Health task force blasted over ‘dangerous guidance’ for cancer screenings

Doctor is working with mammography X-ray scanner in hospital

Medical experts are sounding the alarm about the Canadian Task Force on Preventive Health Care, branding the group’s cancer screening guidelines as “dangerous” and “deplorable.”

Speaking at a Monday media conference, a group of medical experts ranging from radiologists to urologists talked about the urgent need to reform the Canadian Task Force on Preventive Health Care for its “outdated screening guidelines,” arguing that hundreds of Canadians are needlessly dying and suffering as a result.

“I regularly see patients who ask to be screened, only to be denied due to the task force recommendation and ultimately presented with an incurable stage of the disease. These patients feel let down by the system, and their physicians live with enormous regret,” said Dr. Fred Saad, a urological oncologist and the director of prostate cancer research at the Montreal Cancer Institute.

“The task force recommendation against screening is outdated, overly simplistic and goes against all other guidelines that encourage shared decision-making with patients. This has led to an increase in patients presenting with advanced, incurable stages of the disease [prostate cancer], as well as the increased risk of mortality due to the late diagnosis is underestimated,” he said during the media conference.

Video: Expert panel says patients should decide when to get mammograms

The Canadian Task Force on Preventive Health Care is an independent, federally appointed body that sets national guidelines used by family doctors to determine what kind of health screening patients require. The recommendations include guidelines for screening ages of mammograms, colonoscopies and prostate and lung cancer.

According to its website, the task force comprises 15 primary care and prevention experts across Canada, such as family physicians, mental health experts and pediatricians. The task force’s goal is to create guidelines for health professionals, such as physicians, nurses, nutritionists, physician specialists, policymakers, and even Canadian citizens.

“The Canadian Task Force on Preventive Health Care develops rigorous, evidence-based preventive health care guidelines based on the principles of impartiality, collaboration, and inclusivity. It applies international best practices for evidence review and guideline development used by guideline panels around the world,” a task force spokesperson told Global News in an email on Monday.

However, some medical experts say the guidelines do nothing but confuse physicians. For example, a provincial guideline may advise starting screening for breast cancer at age 40, but the task force recommends age 50.

Dr. Shushiela Appavoo, a physician and spokesperson for the Coalition for Responsible Healthcare Guidelines, said she is “deeply disturbed” by the guidelines set forth by the task force.

“Unfortunately, a lot of family physicians are taught and trained to follow the task force guidelines. Despite the clinical practice guidelines, they may still adhere to the task force practices,” she said at the media conference.

As a result, Appavoo, along with her colleagues at the media conference, expressed their desire for a restructuring of the Canadian task force’s guidelines to enhance transparency and involve experienced experts more effectively.

“Lives are at stake,” Appavoo said. “It is our duty to prioritize the well-being of all Canadians.”

During Monday’s media conference, the group of medical experts said that screening ages for cancers such as cervical, breast, lung and prostate, are outdated and putting Canadian’s lives at risk.

For example, in 2013 the task force put together guidelines for cervical cancer screening, advocating for Pap tests. According to the task force, “screening for cervical cancer using the pap test detects precursor lesions, thereby allowing earlier and potentially less invasive treatment than is required for disease that causes symptoms.”

However, recently, many provinces have started steering away from the pap method and instead relying on HPV screening. Prince Edward Island, for example, announced in May 2023 that the HPV test would be used instead of the Pap smear at three-year to five-year intervals, as it can detect high-risk strains of the virus, which are more likely to cause cancer.

“Canadian women are developing avoidable cases of cervical cancer because of this weak national task force leadership,” Appavoo said. “The provinces are finally ignoring the task force, listening to experts and or initiating HPV screening.”

The screening age for breast cancer is also under scrutiny.

Canada’s current guidelines suggest routine mammography screening every two to three years for women aged 50 to 74.

Video: Health Matters: Cervical cancer screening

Dr. Martin Yaffe, the co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, said the task force’s age recommendation for breast cancer screening is outdated and flawed.

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Yaffe, along with many other health groups, such as the Dense Breast Society, recommends screening begin at age 40 to detect breast cancer. This is because the number of women who are getting breast cancer in their 40s is increasing.

Several provinces are also now advocating for women to begin breast cancer screening at the age of 40, with Ontario being one of the most recent ones to make this recommendation.

“I’m here today because of the horrible situation where hundreds of Canadian women are dying of breast cancer each year, and these deaths are avoidable,” Yaffe said.

“The problem is that the women and their doctors are receiving dangerous guidance on breast cancer screening from the Canadian Task Force Preventive Health Care. Besides the unnecessary deaths, many women also undergo harsh therapies for advanced cancer when their diagnosis is delayed. Much of this death and suffering could have been avoided if Canadian screening guidelines had been based on modern scientific evidence.”

In May 2023, the U.S. Preventive Services Task Force released draft recommendations calling for screening of average-risk women in their 40s. The American group said its evidence showed this would have a “moderate benefit” in reducing deaths.

This spring, the task force is set to release updated guidelines on breast cancer screening, but Yaffe said he is “concerned” that the age will still not be lowered.

A Canadian Task Force Preventive Health Care spokesperson told Global News in an email that the current review of breast cancer screening “includes a comprehensive list of observational studies, modelling, as well as randomized controlled trials to ensure that updated recommendations are based on the best evidence available.”

“For each guideline, we rely on subject matter experts and patient partners. For example, the upcoming breast cancer guideline update includes four content experts (a clinical oncologist, a radiation oncologist, a surgical oncologist, a radiologist), and two patient partners,” the spokesperson wrote.

Video: Ontario lowers age for mammograms to 40

In its last update in 2018, one reason cited by the Canadian Task Force on Preventive Health Care for not recommending lowering the screening age to 40 in Canada was concerns regarding overdiagnosis. Screening at a younger age may lead to unnecessary treatment, it stated.

Yaffe addressed this concern.

“It’s suggested by the task force that many of the cancers that are found are never going to develop into something dangerous,” he said. “It’s true that some cancers just grow for a while and sit there, but it’s impossible to know in advance which those cancers are.”

While acknowledging the risk of overdiagnosis, he emphasized: “We have come a long way to address this” with better technology, and “we do a much better job of avoiding this overdiagnosis and especially the overtreatment.”

Global News reached out to the Public Health Agency of Canada for comment on the criticisms of the task force and the calls for screening reform but did not hear back by publication time.

— with files from Global News’ Saba Aziz