With early detection and better investigation and treatment methods, the survival rate for Canadians with cancer is over 60%. By comparison, in the 1940s, this stood at about 25%.

For some cancers, the survival rate is even higher: 88% for breast cancer, 97% for testicular cancer or 96% for prostate cancer.
Currently in Quebec, there are only three anatomical sites for which there exists an effective screening program: breast cancer, cervical cancer and colorectal cancer.

For any testing requested in the absence of symptoms, other than those covered by screening programs available in Quebec, we recommend that you discuss with your family doctor to assess its appropriateness for you.

What is screening?

Screening is a method of detecting certain types of cancer before symptoms appear.

Although no screening test is absolutely foolproof, an effective screening test can reduce mortality in cancer subjects.

It is important to remember that there are advantages and disadvantages to every screening test.

  
Advantages Disadvantages  
Lower mortality FFalse negative (cancer present, but undetected)  
Early detection, long before symptoms appear False positive (cancer suspected, but unconfirmed)  
Treatment begins earlier Pointless medical tests  
Less invasive treatment Overdiagnosis, overtreatment
Reassuring, if the medical results are normal Stress and anxiety  


What is overdiagnosis?

Overdiagnosis is a complex problem. There are several definitions in the literature, but here we are using the one put forward in the Quebec Symposium on diagnosis, which was held on April 2, 2014: "Overdiagnosis occurs when people are diagnosed with a disease that ultimately will not cause them to experience symptoms or early death, or when a procedure is done that does not add value to a treatment."

Several diseases are prone to over-diagnosis, not just cancer. At the symposium, four main causes of this phenomenon were identified: patients' expectations, training of caregivers, the organization of the healthcare system and behaviours that are deeply rooted in culture.

An action plan has been implemented to counteract this phenomenon; its orientations revolve around the main theme of Choosing Wisely.

Cancer of the oral cavity may develop at several places in the mouth and throat, such as tongue, lips, palate, salivary glands and tonsils.

Today, 70% of oral cancers are diagnosed too late, reducing the chances of recovery. The earlier an oral cancer is detected, the more effective the treatment.

Your dentist can detect oral cancer in its early stages, by performing a clinical examination during the routine visit. This painless examination is simple, takes only a few minutes and requires no sophisticated equipment. Just talk to your dentist.

For more information, call the Info-Cancer Line at 1 800 363-0063 1 800 363-0063 FREE.

Sources:
www.odq.qc.ca 
www.e-cancer.fr 
 
Colorectal cancer is preceded for many years by a precancerous condition: polyps.
 
It has been demonstrated that detection and resection of polyps can significantly reduce the incidence of colorectal cancer.
 
Bleeding undetectable to the naked eye is often associated with the presence of polyps or cancer in its early, pre-symptomatic phase.

The recommended screening test is the immunochemical fecal occult blood test (iFOBT). This test involves taking a stool sample, which is then analyzed in a laboratory.

It is recommended that this test be repeated every two years for people presenting no symptoms and no risk factors for colorectal cancer aged 50 to 74.

The Quebec colorectal cancer screening program began gradual deployment in 2011. Pilot projects were conducted in eight institutions in Quebec.
  • CSSS Rivière-du-Loup
  • CSSS Arthabaska-et-l'Érable
  • CHU de Québec
  • CHAU Lévis
  • CSSS du Sud-Ouest-Verdun
  • Hôpital Maisonneuve-Rosemont
  • MUHC
  • CSSS Pierre-Boucher
The aim of these projects was to ensure that digestive endoscopy units have the capacity to meet the quality and accessibility standards required to implement the program.
 
No systematic invitation to participate in this screening will be launched before the necessary adjustments are made. Physicians are nonetheless encouraged as of now to prescribe an iFOBT for patients who they deem to be at risk, as an opportunistic screening measure. We recommend you ask your doctor about applying  for such screening.

Colonoscopy: an effective screening method?

The Canadian Association of Gastroenterology does not consider colonoscopy to be an appropriate screening  method for colorectal cancer. The test is too complex, too expensive, access is too limited, and the risk of serious complications (perforation and hemorrhage) are too high. Moreover, there is no evidence that colonoscopy has more advantages than disadvantages as a screening method in populations at average risk for colorectal cancer.
There are three major types of skin cancer:
  • Basal cell carcinoma is the most common and least dangerous type. It must still be treated quickly to prevent it from spreading. It most often appears on the face and neck, in the form of a small, firm, pink bump, a lesion that heals then reappears or a small, reddish dry patch.
  • Squamous cell carcinoma is the second most common type, and spreads more quickly than the first. It takes the form of a thick crusty reddish nodule, of bumps on the scalp or it may resemble warts.
  • Malignant melanoma is the least common but most serious. If detected early, it can be cured in over 90% of cases. However, if left untreated, it can spread into the deeper layers of the skin, and extend into the blood or lymph systems, resulting in death. To detect, apply the rule of ABCDE by monitoring any changes to a mole in terms of asymmetry, border, colour, diameter (wider than 6 mm or ¼ inch) and evolution.
Early detection: the key to treating every type of cancer.

The Association of Quebec Dermatologists ruled unanimously in favor of screening for skin cancer, especially melanoma.

Skin cancer screening is performed by a general practitioner or family physician during the periodic examination. It consists of a visual examination of the skin. The physician pays particular attention to the backs of men 50 years and older and the lower limbs of women, since it is in these places that melanomas most often occur.

This screening is particularly indicated for the following:
  • Blonde or red-haired people with blue eyes, or with freckles
  • People who have a personal or family history of melanoma and/or skin carcinom
  • People who have evidence of damage caused by sun exposure or who had sunburns at a young age
  • People who have a large number of moles
  • People who are immunosuppressed (e.g. have had an organ transplant)
  • People who attend, or have attended, tanning salons or have had phototherapy treatment.
You can also examine your skin once a month using this simple, practical tool developed by the Canadian Dermatology Association.

Of course, to prevent skin cancer, you should ideally enjoy the sun only in moderation and with caution. It is recommended that you use a sunscreen with an SPF of 30 and above and carefully follow the directions on the product in order to ensure optimal benefit.
 
Sources:
  • Canadian Dermatology Association
  • Capital Santé, vol. 6, No. 8, June 2004, p. 19
  • The College of Family Physicians of Canada. Le cancer de la peau : pour protéger votre peau des effets nuisibles du soleil. 1997
In March 2016, the Canadian Task Force on Preventive Health Care (CTFPHC) issued new recommendation guidelines in favour of lung cancer screening with low-dose computed tomography (LDCT) in adults:
  • 55 to 74 years old
  • with a smoking history of at least 30 packs a year
  • who currently smoke or quit smoking less than 15 years ago 
For all other adults, regardless of age, smoking history or other risk factors, the CTFPHC does not recommend screening for lung cancer with LDCT.

Unlike population-based screening programs for breast, cervical and colorectal cancers, lung cancer screening is delivered to a high-risk population.

What is LDCT?

Conventional tomography is one of the best diagnostic imaging technology modern medicine has to offer. The machine uses a type of X-ray similar to regular radiography, but rotates around the patient. The information obtained is processed by a powerful computer that produces very accurate images of various parts of the body. A contrast agent is sometimes needed for a clearer view of organs and anomalies.

Low-dose computed tomography only uses 10 percent of the radiation dose usually required in conventional tomography. The imaging takes only 10 to 12 seconds and one breath. No contrast agent is required. 

While the CTFPHC recommendations highlight areas for further research, the field of lung cancer screening is continuing to evolve and new data is being published in areas relating to risk assessment, patient selection, false negatives, and cost-effectiveness. The collection of data by organized lung screening initiatives in the Canadian context will support lung cancer screening quality and help to address remaining evidence gaps in order to maximize the benefits and minimize the harms of screening.

Sources:
Outil pour les patients 
Lung Cancer Screening Framework for Canada: Summary and Key Considerations 
Tomodensitométrie (TDM – TACO)Le sanner « lowdose »
Scanner « lowdose »
There is no prostate cancer screening program. However, there are certain screening tests for early detection. These are the prostate specific antigen(PSA) test and the digital rectal examination (DRE).

There are advantages and disadvantages of undergoing a screening test for prostate cancer, and each individual must make his choice according to how important he feels it to be.

According to the College of Physicians of Quebec, screening should not be offered to patients over 70 years of age, or those whose life expectancy is less than 10 years. However, physicians should consider screening their patients aged 55-70 years with a life expectancy of over 10 years, and those under 55 years if they are at risk. They must also inform them of the benefits and potential harm of screening to enable them to make an informed decision.

What is prostate cancer screening?

This is a test called the prostate-specific antigen that is performed using a blood test; the doctor will usually complete the screening with digital rectal examination.

It is important to know that a normal screening result does not necessarily mean that you do not have cancer, nor does it mean that you do have cancer if it is abnormal. Only a positive result from a biopsy will confirm a diagnosis of prostate cancer beyond a doubt.

To help you make a decision

Even though your doctor can’t make the decision for you, his or her role is to help you understand more clearly, so don’t hesitate to ask questions.

To help you make the right choice, you can use the tool developed by Laval University’s Department of Family and Emergency Medicine (in French only) in collaboration with other professionals. It provides a more complete, detailed explanation of prostate cancer and screening.

The Quebec Cancer Foundation also provides a telephone pairing service that allows you to chat with another man who has already been in your situation. For example, you can talk about your concerns over the side effects of a prostate biopsy or cancer treatment, or ask what quality of life you can expect if you are diagnosed with cancer. You can also address all your questions to our qualified nurses via the Info-Cancer line.

For more information, call the Info-Cancer line at 1 800 363-0063 1 800 363-0063 FREE.

Source: Collège des médecins du Quebec. Prostate cancer screening, It’s YOUR decsion​! September 2013
The Québec Breast Cancer Screening Program (PQDCS), was initiated in 1998 by the Ministry of Health and Social Services. The program is similar to those offered in most other Canadian provinces and several other countries.

The program is aimed at women aged 50 to 69 who have never been diagnosed with breast cancer. They are advised to have a screening mammogram every two years.

The invitations are sent by personalized mail, using a list of protected data provided by the Régie de l'assurance maladie du Québec.

Many studies have shown that a screening mammogram can reduce mortality from breast cancer in this specific age group.

For more details about this screening program, please consult the PQDCS website.

What is a mammogram?

A mammogram is a radiological examination that uses x-rays to assess breast tissue.

Mammography remains the most effective and most radiologically sensitive method for detecting anomalies, benign or malignant lesions in the breast.

It permits detection of very small nodules, of a diameter of about 5 millimeters, that are non-palpable under physical examination, as well as microcalcification. The sensitivity of mammography is about 90%. This means that a normal mammogram does not rule out the presence of breast cancer.

During examination, breast compression is uncomfortable, but necessary for the following reasons:
  • it give a better picture of the interior of the breast;
  • it increases the accuracy of details;
  • it separates overlapping structures
  • it reduces movement;
  • it decreases the amount of radiation.
A breast can be compared to a bunch of grapes. The only way to detect a raisin in the centre is by spreading the bunch.

Should I wear a thyroid shield during a screening mammogram?

It is not recommended to wear a thyroid shield during mammography. Not only is the radiation dose transmitted to the thyroid during a mammogram extremely low, but a shield risks masking important parts of the breast, perhaps making it necessary to repeat the procedure. For more details, visit this website: mammothyroide.ca

To find out more about the program, please consult the PQDCS website.

Breast observation

It is important for women of every age to pay careful attention to their breasts.

When on the lookout for any changes in their breasts, women should:
  • know what is normal;
  • be aware of possible signs of cancer;
  • inspect them visually and by touching;
  • seek immediate consultation upon noticing any changes.
Stay attentive to any changes that may occur:
  • change in size, thickness, shape;
  • change in the skin (redness, irritation, folds, vascularization, etc.);
  • change in the nipples (discharge, dimpling, retraction, ulceration, etc.).

What about breast self-examination?

This is no longer recommended as a screening tool.

Numerous scientific studies have demonstrated that this method does not reduce breast cancer mortality and may result in unnecessary tests.

Genetic Testing

One in nine women will develop breast cancer in her lifetime. It is estimated that 5-10% of breast cancers are hereditary, 15 to 20% are familial.

In other words, the majority of breast cancers are unrelated to family history, rather they are caused by a genetic mutation referred to as sporadic or acquired, i.e. the cell damage is often the result of chance or of certain risk factors such as smoking or obesity.

What is genetic testing?

First, you should be aware that the result of this test only determines whether or not a woman is a carrier of a BRCA mutation, and is used to assess her risk of developing breast cancer. It does not predict whether she will develop breast cancer in her lifetime.

Genetic testing is performed on the basis of a blood sample. It detects the presence of a mutation in the genes, such as BRCA genes.

It is compulsory for genetic testing to be preceded by genetic counselling from various oncogenetic specialists. The only access to such counselling is through referral by a physician.

What is a BRCA gene?

The BRCA1 and BRCA2 genes, discovered in the 1990s, take their name from the words BReast CAncer. These genes, which are present in every cell of every human being, are specialized in controlling cell division, and are a protection against developing breast cancer. If one is born with a mutation in one of these genes, its ability to function well is impaired, and the risk of developing several cancers, including breast cancer, is increased.

Eligibility for genetic testing

Women are generally admitted for genetic testing if they are over 18 years of age and their risk of having a gene mutation is higher than 10%. This risk is assessed by taking the following criteria into account:
  • a BRCA mutation previously identified in the family;
  • multiple cases of first degree breast cancer in the family, especially before age 50;
  • breast cancer in a male relative;
  • breast cancer before age 45;
  • bilateral breast cancer, especially before age 50;
  • breast cancer and ovarian cancer;
  • certain types of breast cancer and ovarian cancer;
  • Ashkenazi Jewish ancestry;A family history pointing to a rarer hereditary syndrome.
For more information on genetic testing, call the Info-Cancer Line at 1 800 363-0063 FREE. A nurse will answer all your questions and let you know whether this test is indicated for you.

Source:

Consulter en génétique : cancer du sein ou de l’ovaire. CHU de Québec, Centre des maladies du sein Deschênes-Fabia, Quebec City 2013, 66 pp. Available in electronic format (in French only).
Testicular cancer is the most common cancer in young men aged 15 to 29 years.

The American Cancer Society considers that testicular self-examination has not been sufficiently studied to demonstrate that it reduces the risk of mortality linked to this type of cancer, and therefore does not recommend it. However, it does recommend that an examination should be performed by the family doctor as part of the annual checkup. On the other hand, many doctors encourage men to perform an examination of their testicles once a month in order to detect any abnormalities as of the age of 15. This is especially indicated for men presenting risk factors, the most common being:
  • Cryptorchidism (undescended testicle at birth)
  • Family history of testicular cancer
  • Prior history of testicular cancer
  • Problems with testicular development during childhood.
If you have any of these risk factors, please talk to your doctor or contact our nurse at the Info CancerLine at the following number: 1 800 363-0063 1 800 363-0063 FREE.

What is testicular self-examination?

Regular testicular self-examination is important for young men, especially men at risk for testicular cancer. Knowing the usual size, shape and presence of bumps can help determine if something is wrong. Testicular self-examination can help men to quickly observe changes in their testicles, which can then be examined by a doctor.
 
You can see a step-by-step guide by visiting the website at testicularcancercanada.com.
 
For more information, call the Info-Cancer Line at 1 800 363-0063 1 800 363-0063 FREE.
 
Sources:

Collège des médecins du Québec. Screening for prostate cancer, a decision that belongs to YOU !, September 2013
www.cancer.ca  
www.cancer.org
Cervical cancer screening is performed through analysis of a cytological smear or Pap test.

The procedure has been applied for over 40 years in Quebec and elsewhere in the world. It is most often offered to women by their family physician.

It is estimated that since the introduction of the procedure, the incidence of this type of cancer and mortality associated with it have decreased by over 70% in countries that have high screening participation rates.

The Pap test is performed by a medical professional who takes a small sample of cervical cells that are then examined under a microscope in order to detect abnormal changes prior to the development of cancer.

Here are some recommendations from the Institut de santé publique du Québec:
  • Target population for screening: all women who are, or have been, sexually active.
  • The recommended age for beginning screening is 21.
  • The recommended interval between screening tests is 2 to 3 years.
  • For women who have had regular screening tests, screening can end at age 65 if the results of the last 2 tests carried out in the preceding 10 years were negative.
  • Moreover, the Pap test is not indicated for women who have had a total hysterectomy for a benign condition.
For additional information, please consult the electronic brochure issued by the l'Institut de santé publique du Québec (in French only).

Should I have the screening test if I have been vaccinated against human papillomavirus (HPV)?

The human papillomavirus (HPV) family comprises several types of viruses. Some types of HPV are sexually transmitted. It is possible to catch more than one type of HPV during one’s lifetime.

Vaccination is effective against certain types of HPV. However, it does not protect against all HPV. You are therefore recommended to undergo the same screening if you have been vaccinated.

The vaccine is free to all girls in primary 4.

The following can also get the vaccine free under the Quebec Immunization Program:
  • girls aged 9-17
  • men and women aged 18 to 26 whose immune system is weakened or who are infected with HIV (HIV).
For more information on HPV, visit this Web site.
 

Other cancers

Scientific research is booming and many of the studies currently under way are attempting to demonstrate the effectiveness of one particular cancer screening method or another. But it will probably take several years before these methods receive the approval of the scientific communities, since their effectiveness must be proven beyond a doubt.
 
At present, therefore, there is no single method for detecting cancer.

We invite you to contact our nurse at the Info-Cancer line who will be happy to provide you with further information and respond to any questions and concerns you may have. Call 1 800 363-0063, every day of the week from 9 am to 5 pm.

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