Preventative Health Guidelines - Canada

Important Abbreviations, Resources, and Links

CTFPHC: Canadian Task Force on Preventative Health
CCO: Cancer Care Ontario
Hypertension Canada
CUA: Canadian Urologic Association

Male & Female Adult Guidelines

Type II Diabetes Mellitus: Recommendations for screening apply to asymptomatic adults for type 2 diabetes. They do not apply to people with symptoms of diabetes or those at risk of type 1 diabetes.

• For adults at low to moderate risk of diabetes (using a validated risk calculator), the CTFPHC recommends against routinely screening for type 2 diabetes. (Weak recommendation; low-quality evidence)
  
• For adults at high risk of diabetes (using a validated risk calculator), the CTFPHC recommends routinely screening every 3–5 years with HbA1C. (Weak recommendation; low-quality evidence)
  
• For adults at very high risk of diabetes (using a validated risk calculator), we recommend routine screening annually with HbA1C. (Weak recommendation; low-quality evidence)
  

Hypertension: Recommendations apply to adults aged ?18 years including those with average baseline BP and higher than average risk of HTN and vascular risk (but without previously diagnosed HTN). These recommendations are not applicable to those who already have diagnosed hypertension.

• The CTFPHC recommends blood pressure measurement at all appropriate primary care visits. (Strong recommendation; moderate quality evidence)
  
• The CTFPHC recommends 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 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)
  

Colorectal Cancer Screening: These CTFPHC recommendations apply to adults aged ?50 years who are not at high risk for colorectal cancer (CRC). They do not apply to those with previous CRC or polyps, inflammatory bowel disease, signs or symptoms of CRC, history of CRC in one or more 1st degree relatives, or adults with hereditary syndromes predisposing to CRC (e.g. familial adenomatous polyposis, HNPCC).

• CTFPHC recommends screening adults aged 50 to 59 for CRC with FOBT every two years OR flexible sigmoidoscopy every 10 years. (Weak recommendation; moderate quality evidence)
  
• CTFPHC recommends screening adults aged 60 to 74 for CRC with FOBT every two years OR flexible sigmoidoscopy every 10 years. (Strong recommendation; moderate quality evidence)
  
• CTFPHC recommend not screening adults aged 75 years and over for CRC. (Weak recommendation; low quality evidence)
  
• CTFPHC recommends not using colonoscopy as a screening test for CRC. (Weak recommendation; low quality evidence)
  

Obesity: For apparently healthy adults ?18 years of age who present to primary care. The CTFPHC recommends measuring height, weight and calculating BMI at appropriate primary care visits. These management recommendations apply to adults ? 18 years of age who are overweight or obese (25 ? BMI < 40). Pregnant women and people with health conditions where weight loss is inappropriate are excluded. These guidelines do not apply to people with BMI ? 40, who may benefit from specialized bariatric programs.

• For adults who are overweight and obese (25 ? BMI < 40) and at high risk of diabetes, practitioners should offer or refer to structured behavioural interventions aimed at weight loss.
  
• For adults who are overweight or obese, the CTFPHC does not recommend that practitioners routinely offer pharmacologic interventions (orlistat or metformin) aimed at weight loss.
  

Adult Female-Specific Guidelines

Breast Cancer Screening: Recommendations apply to women aged 40–74 without personal or family history of breast cancer, known BRCA1 or 2 mutation, or prior chest wall radiation.

• The CTFPHC does not recommend advising women to routinely practice Breast Self Exam. (Weak recommendation; moderate quality evidence)
  
• The CTFPHC does not recommend routinely performing the Clinical Breast Exam alone or in conjunction with mammography to screen for breast cancer. (Weak recommendation; low quality evidence). However, the Clinical Breast Exam remains appropriate when women present with, or physicians have concerns about, abnormal breast changes.
  
• For women aged 50–69 years, the CTFPHC recommends routinely screening with mammography every 2 to 3 years. (Weak recommendation; moderate quality evidence).
  
• For women aged 70-74 years, the CTFPHC recommends routinely screening with mammography every 2 to 3 years. (Weak recommendation; low quality evidence).
  

Cervical Cancer Screening: Recommendations apply to asymptomatic women who are or who have been sexually active. These guidelines do not apply to women with symptoms of cervical cancer (e.g. abnormal vaginal bleeding), previous abnormal screening results (until they have been cleared to resume normal screening), to women who do not have a cervix (due to hysterectomy), or to women who are immunosuppressed.

• For women aged <20, the CTFPHC and Cancer Care Ontario recommends not routinely screening for cervical cancer. (Strong recommendation; high quality evidence)
  
• The Ontario Cervical Screening Program recommends that women who are or have been sexually active have a Pap test every 3 years starting at age 21. Regular screening should continue until at least age 70 or when advised by a doctor or nurse practitioner to stop.
  
• Pap tests can stop at the age of 70 if a woman has had 3 or more normal Pap tests in the previous 10 years.
  

Adult Male-Specific Guidelines

Prostate Cancer Screening: This CTFPHC clinical practice guideline applies to all men not previously diagnosed with prostate cancer. This includes men with lower urinary tract symptoms or with benign prostatic hyperplasia. This guideline is currently controversial in the world of urology and preventative medicine as different medical bodies have differing recommendations.

• For men aged less than 55 years, the CTFPHC recommends not screening for prostate cancer with the prostate-specific antigen test. (Strong recommendation; low quality evidence)
  
• For men aged 55–69 years, the CTFPHC recommends not screening for prostate cancer with the prostate-specific antigen test. (Weak recommendation; moderate quality evidence)
  
• For men 70 years of age and older, the CTFPHC recommends not screening for prostate cancer with the prostate-specific antigen test. (Strong recommendation; low quality evidence)
  
• Conversely, the Canadian Urologic Association suggests offering PSA screening to men with a life expectancy >10 years. The decision of whether or not to pursue PSA screening should be based on shared decision-making after the potential benefits and harms associated with screening have been discussed (Level of evidence: 1; Grade of recommendation: B)
  
• The American Urological Association, National Comprehensive Cancer Network, European Association of Urology, and the American College of Physicians also recommend offering PSA screening to interested men after a thorough discussion of the benefits and harms.
  
• The United States Preventative Services Task Force (USPSTF) recently recommended a similar shared decision-making approach in men aged 55–69 after previously recommending against screening.