positive FOBT. As bleeding from cancers or adenomas may be intermittent, any positive result must be investigated. Further FOB testing for an individual with a positive result is unwarranted and does not rule out serious pathology, even if it is negative.
  • For the Hemoccult II Sensa, the sensitivity ranges from 64% - 85% and the specificity ranges from 87% - 95%.
  • Double contrast barium enema or CT colonography may be an alternative in indivdiuals with a positive FOBT if colonoscopy is refused, medically unsuitable or unsuccessful.
 

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